Phase I Trial of In Situ Gene Therapy for Locally Recurrent Prostate Cancer Following Radiation Therapy Failure Using Sodium/Iodide Symporter and Radioiodine
Phase I Trial of In Situ Gene Therapy for Locally Recurrent Prostate Cancer Following Radiation Therapy Failure Using Sodium/Iodide Symporter and Radioiodine
RATIONALE: Radioactive drugs, such as radioactive iodine, may carry radiation directly to tumor cells and not harm normal cells. Placing a gene called Ad5CMV-NIS in prostate cancer cells may help the prostate cells take in more radioactive iodine and thus kill the cancer cells. Drugs, such as liothyronine sodium, may protect the thyroid from the side effects of radioactive iodine.
PURPOSE: This phase I trial is studying the side effects and best dose of gene therapy given together with radioactive iodine in treating patients with locally recurrent prostate cancer that did not respond to definitive radiation therapy.
OBJECTIVES:
Primary
Secondary
OUTLINE: This is a dose-escalation study of Ad5CMV-NIS.
Patients receive intraprostate Ad5CMV-NIS, via transperineal injection under anesthesia, on day 1. They receive dosimetry oral iodine I-123 on day 4 and undergo image studies periodically for the next 24 hours for measurement of radioiodine uptake. Patients with sufficient prostatic iodine I-123 uptake receive therapeutic oral iodine I-131 on days 5-7.
All patients with intact thyroid glands (i.e., not previously surgically removed or ablated) receive TSH suppressive doses of oral liothyronine sodium 3 times daily for 10 days prior and for 15 days post administration of iodine I-123.
Blood samples are collected periodically for measurement of PSA, fT4, and TSH; and peripheral blood cells are monitored for evidence of virus DNA via quantitative reverse-transcriptase-PCR.
After completion of study therapy, patients are followed every 3 months for 1 year, every 4 months for 1 year, and then every 6 months for 10 years. A transrectal tumor biopsy is to be performed at 3 months and 1 year post-treatment.
DISEASE CHARACTERISTICS:
Histologically confirmed recurrent adenocarcinoma of the prostate within the past year
Disease recurred ≥ 18 months after completion of prior external beam radiotherapy or brachytherapy for stage T1-T3, N0/X, M0 disease
Biochemical failure as defined by the Phoenix definition (rise in PSA by 2 ng/mL or more above the nadir PSA)
Pre-treatment PSA < 50 ng/mL
Prior locally recurrent hormone-refractory disease allowed
American Urologic Association Obstructive Symptom Index Score ≤ 24
No known standard therapy that is potentially curative or definitely capable of extending life expectancy
No evidence of or history of metastatic adenocarcinoma of the prostate
Negative radiographic metastatic work-up including whole-body radionuclide bone scan, CT and/or MR scan of the pelvis and abdomen, and chest x-ray
No known CNS metastases
No prostate size > 140 cc
PATIENT CHARACTERISTICS:
ECOG performance status 0-2
Life expectancy ≥ 12 weeks
ANC ≥ 1,500/μL
Platelet count ≥ 100,000/μL
Hemoglobin ≥ 8.5 g/dL
Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
INR ≤ 1.4 times ULN
Creatinine ≤ 1.5 times ULN
Thyroid-stimulating hormone 0.3-5.0 μIU/mL and free thyroxine 0.8-1.87 ng/dL
Willing to provide biologic specimens and participate in imaging studies as required
Willing to maintain a low-iodine diet for 12 days
No more than 1 of the following renal/genitourinary toxicities:
No urinary tract infection within 72 hours prior to registration
No pubic arch interference study demonstrating unacceptable prostate access by the transperineal approach
No absence of rectum or other anatomic features that would preclude transperineal needle insertion into the prostate
No coagulopathy that contraindicates transperineal and intraprostatic needle insertion
No other cancer within the past 2 years, except for squamous cell and basal cell skin cancers
No uncontrolled infection or fever > 100°F
No known cardiac disease
No seizure disorder
No documented history of HIV positivity or other acquired immunodeficiency disorder or congenital immunodeficiency disorder
PRIOR CONCURRENT THERAPY:
See Disease Characteristics
Recovered from acute, reversible effects of prior chemotherapy
Androgen-deprivation therapy (if applicable) initiated more than 3 months prior to registration
At least 6 weeks since prior bicalutamide, nilutamide, or oral or intravenous iodinated contrast
At least 4 weeks since prior chemotherapy (6 weeks for mitomycin C or nitrosoureas), immunotherapy, biologic therapy, or other experimental drugs
At least 4 weeks since prior and no concurrent anti-androgens (e.g., flutamide, estrogens, ketoconazole, PC-SPES, finasteride, or megestrol acetate)
At least 2 weeks since prior and no concurrent exogenous corticosteroids
No antibiotic therapy within the past 72 hours
No prior organ transplantation
No prior salvage prostatectomy
No other concurrent chemotherapy, immunotherapy, radiotherapy, or any ancillary therapy considered investigational
No concurrent prophylactic use of colony-stimulating factors
No concurrent enrollment in any other study involving a pharmacologic agent (drugs, biologics, immunotherapy approaches, gene therapy) whether for symptom control or therapeutic intent