E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
metastatic castrate-resistant prostate cancer |
|
E.1.1.1 | Medical condition in easily understood language |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10036909 |
E.1.2 | Term | Prostate cancer metastatic |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Part A participating countries Belgium, The Netherlands and UK - to
assess the safety and tolerability of olaparib when given in addition to
abiraterone and to establish a recommended dose of olaparib for further
study when given in addition to abiraterone. In Part B efficacy of
olaparib when given with abiraterone. |
|
E.2.2 | Secondary objectives of the trial |
To evaluate presence of any drug interaction between olaparib and
abiraterone. To compare safety, tolerability, anti-tumour activity,
efficacy of olaparib, when given in addition to abiraterone with placebo.
To investigate BRCA and ATM mutations. |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Provision of signed and dated written informed consent prior to any study specific procedures. 2. Male aged 18 years and older. 3. Histologically or cytologically proven diagnosis of prostate cancer. 4. Candidate for abiraterone therapy with documented evidence of metastatic castration-resistant prostate cancer. Metastatic status is defined as at least one documented metastatic lesion on either bone scan or CT/MRI scan. Castration resistant prostate cancer is defined as rising PSA or other signs of disease progression despite treatment with androgen deprivation therapy and the presence of a castrate level of testosterone (≤50 ng/dL). 5. Eastern Cooperative Oncology Group (ECOG) performance status 0 to 2 with no deterioration over the previous 2 weeks. 6. Patients must have a life expectancy ≥12 weeks. 7. Patients are willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations, and completing PRO instruments. 8. Patients must be on a stable concomitant medication regimen, defined as no changes in medication or in dose within 2 weeks prior to start of olaparib dosing, except for bisphosphonates, denosumab and corticosteroids, which should be stable for at least 4 weeks prior to start of olaparib dosing. 9. For the randomised phase only, patients must have received chemotherapy in the form of docetaxel treatment for metastatic castration-resistant prostate cancer. Note: patients who discontinued docetaxel for toxicity reasons and without completing the full course will still be eligible to enter this study provided they received at least 2 cycles of chemotherapy. |
|
E.4 | Principal exclusion criteria |
1. Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff, its agents and/or staff at the study site). 2. Previous treatment in the present study. 3. Treatment with any of the following:- Previous exposure to any 2nd generation anti-hormonal including abiraterone and enzalutamide- More than 2 prior courses of chemotherapy for metastatic prostate cancer- Previous use of immunotherapy or radium-223 for the treatment of metastatic prostate cancer- Any investigational agents or study drugs from a previous clinical study within 30 days of the first dose of study treatment;- Any previous exposure to a CYP17 (17α-hydroxylase/C17,20-lyase) inhibitor;- Substrates of CYP2D6 with a narrow therapeutic index (eg, thioridazine);- Potent inhibitors or inducers of CYP3A4 within 2 weeks before the first dose of study treatment (3 weeks for St John’s Wort).- Any previous treatment with a PARP inhibitor, including olaparib. 4. With the exception of alopecia or toxicities related to the use of gonadotropinreleasing hormone agonists, any unresolved toxicities from prior therapy greater than CTCAE Grade 2 at the time of starting study treatment. 5. Spinal cord compression or brain metastases unless asymptomatic, treated and stable and not requiring steroids for at least 4 weeks prior to start of study treatment. 6. As judged by the Investigator, any evidence of severe or uncontrolled systemic diseases, including uncontrolled hypertension, active bleeding diatheses, or active infection including hepatitis B, hepatitis C and human immunodeficiency virus (HIV). Screening for chronic conditions is not required. 7. Any of the following cardiac criteria:− Mean resting QTc >470 msec obtained from 3 ECGs− Any clinically important abnormalities in rhythm, conduction or morphology of resting ECG eg, complete left bundle branch block, third degree heart block− Any factors that increase the risk of QTc prolongation or risk of arrhythmic events such as heart failure, hypokalaemia, congenital long QT syndrome, family history of long QT syndrome or unexplained sudden death under 40 years of age or any concomitant medication known to prolong the QT interval. 8. Other malignancy within the last 5 years except: adequately treated non-melanoma skin cancer or other solid tumours including lymphomas (without bone marrow involvement) curatively treated with no evidence of disease for ≥5 years. 9. Inadequate bone marrow reserve or organ function as demonstrated by any of the following laboratory values:− Absolute neutrophil count (ANC) <1.5 x 109/L− Platelet count <100 x 109/L− Haemoglobin (Hb) <100 g/L− Aspartate aminotransferase (AST) or alanine aminotransferase (ALT)> 2.5 x upper limit of normal (ULN) if no demonstrable liver metastases or> 5 x ULN in the presence of liver metastases− Total bilirubin >1.5 x ULN if no liver metastases or >3 x ULN in the presence of liver metastases (except in the case of Gilbert’s disease)− Creatinine >1.5 x ULN concurrent with creatinine clearance <50 mL/min (measured or calculated by Cockcroft and Gault equation); confirmation of creatinine clearance is only required when creatinine is >1.5 x ULN− If bone metastases are present and liver function is otherwise considered adequate by the Investigator then elevated alkaline phosphatase (ALP) will not exclude the patient. 10. Refractory nausea and vomiting, chronic gastrointestinal diseases, inability to swallow the formulated product or previous significant bowel resection that would preclude adequate absorption of olaparib or abiraterone. 11. History of hypersensitivity to active or inactive excipients of olaparib or abiraterone or drugs with a similar chemical structure or class to olaparib or abiraterone. 12. Patients with myelodysplastic syndrome/acute myeloid leukaemia. 13. Current disease or condition known to interfere with absorption, distribution, metabolism, or excretion of drugs, at the Investigator’s discretion. 14. Major surgery within 2 weeks of starting study treatment and patients must have recovered from any effects of any major surgery. 15. Judgment by the Investigator that the patient should not participate in the study if the patient is unlikely to comply with study procedures, restrictions and requirements. |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Part A participating countries Belgium, The Netherlands and UK - To evaluate the safety, tolerability of daily olaparib when given in addition to abiraterone and prednisolone.:-
The parameters describing the safety and tolerability of olaparib will include: - The percentage of patients with DLTs; -The percentage of patients with adverse events by National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE) (version 4.03) grade; - The percentage of patients with serious adverse events; - The percentage of patients who discontinue olaparib due to adverse events or serious adverse events. Adverse events will be assessed by graded Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Clinical chemistry and haematology laboratory tests, and vital signs will also be measured. The number of adverse events that constitute dose limiting toxicities will be derived and used to select a dose to evaluate further in Part B of the study.
Part B. Radiologic Progression-Free Survival (rPFS).
rPFS will be assessed from andomization, every 12 weeks, until disease progression or death. Progression-free survival is defined as the time from randomisation until the date of objective disease progression according to RECIST 1.1 (for soft tissue disease) and/or PCWG-2 criteria (for bone
disease), or death (by any cause in the absence of progression) regardless of whether the patient withdraws from randomised therapy or receives another anti-cancer therapy prior to progression. |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
Part A participating countries Belgium, The Netherlands and UK -
Assessed over 12 months
Part B - Assessed over 24 months |
|
E.5.2 | Secondary end point(s) |
Part A participating countries Belgium, The Netherlands and UK :
Olaparib and abiraterone PK parameters: AUCss. Cmax ss, tmax ss, Cmin
ss.
Treatment ratios for abiraterone steady state Cmax and AUC (in combination : alone) and olaparib steady state Cmax and AUC (in combination : alone) will be calculated to assess the
drug -drug interaction potential between olaparib and abiraterone
Part B: Overall survival (OS).
Overall survival is defined as the time from the date of randomisation until death due to any cause.
Part B: Investigate BRCA andf ATM mutations
As candidate predictors of response to olaparib.
Part B: The time to second progression (PFS2)
PFS2. Progression defined by local standard clinical practice. May involve any of: objective radiological progression, symptomatic progression, PSA or death.
Part B: Response to treatment as shown by Overall Response Rates (ORR), changes in PSA
levels, change in CTC levels over time and measurement of time to requiring further prostate cancer treatment
Part B: To evaluate the safety, tolerability of daily olaparib when given in addition to abiraterone and prednisolone
The parameters describing the safety and tolerability of olaparib will include: - The percentage of patients with adverse events by National Cancer Institute Common
Toxicity Criteria for Adverse Events (NCI CTCAE) (version 4.03) grade; - The percentage of patients with serious adverse events; - The percentage of patients who discontinue
olaparib due to adverse events or serious adverse events; Assessment of AEs graded by CTCAE v4.0. Clinical chemistry and haematological laboratory tests and vital signs
also evaluated.
|
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
Part A participating countries Belgium, The Netherlands and UK - PK
sample timpoints Olaparib pre, 0.5, 1, 2, 3, 4, 6, 8 +12 hrs, abiraterone
pre, 0.5, 1, 2, 3, 4, 6, 8, 12 + 24 hrs post am dose. On each specified
sampling day uo to 14 days
Part B - Assessed over 37 months |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Part A in Belgium, Netherlands, UK safety tolerabilty and pK, B to assess safety and tolerability |
|
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 38 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Belgium |
Canada |
Czech Republic |
France |
Italy |
Netherlands |
Poland |
Russian Federation |
Spain |
United Kingdom |
United States |
|
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 4 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 6 |