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Fexapotide triflutate: results of long-term safety and efficacy trials of a novel injectable therapy for symptomatic prostate enlargement

  • Neal Shore 1,
  • Ronald Tutrone 2,
  • Mitchell Efros 3,
  • Mohamed Bidair 4,
  • Barton Wachs 5,
  • Susan Kalota 6,
  • Sheldon Freedman 7,
  • James Bailen 8,
  • Richard Levin 9,
  • Stephen Richardson 10,
  • Jed Kaminetsky 11,
  • Jeffrey Snyder 12,
  • Barry Shepard 13,
  • Kenneth Goldberg 14,
  • Alan Hay 15,
  • Steven Gange 16,
  • Ivan Grunberger 17
1 Carolina Urologic Research Center, Myrtle Beach, USA 2 Chesapeake Urology Research Associates, Baltimore, USA 3 Accumed Research, Garden City, USA 4 San Diego Clinical Trials, San Diego, USA 5 Atlantic Urology Medical Group, Long Beach, USA 6 Urological Associates of Southern Arizona, Tucson, USA 7 Freedman Urology, Las Vegas, USA 8 First Urology, Louisville, USA 9 Chesapeake Urology Research Associates, Towson, USA 10 Jean Brown Research, Salt Lake City, USA 11 University Urology, New York, USA 12 Genitourinary Surgical Consultants, Denver, USA 13 Urological Surgeons of Long Island, Garden City, USA 14 U T Southwestern Dept of Urology, Lewisville, USA 15 Willamette Urology, Salem, USA 16 Summit Urology Group, Salt Lake City, USA 17 Brooklyn Urology, Brooklyn, USA

Publication: World Journal of Urology, Volume 36, Issue 5, May 2018, Pages 801-809

DOI: 10.1007/s00345-018-2185-y

Purpose

These studies were undertaken to determine if fexapotide triflutate 2.5 mg transrectal injectable (FT) has significant long-term (LT) safety and efficacy for the treatment of benign prostatic hyperplasia (BPH).

Methods
Two placebo controlled double-blind randomized parallel group trials with 995 BPH patients at 72 sites treated 3:2 FT:placebo, with open-label FT crossover (CO) re-injection in 2 trials n = 344 and long-term follow-up (LF) 2–6.75 years (mean 3.58 years, median 3.67 years; FT re-injection CO mean 4.27 years, median 4.42 years) were evaluated. 12 months post-treatment patients elected no further treatment, approved oral medications, FT, or interventional treatment. Primary endpoint variable was change in Symptom Score (IPSS) at 12 months and at LF. CO primary co-endpoints were 3-year incidence of (1) surgery for BPH in FT treated CO patients versus patients crossed over to oral BPH medications and (2) surgery or acute urinary retention in FT-treated CO placebo patients versus placebo patients crossed over to oral BPH medications. 28 CO secondary endpoints assessed surgical and symptomatic outcomes in FT reinjected patients versus conventional BPH medication CO and control subgroups at 2 and 3 years.

Results
FT injection had no significant safety differences from placebo. LF IPSS change from baseline was higher in FT treated patients compared to placebo (median FT group improvement − 5.2 versus placebo − 3.0, p < 0.0001). LF incidence of AUR (1.08% p = 0.0058) and prostate cancer (PCa) (1.1% p = 0.0116) were both reduced in FT treated patients. LF incidence of intervention for BPH was reduced in the FT group versus oral BPH medications (8.08% versus 27.85% at 3 years, p < 0.0001). LF incidence of intervention or AUR in placebo CO group with FT versus placebo CO group with oral medications was reduced (6.07% versus 33.3% at 3 years, p < 0.0001). 28/28 secondary efficacy endpoints were reached in LF CO re-injection studies.

Conclusions
FT 2.5 mg is a safe and effective transrectal injectable for LT treatment of BPH. FT treated patients also had reduced need for BPH intervention, and reduced incidence of PCa and AUR.