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Metastatic Castration-resistant Prostate CancerPhase 2NCT06922318

The COSMYC Trial (COmbined Suppression of MYC)

A Phase 2 study testing ZEN-3694, Testosterone cypionate and Enzalutamide in people with Metastatic Castration-resistant Prostate Cancer, run by Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

This research is being done to determine if receiving the combination of testosterone and ZEN-3694 followed by the combination of enzalutamide plus ZEN-3694 will decrease the size of tumors in patients with prostate cancer that has become resistant to castration and other therapies. Read more about this study

Who is it for?
Ages 18 years and older, men only
What is being tested?
ZEN-3694, Testosterone cypionate and Enzalutamide
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
1 siteUnited States
Study dates
19 Aug 2025to 30 Aug 2031
Phase
Phase 2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Men only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Eastern Cooperative Oncology Group (ECOG) Performance status ≤2.
  • Age ≥18 years.
  • Histologically-confirmed adenocarcinoma of the prostate.
  • Treated with continuous androgen ablative therapy (either surgical castration or LHRH agonist/antagonist).
  • Documented castrate level of serum testosterone (<50 ng/dl).
  • Metastatic disease radiographically documented by CT or bone scan. While CT scan is preferred, Prostate-Specific Membrane Antigen (PSMA) scan (e.g. Pylarify) may be substitute for CT scan if evidence of metastatic disease observed on the CT portion of the PSMA scan.
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  • Must have had disease progression while on a second-generation AR-axis inhibitor (Abiraterone, Enzalutamide, Darolutamide, or Apalutamide) based on:
  • PSA progression defined as an increase in PSA, as determined by 2 separate measurements taken at least 1 week apart i. And/ Or Radiographic disease progression, based on RECIST 1.1 in patients with measurable soft tissue lesions or PCWG3 for patients with bone disease
  • Screening PSA must be ≥ 1.0 ng/mL.
  • Patients with soft tissue lesion amenable to biopsy must agree to biopsy collection pre-treatment and at a defined point on treatment to perform tumor tissue analysis.
  • Prior treatment with Provenge vaccine, 223 Radium (Xofigo), poly(ADP-ribose) polymerase (PARP) inhibitors, taxane chemotherapy, Pluvicto, antiandrogens (including enzalutamide, darolutamide, and apalutamide), and radiation is allowed if >4 weeks from last dose.
  • Prior treatment with BAT is allowed if the patient has progressed on an AR-axis inhibitor (i.e. abiraterone or antiandrogen) since BAT treatment.
  • Patients must be withdrawn from second-generation AR-axis inhibitor (Abiraterone, Enzalutamide, Darolutamide, or Apalutamide) for ≥ 2 weeks.
  • Attempts must be made to wean patients off prednisone prior to starting therapy. Patients who cannot be weaned due to symptoms may continue on lowest dose of prednisone achieved during weaning period.
  • Acceptable liver function:
  • Bilirubin < 2.5 times institutional upper limit of normal (ULN)
  • Aspartate Transferase (AST) (SGOT) and Alanine Transaminase (ALT) (SGPT) < 2.5 times ULN
  • Acceptable renal function:
  • Serum creatinine <2.5 times ULN
  • Acceptable hematologic status:
  • Absolute neutrophil count (ANC) ≥ 1000 cells/mm3 (1.5 ×109/L)
  • Platelet count ≥ 100,000 platelet/mm3 (100 ×109/L)
  • Hemoglobin ≥ 7.5 g/dL.
  • Ability to understand and willingness to sign a written informed consent document.
  • Sexually active participants with female partners of childbearing potential are eligible to participate if they agree to follow 1 of the following methods of contraception consistently, starting from screening, during the study and for at least 3 months after the last dose of ZEN-3694 and/or enzalutamide:
  • Are abstinent from penile-vaginal intercourse as their usual and preferred lifestyle (abstinent on a long-term and persistent basis) and agree to remain abstinent.
  • Are sterilized (with the appropriate post-vasectomy documentation of the absence of sperm in the ejaculate); iii. Agree to use a male condom and have their partner use a contraceptive method with a failure rate of <1% per year as described below when having penile-vaginal intercourse with a woman of childbearing potential who is not currently pregnant, and who agrees to the use of a condom by her partner.
  • In addition, participants must refrain from donating sperm starting from Screening, during the study and for at least 3 months after the last dose of ZEN-3694 and/or enzalutamide.
  • Sexually active participants with a pregnant or breastfeeding partner must agree to remain abstinent from penile-vaginal intercourse; or use a male condom during each episode of penile penetration during the study
  • Patients with soft-tissue disease amenable to biopsy as determined by Interventional Radiology must agree to serial biopsies as per the study schedule to be eligible.

Who cannot join

  • Pain due to metastatic prostate cancer requiring treatment intervention with opioid pain medication.
  • ECOG Performance status ≥3
  • Requirement for urinary self-catheterization for voiding due to obstruction secondary to prostatic enlargement well documented to be due to prostate cancer or benign prostatic hyperplasia (BPH). Patients with indwelling Foley or suprapubic catheter for obstructive symptoms are eligible.
  • Active uncontrolled infection. Patients with a history of HIV/AIDS may be eligible if cluster of differentiation 4 (CD4)+ T cell counts are ≥ 350 cell/ul, they have had no opportunistic infection within the past 12 months, they have been on established antiretroviral therapy (ART) for at least four weeks, the HIV viral load is less than 400 copies/ml prior to enrollment, and there is no significant drug-drug interaction with ART and the study drugs. Patients with chronic hepatitis B virus (HBV) infection with active disease who meet criteria for anti HBV therapy are eligible if they are on a suppressive antiviral therapy prior to enrollment and there is no drug-drug interaction with the study drugs. Patients with a history of HCV infection are eligible if they have completed curative antiviral treatment and the hepatitis C virus (HCV) viral load is below the limit of quantification.
  • Any condition or mental impairment that may compromise the ability to give informed consent, patient's safety or compliance with study requirements as determined by the investigator.
  • Patients receiving anticoagulation therapy with warfarin, rivaroxaban, or apixaban are not eligible for study. [Patients on enoxaparin or edoxaban are eligible for study. Patients on warfarin, rivaroxaban, or apixaban, who can be transitioned to one of these alternative agents prior to starting study treatments will be eligible].
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  • Patients are excluded with prior history of a thromboembolic event within the last 12 months that are not being treated with systemic anticoagulation.
  • Hematocrit >51%, untreated severe obstructive sleep apnea, uncontrolled or poorly controlled heart failure [per Endocrine Society Clinical Practice Guidelines (34)]
  • Patients allergic to sesame seed oil or cottonseed oil are excluded.
  • Major surgery (i.e. as defined by treating physician) within 3 weeks before screening, or has not fully recovered from prior surgery (i.e., unhealed wound). Note: subjects with planned surgical procedures to be conducted under local anesthesia may participate.
  • Patients with history of seizure or any condition that may predispose to seizure (e.g., prior cortical stroke or significant brain trauma, brain arteriovenous malformation).

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Samuel Denmeade, MD contact

410-733-3232

denmesa@jhmi.edu

Sin Chan, MS contact

410-614-3630

schan44@jhmi.edu

United States1 site, 1 recruiting

  • Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

    Baltimore, Maryland, 21205

    Samuel Denmeade, MD, 410-733-3232, denmesa@jhmi.edu

    Recruiting

Other trials in United States

About this study

Official title: A Phase II Study of Sequential Bipolar Androgen Therapy and ZEN-3694 in Sequence With Enzalutamide + ZEN-3694 in Asymptomatic Patients With Metastatic CRPC: The COSMYC Trial (COmbined Suppression of MYC)

This research is being done to determine if receiving the combination of testosterone and ZEN-3694 followed by the combination of enzalutamide plus ZEN-3694 will decrease the size of tumors in patients with prostate cancer that has become resistant to castration and other therapies. The investigators also want to determine if dosing first with the combination of testosterone and ZEN-3694 may cause enzalutamide and ZEN-3694 to work more effectively.

Read the detailed description

The primary objectives of the study are first to determine if treatment with the combination of ZEN-3694 and Bipolar Androgen Therapy (i.e. BATZEN) will improve the progression-free survival in patients with metastatic castrate-resistant prostate cancer (mCRPC) compared with historical controls. The second primary objective is to determine if treatment with ZEN-3694 and Enzalutamide (i.e. ZENZA) after progression on Bipolar Androgen Therapy (BAT) will improve PSA-progression-free survival compared to historical controls.

Asymptomatic patients with mCRPC without pain due to prostate cancer will be treated on an open label study to evaluate effectiveness of sequential treatment with the combination of ZEN-3694 and high dose testosterone in sequence with enzalutamide and ZEN-3694 to improve primary and secondary outcomes.

Eligible patients are those with mCRPC who have progressive disease after treatment with a second-generation AR-axis inhibitor (Abiraterone, Enzalutamide, Darolutamide, or Apalutamide) used as treatment for castration-sensitive or castration-resistant disease. Patients will continue on Androgen Deprivation Therapy (ADT) with LHRH agonist (i.e. Zoladex, Trelstar, Eligard, or Lupron) or LHRH antagonist (Degarelix or Relugolix) if not surgically castrated throughout the duration of the study to inhibit endogenous testosterone production. One cycle of treatment will be 28 days.

Being tested
ZEN-3694, Testosterone cypionate, Enzalutamide, Luteinizing hormone-releasing hormone (LHRH) analogue
Keywords
Prostate Cancer, ZEN-3694, Bipolar androgen therapy, testosterone cypionate, enzalutamide
Medical subject headings
Prostatic Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ZEN-3694Drug

    ZEN-3694 is available in two capsule strengths for this study: 12 mg and 48 mg.

  • Testosterone cypionateDrug

    On day 1 of each BATZEN cycle testosterone cypionate (400 mg) injection to the buttocks will be administered.

  • EnzalutamideDrug

    Enzalutamide 160 mg (four 40 mg tablets) taken daily by mouth on each ZENZA cycle.

  • Luteinizing hormone-releasing hormone (LHRH) analogueDrug

    Also called Zoladex, Trelstar, Eligard, Lupron

    Patients will continue on ADT with LHRH agonist (i.e. Zoladex, Trelstar, Eligard or Lupron) or LHRH antagonist (Degarelix or Relugolix) if not surgically castrated throughout the duration of the study to inhibit endogenous testosterone production.

Study groups in NCT06922318
Study groupRoleWhat they receive
BATZENExperimentalZEN-3694 48 mg (one 48 mg capsules) will be taken once per day by mouth each cycle (each cycle is 28 days). On the first day of each cycle, testosterone cypionate (400 mg) injection will be administered into the buttocks. The participant will continue with additional 28-day cycles of ZEN-3694 pills and testosterone injections until there is disease progression on bone and CT scans.
Receives: Drug: ZEN-3694; Drug: Testosterone cypionate; Drug: Luteinizing hormone-releasing hormone (LHRH) analogue
ZENZAExperimentalZENZA cycles will begin once there is disease progression on bone and CT scans. ZEN-3694 dose will increase to 72 mg (one 48 mg and two 12 mg tablets) to be taken daily by mouth. Enzalutamide 160 mg (four 40 mg tablets) will be taken daily by mouth.
Receives: Drug: ZEN-3694; Drug: Enzalutamide; Drug: Luteinizing hormone-releasing hormone (LHRH) analogue

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Clinical/radiographic progression free survival (PFS) with BATZEN

    Median time from the first date of BATZEN to the date of first documented radiological progression per RECIST 1.1 for soft tissue or per Prostate Cancer Working Group 3 (PCWG3) for bone lesions, the development of symptoms or complications attributable to cancer progression, or death, whichever occurs first.

    Measured: 2 years

  2. Prostate specific antigen (PSA)-Progression free survival (PFS) with ZENZA

    PSA-PFS on ZENZA is the median time from start of ZENZA to time of PSA progression according to PCWG3 criteria ,or censored at the last date of PSA assessment for patients without PSA progression.

    Measured: 2 years

Secondary outcomes (9)

  1. Number of participants with PSA 50 (≥50% PSA reduction) response to BATZEN

    Number of participants with ≥50% PSA reduction from baseline level at screening.

    Measured: 2 years

  2. Number of participants with PSA50 response to ZENZA

    Number of participants with ≥50% PSA reduction from PSA level at time of progression on BATZEN

    Measured: 2 years

  3. Time to PSA progression while on BATZEN

    Median time (months) from start of BATZEN to date of PSA progression on ZENZA

    Measured: 2 years

  4. Number of participants with Objective response to BATZEN and ZENZA, respectively per RECIST 1.1 criteria

    The number of participants with measurable disease who achieve either complete response or partial response to per RECIST 1.1

    Measured: 2 years

  5. Progression Free Survival (PFS2) (PSA progression on ZENZA)

    Median time from start of BATZEN to date of PSA progression on ZENZA

    Measured: 2 years

  6. Overall Survival

    Number of months from start of study therapy to death from any cause.

    Measured: 5 years

  7. Quality of Life as assessed by the Functional Assessment of Chronic Illness Therapy (FACIT) - Fatigue Scale

    Quality of life over time based on the FACIT-Fatigue. The Functional Assessment of Chronic Illness Therapy - Fatigue Scale (FACIT-Fatigue) is a 13-item measure that assesses self-reported fatigue and its impact upon daily activities and function. The total score ranges between 0 and 52, with higher scores denoting less fatigue.

    Measured: 1 year

  8. Quality of Life as assessed by the Short Form-36 (SF-36)

    Quality of life over time based on the SF-36 survey. Short Form 36 (SF-36) is a set of generic, coherent, and easily administered quality-of-life measures. Score range 0-100, lower scores represent more physical function disability, while higher scores represent less disability.

    Measured: 1 year

  9. Number of participants with treatment-related adverse events

    Measured by the number of participants with treatment-related adverse events as assessed by the Common Terminology Criteria for Adverse Events (CTCAE) v5.0

    Measured: 2 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Apr 2025
  2. Study start19 Aug 2025
  3. Primary completion30 Aug 2031 (estimated)
  4. Study completion30 Aug 2031 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
50 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06922318
Sponsor's protocol ID
J2513
Other IDs
IRB00480365, P50CA272391
Status last verified
Oct 2026
First submitted
3 Apr 2025
Last updated
30 Oct 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing ZEN-3694, Testosterone cypionate and Enzalutamide in people with Metastatic Castration-resistant Prostate Cancer, run by Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 30 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 30 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Samuel Denmeade, MD (410-733-3232, denmesa@jhmi.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Clinical/radiographic progression free survival (PFS) with BATZEN (time frame: 2 years). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06922318.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Oct 2026; AzTrials last refreshed its copy on 7 Nov 2026.

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