Cabazitaxel (with or without carboplatin) versus 177Lu-PSMA-617 for PSMA-positive metastatic castration-resistant prostate cancer

Carboplatin and Cabazitaxel Versus 177Lu-PSMA-617 in Patients With Aggressive, Metastatic Castrate-resistant Prostate Cancer (CATCH-177)

This trial will try whether cabazitaxel (with or without carboplatin) or the PSMA-targeted radioligand 177Lu-PSMA-617 works better for people with PSMA-positive metastatic castration-resistant prostate cancer who have progressed after hormonal therapy.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 44 (estimated)
• Ages: 19 Years and up
• Sex: All
• Sponsor: Case Comprehensive Cancer Center (Academic / other)
• Drugs / interventions: denosumab
• Locations: 1 site (Cleveland, Ohio)
• Trial ID: NCT06738303 on ClinicalTrials.gov

What this trial studies

This randomized phase 2 trial compares cabazitaxel chemotherapy (given with or without carboplatin) to the PSMA-targeted radioligand 177Lu-PSMA-617 in patients with PSMA-positive metastatic castration-resistant prostate cancer. Eligibility requires a recent 18F-rhPSMA-7.3 PET scan showing PSMA positivity (including at least one lesion with SUVmax ≥10) or predefined high-risk clinical/genomic features such as visceral metastasis, ≥5 bone lesions, or TP53/PTEN/RB1 alterations. Participants are randomized to one of the treatment arms and followed for imaging responses, clinical outcomes, and safety measures. The design aims to inform optimal sequencing of chemotherapy versus PSMA-directed therapy in this biomarker-selected population.

Who should consider this trial

Good fit: Adults with metastatic castration-resistant prostate cancer who are PSMA-positive on 18F-rhPSMA-7.3 PET, have progressed after an androgen receptor pathway inhibitor (and commonly after docetaxel), have ECOG 0–2, and meet laboratory organ-function requirements are ideal candidates.

Not a fit: Patients who are PSMA-negative, have poor organ function or ECOG >2, or have other exclusionary comorbidities are unlikely to qualify and may not benefit from the study treatments.

Why it matters

Potential benefit: If successful, the results could help doctors choose the better next treatment for PSMA-positive mCRPC patients and may improve disease control or survival.

How similar studies have performed: Previous trials have shown that 177Lu-PSMA-617 improves outcomes in PSMA-positive mCRPC and that cabazitaxel is active in this setting, but directly comparing chemotherapy +/- carboplatin to Lu-PSMA in a biomarker-selected population is less well studied.

Eligibility criteria

Inclusion Criteria:

1. Subjects must have histologically or cytologically confirmed metastatic castrate-resistant prostate cancer that has previously been treated with an androgen receptor pathway inhibitor. Prior docetaxel exposure is recommended but not mandatory. Tissue is not mandatory, but a pathologic report is required at time of enrollment.
2. Participants must have a PSMA-positive 18F-rhPSMA-7.3 performed within 12 weeks from C1D1 with ≥1 site with SUVmax ≥10) mCRPC with progression on prior novel hormonal agent to include at least one of the following:

   1. PSMA SUV mean \<10
   2. ≥1 visceral metastasis
   3. ≥5 bone metastases

   OR two of the following
   1. TP53
   2. PTEN
   3. RB1 mutation.
3. Age \> 18 years.
4. ECOG performance status of 0 to 2.
5. Subjects must have adequate organ and marrow function as defined below to be suitable for the randomized treatment outlined in this:

   * Absolute neutrophil count \>1000/μL; platelet count \>90 000/μL; hemoglobin \>8.5 g/dL) at screening.

   Note: Subjects must not have received any growth factors within 7 days or blood transfusions within 14 days prior to the hematologic laboratory values obtained at screening).
   * Total bilirubin (TBIL) \<2.5 × the upper limit of normal (ULN) at screening, except subjects with documented Gilbert syndrome who must have a TBIL \<3 mg/dL
   * Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) \< 5 ULN at screening
   * Creatinine clearance ≥40 mL/min and/or estimated glomerular filtration rate (eGFR) ≥30
   * Albumin \>30 g/L (3.0 g/dL) at screening
6. Subjects receiving bisphosphonates or other approved bone-targeting therapy (e.g., denosumab) must be on a stable dose for at least 14 days before the start of study treatment.
7. Subjects of child-producing potential agree to use highly effective contraceptive methods (i.e., barrier contraception measures such as a male condom with spermicide during intercourse) and avoid sperm donation during the study treatment and for 3 months after the last dose of study treatment. A man is considered to be of child producing potential, unless he has had a bilateral vasectomy with documented aspermia or a bilateral orchiectomy. Partners of participants must also practice approved forms of birth control
8. Subjects must have the ability to understand and the willingness to sign a written informed consent form (ICF).
9. Members of all races and ethnic groups are eligible for this trial.

Exclusion Criteria:

1. Evidence of hormone-sensitive prostate cancer (HSPC)
2. Evidence of small cell prostate cancer
3. Subjects receiving any other investigational agents.
4. Diagnosis of another clinically significant malignancy within the previous 2 years other than curatively treated non-melanomatous skin cancer or superficial urothelial carcinoma and other in situ or noninvasive malignancies, as determined by the PI or Co-PI.
5. Subjects with brain metastases/central nervous system (CNS) disease that are treated prior to enrollment will be allowed in this clinical trial.
6. Known or suspected significant hypersensitivity to any components of the formulation used for Cabazitaxel, carboplatin or 177Lu-PSMA-617.
7. 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 considered by the Investigator to limit compliance with study requirements.
8. Prior treatment toxicities not resolved to ≤ Grade 2 according to NCI CTCAE Version 5.0

Where this trial is running

Cleveland, Ohio

• Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center Seidman Cancer Center, Cleveland Clinic Taussig Cancer Center — Cleveland, Ohio, United States (Recruiting)

Study contacts

• Principal investigator: Pedro Barata, MD, MSc — Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center Seidman Cancer Center, Cleveland Clinic Taussig Cancer Institute
• Study coordinator: Pedro Barata, MD, MSc

Conditions Metastatic Prostate Cancer; Metastatic Castration-resistant Prostate Cancer; Cabazitaxel; Lu-PSMA-617; Carboplatin