Intermittent Chemotherapy With or Without Granulocyte-macrophage Colony-stimulating Factor (GM-CSF) for Metastatic Hormone Refractory Prostate Cancer (HRPC)

Inclusion criteria

• Age over 18 years
• Histologically documented adenocarcinoma of the prostate
• Progressive metastatic prostate cancer
• Castrate levels of testosterone (<50 ng/ml) must be maintained
• Prior hormonal therapy or medications :

Patients who are receiving an anti-androgen, secondary hormonal therapy (i.e. ketoconazole, aminoglutethimide, megestrol acetate, diethylstilbestrol), 5-alpha reductase inhibitor (i.e. finasteride (Proscar), dutasteride (Avodart)) or herbal prostate medication (i.e. saw palmetto, PC-SPES, PC-PLUS) must discontinue the drug by the date of initiation of chemotherapy on study

• ≥ 4 weeks since major surgery and fully recovered
• ≥ 4 weeks since any prior radiation with any toxicity attributable to radiation resolved to ≤grade 1
• ≥ 8 weeks since the last dose of strontium or samarium
• Sexually active patients must agree to use adequate contraception
• Karnofsky Performance Status ≥ 60%
• Life expectancy >12 weeks
• Required initial laboratory values Absolute neutrophil count > 1500/ul Platelets > 100,000/ul Hemoglobin > 8.0 g/dl Creatinine ≤ 2.0 X upper limit of normal Bilirubin ≤upper limit of normal (ULN)

aspartate aminotransferase (AST) / alanine aminotransferase (ALT) / alkaline phosphatase: AST AND ALT AND alkaline phosphatase must be within the range allowing for eligibility In determining eligibility, the more abnormal of the 2 values (AST or ALT should be used. An abnormal alkaline phosphatase must be attributed to liver dysfunction and not metastatic bone involvement (i.e elevated gamma-glutamyl transpeptidase (GGTP) or evidence of liver metastases)

Inclusion criteria

for late enrolling patients:

• Age over 18 years
• Histologically documented adenocarcinoma of the prostate
• ≤3 cycles of prior docetaxel chemotherapy for metastatic disease permitted prior to enrollment
• Docetaxel must have been administered on an every 3 week schedule
• Each docetaxel dose must have been between 60 and 75 mg/m2
• Castrate levels of testosterone <50 ng/mL
• Daily use of other steroids (hydrocortisone, dexamethasone) instead of prednisone or no steroids, is permitted up until time of enrollment
• A Prostate-specific antigen (PSA) level must have been documented within 6 weeks of initiating docetaxel chemotherapy

Exclusion criteria

• Prior systemic chemotherapy for prostate cancer, other than q 3-week docetaxel/prednisone. Prior neoadjuvant or adjuvant chemotherapy is permitted if there was no evidence of disease relapse within 12 months of the last dose of chemotherapy.
• >3 cycles of q3 week docetaxel/prednisone chemotherapy has already been administered to the patient
• Peripheral neuropathy >grade 1
• Prior immunotherapy including systemic GM-CSF or vaccines utilizing GM-CSF; prior G-CSF support of chemotherapy-related neutropenia is permitted
• Prior biologic agents (i.e.,anti-angiogenic agents, anti-Epithelial Growth Factor Receptor (EGFR) inhibitors)≤ 4 weeks prior to registration
• More than two prior therapies with an investigational agent, completed ≤ 4 weeks prior to enrollment (no prior immunotherapeutics are allowed)
• Myocardial infarction or significant change in anginal pattern within the last 6 months, symptomatic congestive heart failure (NYHA Class III or higher) or uncontrolled cardiac arrhythmia
• Because patients with immune deficiency are at increased risk of lethal infections when treated with marrow-suppressive therapy, HIV-positive patients receiving combination anti-retroviral therapy are excluded
• Patients with a history of severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80 will be excluded
• Poorly controlled diabetes (fasting blood glucose >250) despite optimization of medical therapy

Exclusion criteria

for late enrolling patients:

• Prior immunotherapy including systemic GM-CSF or vaccines utilizing GM-CSF; prior G-CSF support for chemotherapy-related neutropenia is permitted
• Delay of ≥6 weeks between any 2 chemotherapy cycles prior to enrollment on study
• Cumulative delays ≥8 weeks between chemotherapy cycles prior to enrollment on study