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Phase 2 Trial of phenelzine in non-metastatic recurrent prostate cancer

Description

Prostate cancer is the most common non-cutaneous cancer diagnosed in men in the United State with a projected annual incidence of ~29,000 deaths in 2013. For most patients, prostate cancer is adequately treated with primary therapy which may include radiation, surgery (radical prostatectomy, or active surveillance. However, in about one third of patients, cancer recurs following primary therapy usually manifested as an asymptomatic rise in plasma prostate specific antigen (PSA) level. Biochemical recurrence (BCR) defines patients with a confirmed elevation in PSA in the absence of clinically detectable metastatic disease. Given the slow disease course of BCR prostate cancer and the frequent occurrence of other life-altering co-morbidities in this patient population, BCR is a very common condition for which there are no clear standards in terms of the composition of timing of potential treatments. We hypothesize that phenelzine will exert an anti-cancer effect demonstrated by decreasing PSA values in biochemical recurrent prostate cancer patients. In this trial, a dose of 60 mg daily is set as the target dose level based on patient tolerance drawn from the experience in patients with depression. The primary objective in this study is to assess the proportion of patients with biochemically recurrent prostate cancer treated with phenelzine who achieve a PSA decline of >/= 50% from baseline. The secondary objectives of this study are to monitor for potential toxicities and/or beneficial effects of phenelzine in prostate cancer without depression, mania or other primary psychiatric diagnosis; to assess time to radiographic disease progression for patients with recurrent prostate cancer treated with phenelzine. The exploratory objective is to collect blood and other samples to study the relationship between MAO activity, biomarkers and prostate cancer. The study population for this study will be men with asymptomatic non-metastatic prostate cancer. A total of 46 patients will be enrolled. 23 with non-castrate circulating androgen levels (testosterone > 50 ng/dl); 23 with castrate levels of circulating androgens (testosterone <50 ng/dl). The dose of phenelzine will be 30mg orally twice a day. The starting dose will be 15 mg daily escalated to 30 mg twice a day over 15 days (Please see section 4.1). Laboratory assessments, including plasma PSA at baseline and following every 28 day cycle. Imaging assessment including CT scans of chest/abdomen/pelvis and bone scan at baseline and every 12 weeks or as clinically indicated.

Phase

Phase 2 - takes the treatment one step further, assessing the activity of a particular therapy in a disease, often building upon leads from the Phase I trial. While patients are generally required to be previously untreated, participation in a Phase II trial doesn't usually preclude the patient from getting the standard treatment after they've received the investigational agent. At best they are allowed to get a new drug they wouldn't be able to get otherwise that may turn out to be better for their disease.

Inclusion and Exclusion Criteria

  • Histologically confirmed adenocarcinoma of the prostate
  • Recurrent prostate cancer following primary therapy as defined by:
  • Post-radical prostatectomy: Any PSA >= 0.4 ng/ml
  • Post-primary radiotherapy: PSA >= 2 ng/ml above a post-radiotherapy nadir
  • Post-primary androgen-deprivation therapy: A confirmed rise of PSA >= 2 ng/ml above a post-therapy nadir
  • For patients with non-castrate levels of circulating androgen levels (testosterone >= 50 g/dl)
  • PSA levels should be increasing on at least two occasions >= 1 week apart
  • Patients should not be considered candidates for radiation therapy
  • For patients with castrate levels of circulating androgen levels (testosterone < 50 ng/dl):
  • PSA levels must be >= 0.4 ng/ml (if history of radical prostatectomy) or >= 2 ng/ml (if history of non-surgical primary treatment) and found to be increasing on at least two occasions >= 1 week apart
  • At least 4 weeks must have elapsed since any changes to hormonal therapy, including at least 4 weeks since flutamide and at least 6 weeks since bicalutamide, nilutamide, or enzalutamide
  • No evidence of metastatic cancer on imaging including a bone scan and computed tomography (CT) scan of chest/abdomen/pelvis
  • Able to understand and adhere to dietary and medication restrictions as recommended for the safe use of phenelzine
  • Men with child bearing potential are required to use an effective means of contraception
  • Leukocytes >= 3,000/mcL
  • Absolute neutrophil count >= 1,500/mcL
  • Platelets >= 100,000/mcL
  • Total bilirubin =< 1.5 x upper limit of normal (ULN)
  • Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SPGT]) =< 2.5 x ULN
  • Creatinine =< 1.5 x ULN

  • Uncontrolled hypertension despite appropriate medical therapy (blood pressure [BP] greater than 160 mmHg systolic and 90 mmHg diastolic at 2 separate measurements no more than 60 minutes apart during the screening visit); Note: patients may be rescreened after adjustment of antihypertensive medications
  • Known prior history of mania or major psychiatric illness (schizophrenia, bipolar disorder, severe major depression requiring hospitalization, etc.)
  • Concurrent use of medications contra-indicated due to potential interactions with phenelzine
  • Inability to comply with dietary restrictions for foods, supplements, and medications with potential for adverse interactions with phenelzine or to otherwise cooperate fully with the investigator and study personnel
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to phenelzine or other monoamine oxidase inhibitors
  • Patients may not be receiving any other investigational agents
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements

Sites

  • California

    • Los Angeles County-USC Medical Center, Los Angeles, California, 90033
    • USC Norris Comprehensive Cancer Center, Los Angeles, California, 90033
    • Keck Medical Center of USC Pasadena, Pasadena, California, 91105
    • USC Norris Westside Cancer Center, Beverly Hills, California, 90211
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