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High Dose Testosterone for ATM, CDK12 or CHEK2 Altered Prostate Cancers

NCT05011383 · VA Office of Research and Development
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Official title
High-dose Testosterone in Men With Metastatic Castration-resistant Prostate Cancer and ATM or CDK12 Deficiency
About this study
This is an unblinded, three cohort phase II study evaluating the efficacy of high dose testosterone (BAT) for patients with mCRPC and inactivating mutations in ATM, CDK12 or CHEK2. Patients will receive BAT until disease progression or intolerance, whichever occurs first. Throughout the study, safety and tolerability will be assessed by frequent recording of adverse events, vital signs and safety laboratory assessments. Progression will be evaluated with bone scan, CT of the abdomen/pelvis and PSA as per PCWG3 criteria.
Eligibility criteria
Inclusion Criteria: * Signed informed consent form (ICF) providing agreement to adhere to the dosing schedule, report for all trial visits and authorization, use and release of health and research trial information * Male age \> 18 years * Histologically or cytologically confirmed adenocarcinoma of the prostate * Ongoing gonadal androgen deprivation therapy with gonadotropin-releasing hormone (GnRH) analogues, antagonists or orchiectomy. Patients who have not had an orchiectomy must be maintained on effective GnRH analogue/antagonist therapy * Castration resistant prostate cancer as defined by serum testosterone \< 50 ng/ml and one of the following: * PSA level of at least 2 ng/ml that has risen on at least 2 successive occasions at least 1 week apart. * Evaluable disease progression by modified RECIST 1.1 (Response Evaluation Criteria in Solid Tumors) * Progression of metastatic bone disease on bone scan with \> 2 new lesions * Presence of metastatic disease on bone or CT scan * Patients must have progressed on 1 next-generation AR-signaling inhibitor (e.g. abiraterone, enzalutamide, apalutamide, darolutamide, etc.). * Asymptomatic or minimal cancer related symptoms * Eastern Cooperative Oncology Group (ECOG) Performance Status of \< 2 * Presence of inactivating mutations in ATM, CDK12 or CHEK2 as determined by a CLIA level assay for DNA sequencing. Exclusion Criteria: * Currently receiving active therapy for other neoplastic disorders will not be eligible. * Histologic evidence of small cell carcinoma (morphology alone - immunohistochemical evidence of neuroendrocrine differentiation without morphologic evidence is not exclusionary) * Known parenchymal brain metastasis * Liver metastases * Active or symptomatic viral hepatitis or chronic liver disease AST or ALT \> 2.5 x ULN or total bilirubin \> ULN (unless Gilbert's syndrome is the etiology of hyperbilirubinemia). * Clinically significant heart disease as evidenced by myocardial infarction, or arterial thrombotic events in the past 6 months, severe or unstable angina, or New York Heart Association (NYHA) Class II-IV heart disease or cardiac ejection fraction measurement of \<35 % at baseline * Patients with pain attributable to their prostate cancer and requiring the use of opioids. * Tumor causing urinary outlet obstruction that requires catheterization for voiding. Patients that require catheterization to void secondary to benign strictures or other non-cancer causes will be permitted to enroll. * Presence of dementia, psychiatric illness, and/or social situations limiting compliance with study requirements or understanding and/or giving of informed consent. * Any condition(s), medical or otherwise, which, in the opinion of the investigators, would jeopardize either the patient or the integrity of the data obtained.
Study design
Enrollment target: 51 participants
Allocation: non_randomized
Masking: none
Age groups: adult, older_adult
Timeline
Starts: 2021-08-31
Estimated completion: 2027-08-31
Last updated: 2025-07-09
Interventions
Drug: High dose testosterone
Primary outcomes
  • PSA response (12 weeks)
Sponsor
VA Office of Research and Development · fed
Contacts & investigators
ContactRobert B Montgomery, MD · contact · rbmontgo@uw.edu · (206) 277-6878
ContactElahe Mostaghel, MD · contact · emostagh@fhcrc.org · (206) 762-1010
InvestigatorRobert B. Montgomery, MD · principal_investigator, VA Puget Sound Health Care System Seattle Division, Seattle, WA
All locations (17)
Rocky Mountain Regional VA Medical Center, Aurora, CORecruiting
Aurora, Colorado, United States
VA Connecticut Healthcare System West Haven Campus, West Haven, CTRecruiting
West Haven, Connecticut, United States
North Florida/South Georgia Veterans Health System, Gainesville, FLRecruiting
Gainesville, Florida, United States
Orlando VA Medical Center, Orlando, FLRecruiting
Orlando, Florida, United States
Atlanta VA Medical and Rehab Center, Decatur, GARecruiting
Decatur, Georgia, United States
Robley Rex VA Medical Center, Louisville, KYRecruiting
Louisville, Kentucky, United States
Kansas City VA Medical Center, Kansas City, MORecruiting
Kansas City, Missouri, United States
St. Louis VA Medical Center John Cochran Division, St. Louis, MORecruiting
St Louis, Missouri, United States
Durham VA Medical Center, Durham, NCRecruiting
Durham, North Carolina, United States
Salisbury W.G. (Bill) Hefner VA Medical Center, Salisbury, NCRecruiting
Salisbury, North Carolina, United States
VA Portland Health Care System, Portland, ORRecruiting
Portland, Oregon, United States
Ralph H. Johnson VA Medical Center, Charleston, SCRecruiting
Charleston, South Carolina, United States
Memphis VA Medical Center, Memphis, TNRecruiting
Memphis, Tennessee, United States
Tennessee Valley Healthcare System Nashville Campus, Nashville, TNRecruiting
Nashville, Tennessee, United States
Michael E. DeBakey VA Medical Center, Houston, TXNot Yet Recruiting
Houston, Texas, United States
VA Puget Sound Health Care System Seattle Division, Seattle, WARecruiting
Seattle, Washington, United States
William S. Middleton Memorial Veterans Hospital, Madison, WIRecruiting
Madison, Wisconsin, United States
High Dose Testosterone for ATM, CDK12 or CHEK2 Altered Prostate Cancers · TrialPath