Intra-operative Optical Imaging With MDX1201-A488 in Patients With Prostate Cancer

Intra-operative Optical Imaging Utilizing Anti-PSMA (Prostate Specific Membrane Antigen) Fluorescent Antibody During Robotic Assisted Laparoscopic Prostatectomy

This pilot clinical trial studies the best dose of anti-prostate specific membrane antigen (PSMA) monoclonal antibody MDX1201-A488 (MDX1201-A488) given before surgery to aid in visualization of the prostate. Attaching a fluorescence, a substance that emits radiation that is visible, to the anti-PMSA antibody and injecting it into the body may help identify the tumor when specialized microscopes are used.

PRIMARY OBJECTIVES: I. Determine the preferred imaging dose (if any), based on image quality and correlation with pathological findings, of intravenously administered MDX1201-A488 in a dose-escalating study (doses of 5 and 15 mg) in patients with moderate to high-risk prostate cancer prior to undergoing robotic assisted laparoscopic prostatectomy (RALP), subject to predetermined safety stopping rules.

SECONDARY OBJECTIVES: I. Correlate intra-operative optical imaging (IOOI) findings with pre-operative magnetic resonance imaging (MRI) findings and clinical staging.

OUTLINE: This is a dose-escalation study. Patients receive anti-PSMA monoclonal antibody MDX1201-A488 intravenously (IV) over 30 minutes on day 1 and undergo IOOI during RALP on day 5.

After completion of study treatment, patients are followed up at 4-7 weeks, 3 months, 6 months, 9 months, and 1 year.

Inclusion Criteria:

• Histologically confirmed adenocarcinoma of the prostate; patients with small cell, neuroendocrine, and transitional cell carcinomas are not eligible

• Patients being considered for RALP and pelvic lymphadenectomy with life expectancy greater than 10 years as determined by treating physician

• Patients with moderate to high-risk disease as defined by D' Amico risk stratification and having at least one of the following:

  • Prostate-specific antigen (PSA) level > 10 ng/ml
  • Gleason score >= 7
  • Clinical stage >= T2c

• Any performance status on the Eastern Cooperative Oncology Group (ECOG)

• Men must agree to use adequate contraception (hormonal or barrier method of birth control or abstinence) prior to study entry and for six months following duration of study participation

• Bone scan without evidence of skeletal metastases

• Skeletal x-ray film or MRI confirmation of absent skeletal metastases if bone scan findings are equivocal

• 3Tesla (T) multiparametric MRI of the prostate performed at City of Hope (COH) within 6 week time period prior to surgery; MRI without evidence of bladder neck involvement, rectal wall involvement, or pelvic lymphadenopathy with no nodes > 1 cm

• White blood cell (WBC) within normal limits

• Hemoglobin (hgb) > 10 G/dL

• Platelet count (PLT) > 100 K/uL

• Creatinine clearance within normal limits

• Serum glutamic oxaloacetic transaminase (SGOT) < 1.5 x upper limit of normal (ULN)

• Serum glutamate pyruvate transaminase (SGPT) < 1.5 x ULN

• Bilirubin < 1.5 x ULN

• All subjects must have the ability to understand and the willingness to sign a written informed consent

Exclusion Criteria:

• Patients should not have any uncontrolled illness including ongoing or active infection
• Prior treatment of prostate cancer including brachytherapy, radiation therapy, cryosurgery, high-intensity focused ultrasound (HIFU), or vaccine therapy
• Prior pelvic surgery or radiation
• Urinary incontinence requiring condom catheter use or >= 1 pad/day
• Prior anti-incontinence surgery
• Use of neoadjuvant hormonal manipulation
• History of active co-existing non-prostatic malignancies except basal cell skin cancer or squamous cell skin cancer
• Subjects, who in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study