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NCT07190300PHASE1, PHASE2Recruiting

TulmiSTAR-02: A Phase I/II Open-label Study of Tulmimetostat in Combination With Darolutamide vs. Darolutamide, and Tulmimetostat With Abiraterone in Patients With Metastatic Hormone-sensitive Prostate Cancer (mHSPC)

Novartis Pharmaceuticals

Start Date

1/13/2026

Completion Date

8/2/2032

Summary

The purpose of this study is to evaluate the safety, tolerability, and efficacy of two different treatment combinations of tulmimetostat in participants with de novo or recurrent metastatic hormone-sensitive prostate cancer (mHSPC). Phase I aims to determine the recommended dose(s) for expansion (RDE) of tulmimetostat in combination with darolutamide or abiraterone. Phase II is designed to further evaluate the efficacy and safety of tulmimetostat in combination with darolutamide compared with darolutamide alone in participants with mHSPC.

Detailed Description

This is a Phase I/II, open-label, global, multicenter study evaluating tulmimetostat in combination with androgen receptor pathway inhibitors in participants with de novo or recurrent metastatic hormone-sensitive prostate cancer (mHSPC). The study consists of two phases: Phase I (Dose Escalation) Phase I includes two treatment groups: 1. Group A (Part 1): tulmimetostat in combination with darolutamide. 2. Group B (Part 2): tulmimetostat in combination with abiraterone. The primary objective of Phase I is to determine the recommended dose(s) for expansion (RDE) of tulmimetostat in each combination regimen through a parallel dose-escalation design guided by a Bayesian Logistic Regression Model (BLRM). Enrollment will follow a staggered approach between the two groups. Participants may have received prior taxane-based chemotherapy and/or prior androgen receptor pathway inhibitor (ARPI) therapy and must not have received prior radioligand therapy. Participants will continue androgen deprivation therapy (ADT) to maintain castrate testosterone levels (\<50 ng/dL or \<1.7 nmol/L) according to investigator choice and local prescribing information. In Group B, abiraterone will be administered with prednisone or prednisolone according to local prescribing information. Phase II (Dose Expansion) Phase II is a randomized, open-label, multicenter dose-expansion study designed to further characterize the recommended dose(s) of tulmimetostat in combination with darolutamide and to provide proof-of-concept for the efficacy and safety of tulmimetostat plus darolutamide compared with darolutamide alone. Eligible participants are adult men with de novo or recurrent mHSPC who have not received prior radioligand therapy and may have received prior taxane-based chemotherapy and/or prior ARPI therapy (excluding darolutamide), with a maximum prior ARPI exposure of 4 months in the mHSPC setting. Participants will continue ADT throughout the study according to investigator choice and local prescribing information. Based on Phase I results, one or two tulmimetostat dose levels in combination with darolutamide may be evaluated. Study Duration and Follow-up For each participant, the study consists of a screening period, a treatment period, and post-treatment follow-up. Post-treatment follow-up includes: 1. A 30-day safety follow-up visit after permanent discontinuation of study treatment. 2. An efficacy follow-up period for participants who discontinue study treatment without documented disease progression or initiation of new anti-neoplastic therapy, including scheduled imaging assessments. 3. Long-term follow-up to collect survival status, new anti-neoplastic therapies, suspected treatment-related serious adverse events, and second primary malignancies. Participants will be contacted approximately every 12 weeks during the first 3 years and every 24 weeks thereafter until death, loss to follow-up, or withdrawal of consent. The study is designed to evaluate whether inhibition of EZH1/2 with tulmimetostat in combination with androgen receptor pathway inhibition may improve clinical outcomes in men with metastatic hormone-sensitive prostate cancer.

Eligibility Criteria

Age Range: 18 years to No maximum

Key Inclusion Criteria: * Adult men ≥ 18 years old with de novo or recurrent mHSPC (without neuroendocrine or small cell features). The tumor lesion(s) may be located in the bone, soft tissue/visceral region, or both. * Participants must have castrate levels of testosterone, i.e., ≤ 50 ng/dL (≤ 1.7 nM). * Eastern Cooperative Oncology Group (ECOG) performance status 0 to 2 * Adequate bone marrow and organ function * Prior ADT: Participants must have started ADT at least 1 month (at least 28 days) but no more than 12 months before study entry and be willing to continue ADT during treatment * Prior taxane use for mHSPC is permitted: * Phase I and II: Participants may have received, but not progressed on, one prior taxane-based therapy. * Phase II: Limited to 25% participants with prior taxane use. * Prior ARPI is allowed in both Phase I and Phase II: * Prior ARPI use in biochemical recurrence (BCR) or curative treatment is allowed for any duration, provided therapy was discontinued and participant had no evidence of conventional imaging positive metastatic disease at that time * Prior ARPI use in mHSPC is permitted but not mandated. If participants meet all study eligibility criteria, they are required to stop their prior ARPI after providing informed consent and remain off ARPI until Cycle 1 Day 1, when study treatment is initiated. * Phase I: Allowed for any duration. * Phase II: Allowed prior exposure to ARPI is ≤4 months. Participants with ongoing use of darolutamide are not eligible. Participants with ongoing ARPI are eligible for a switch from their ongoing ARPI therapy if they have not progressed to CRPC disease, and meet any of the criteria, indicative of suboptimal biochemical response, or intolerability, as assessed by the Investigator: * Evidence of insufficient PSA control or suboptimal PSA response, defined as PSA ≥ 0.2 ng/mL after 6-12 months ADT and no more than 4 months of current ARPI therapy in mHSPC with declining or stable PSA trend. Eligibility based on biochemical progression should be supported by objective evidence (e.g. PSA results). * Intolerance and non-compliance: Participant's inability to tolerate or comply with the prescribed ARPI. The site should maintain documentation to support the appropriateness of therapy changes resulting from intolerance or non-compliance. • Other permitted prior local therapy for mHSPC: * Phase I and II: Prior prostate-directed radiation or surgical intervention. Radiation must be completed before study entry; surgery at least 2 weeks prior. Key Exclusion Criteria: * Participants with evidence of mCRPC or biochemical recurrence / PSA only disease or asymptomatic prostate cancer without known metastatic disease and with no requirement for therapy and with normal PSA for ≥ 1 year prior to the start of study treatment. * Participants who have not received ARPI treatment for mHSPC and present with PSA levels of ≤0.5 ng/mL or those with prior/ongoing ARPI treatment presenting with PSA levels of ≤ 0.2 ng/mL prior to treatment assignment/randomization. * Participants with CNS metastases are excluded unless: * they have received prior therapy (e.g. surgery, radiotherapy, gamma knife), are neurologically stable and asymptomatic. * they are not receiving corticosteroid for the purpose of maintaining neurologic integrity and have baseline and subsequent radiological imaging of the brain. * Concurrent use of first-generation anti-androgens (like bicalutamide). Prior use of a first-generation anti-androgen drug in the context of ADT initiation with a GNRH analog is allowed, provided it was administered for ≤14 days and the last dose was administered ≥7 days from the study entry. * Systemic ketoconazole is used as antineoplastic treatment for prostate cancer. * Previous exposure to radioligand therapy. * Treatment with any investigational agent within 28 days (or 5 half-lives, whichever is longer) prior to study entry. * Previous treatment with any Polycomb Repressive Complex 2 (PRC2) inhibitor, including but not limited to Enhancer of Zeste Homolog 2 (EZH2) inhibitors, EZH2/1 inhibitors, or embryonic ectoderm development (EED) inhibitors. * Herbal products that may decrease PSA levels within 4 weeks prior to the start of study drug treatment and while on study. * Participants taking prohibited medication(s) (e.g., strong CYP3A4 inducers or strong or moderate CYP3A4 inhibitors that cannot be stopped within 7 days or 5 half-lives (whichever is longer) prior to study treatment and for the duration of the study treatment or prohibited herbal product(s) that cannot be stopped 7 days prior to study treatment. * Have a history of a concurrent or second malignancy except for adequately treated local basal cell or squamous cell carcinoma of the skin, cervical carcinoma in situ, superficial bladder cancer, adequately treated Stage 1 or 2 cancer currently in complete remission, or any other cancer that has been in complete remission for ≥ 3 years. Participants with a history of leukemia/lymphoma and/or MDS are not eligible. Other inclusion/exclusion criteria may apply

Interventions

DRUG

Tulmimetostat

DRUG

Darolutamide

DRUG

Abiraterone

DRUG

Prednisone/Prednisolone

DRUG

Androgen Deprivation Therapy (ADT)

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Conditions

Metastatic Hormone-Sensitive Prostate Cancer (mHSPC)

Locations

Univ of Alabama at Birmingham

Birmingham, Alabama 35294-3300

United States

Uni Of Iowa Hospitals And Clinics

Iowa City, Iowa 52242

United States

University of Kansas Cancer Center

Westwood, Kansas 66205

United States

Wichita Urology Group PA

Wichita, Kansas 67226

United States

Duke University Medical Center

Durham, North Carolina 27710

United States

Medical University of South Carolina MUSC

Charleston, South Carolina 29425

United States

Carolina Urologic Research Center

Myrtle Beach, South Carolina 29572

United States

Huntsman Cancer Institute

Salt Lake City, Utah 84112

United States

Novartis Investigative Site

Camperdown, New South Wales 2050

Australia

Novartis Investigative Site

Wollongong, New South Wales 2500

Australia

Novartis Investigative Site

Porto Alegre, Rio Grande do Sul 90610-001

Brazil

Novartis Investigative Site

Montreal, Quebec H2X 1R9

Canada

Novartis Investigative Site

Guangzhou, 510060

China

Novartis Investigative Site

Créteil, 94010

France

Novartis Investigative Site

Lille, 59020

France

Novartis Investigative Site

Nantes, 44093

France

Novartis Investigative Site

Jena, Thuringia 07740

Germany

Novartis Investigative Site

Essen, 45147

Germany

Novartis Investigative Site

Hong Kong, 999077

Hong Kong

Novartis Investigative Site

Budapest, 1083

Hungary

Novartis Investigative Site

Budapest, 1122

Hungary

Novartis Investigative Site

Szeged, 6725

Hungary

Novartis Investigative Site

Rozzano, MI 20089

Italy

Novartis Investigative Site

Verona, VR 37134

Italy

Novartis Investigative Site

Seoul, 05505

South Korea

Novartis Investigative Site

Seoul, 06591

South Korea

Novartis Investigative Site

Madrid, 28034

Spain

Novartis Investigative Site

Madrid, 28040

Spain

Novartis Investigative Site

Madrid, 28222

Spain

Novartis Investigative Site

Ankara, Sihhiye Altindag 06230

Turkey (Türkiye)

Novartis Investigative Site

London, W1G 6AD

United Kingdom