Phase III, randomized, double-blind, multicenter trial comparing orteronel (TAK-700) plus prednisone with placebo plus prednisone in patients with metastatic castration-resistant prostate cancer that has progressed during or after docetaxel-based therapy: ELM-PC 5.

Abstract

PURPOSE:

Orteronel (TAK-700) is an investigational, nonsteroidal, reversible, selective 17,20-lyase inhibitor. This study examined orteronel in patients with metastatic castration-resistant prostate cancer that progressed after docetaxel therapy.

PATIENTS AND METHODS:

In our study, 1,099 men were randomly assigned in a 2:1 schedule to receive orteronel 400 mg plus prednisone 5 mg twice daily or placebo plus prednisone 5 mg twice daily, stratified by region (Europe, North America [NA], and non-Europe/NA) and Brief Pain Inventory-Short Form worst pain score. Primary end point was overall survival (OS). Key secondary end points (radiographic progression-free survival [rPFS], ≥ 50% decrease of prostate-specific antigen [PSA50], and pain response at 12 weeks) were to undergo statistical testing only if the primary end point analysis was significant.

RESULTS:

The study was unblinded after crossing a prespecified OS futility boundary. The median OS was 17.0 months versus 15.2 months with orteronel-prednisone versus placebo-prednisone (hazard ratio [HR], 0.886; 95% CI, 0.739 to 1.062; P = .190). Improved rPFS was observed with orteronel-prednisone (median, 8.3 v 5.7 months; HR, 0.760; 95% CI, 0.653 to 0.885; P < .001). Orteronel-prednisone showed advantages over placebo-prednisone in PSA50 rate (25% v 10%, P < .001) and time to PSA progression (median, 5.5 v 2.9 months, P < .001) but not pain response rate (12% v 9%; P = .128). Adverse events (all grades) were generally more frequent with orteronel-prednisone, including nausea (42% v 26%), vomiting (36% v 17%), fatigue (29% v 23%), and increased amylase (14% v 2%).

CONCLUSION:

Our study did not meet the primary end point of OS. Longer rPFS and a higher PSA50 rate with orteronel-prednisone indicate antitumor activity.

• Authors: Karim Fizazi, Robert Jones, Stephane Oudard, Eleni Efstathiou, Fred Saad, Ronald de Wit, Johann De Bono, Felipe Melo Cruz, George Fountzilas, Albertas Ulys, Flavio Carcano, Neeraj Agarwal, David Agus, Joaquim Bellmunt, Daniel P Petrylak, Shih-Yuan Lee, Iain J Webb, Bindu Tejura, Niels Borgstein, Robert Dreicer
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 33 Issue 7 Pg. 723-31 (Mar 01 2015) ISSN: 1527-7755 [Electronic] United States
• PMID: 25624429 (Publication Type: Clinical Trial, Phase III, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 by American Society of Clinical Oncology.

Chemical References

• Biomarkers, Tumor
• Imidazoles
• Naphthalenes
• Taxoids
• Docetaxel
• Prostate-Specific Antigen
• orteronel
• Prednisone

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Biomarkers, Tumor (blood)
• Disease Progression
• Disease-Free Survival
• Docetaxel
• Double-Blind Method
• Drug Administration Schedule
• Europe
• Humans
• Imidazoles (administration & dosage, adverse effects)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Naphthalenes (administration & dosage, adverse effects)
• Neoplasm Grading
• North America
• Odds Ratio
• Pain Measurement
• Prednisone (administration & dosage)
• Prostate-Specific Antigen (blood)
• Prostatic Neoplasms, Castration-Resistant (blood, drug therapy, pathology)
• Taxoids (administration & dosage)
• Treatment Outcome