Description:
This study evaluates the use of chemotherapy with cabazitaxel in addition to abiraterone
acetate, prednisone, and leuprolide in neoadjuvant setting prior to radical prostatectomy in
patients with high-risk prostate carcinoma. Half of the participants will receive treatment
with abiraterone acetate, prednisone, leuprolide, and cabazitaxel, while the other half will
receive only abiraterone acetate, prednisone, and leuprolide.
Title
- Brief Title: Anti-Androgens and Cabazitaxel in Defining Complete Response in Prostatectomy (ACDC Trial)
- Official Title: Anti-Androgens and Cabazitaxel in Defining Complete Response in Prostatectomy (ACDC-RP Trial): A Randomized, Open-label, Multi-centre Phase-2 Study Evaluating the Pathological Complete Response (pCR) Rate Following Neoadjuvant Therapy in Participants With High-risk Prostate Carcinoma for Whom Radical Prostatectomy is Indicated
Clinical Trial IDs
- ORG STUDY ID:
15-051
- NCT ID:
NCT02543255
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Abiraterone acetate with prednisone | | Abiraterone acetate + prednisone + leuprolide |
Leuprolide | | Abiraterone acetate + prednisone + leuprolide |
Cabazitaxel with peg-filgrastim | | Abiraterone acetate + prednisone + leuprolide + cabazitaxel |
Purpose
This study evaluates the use of chemotherapy with cabazitaxel in addition to abiraterone
acetate, prednisone, and leuprolide in neoadjuvant setting prior to radical prostatectomy in
patients with high-risk prostate carcinoma. Half of the participants will receive treatment
with abiraterone acetate, prednisone, leuprolide, and cabazitaxel, while the other half will
receive only abiraterone acetate, prednisone, and leuprolide.
Trial Arms
Name | Type | Description | Interventions |
---|
Abiraterone acetate + prednisone + leuprolide + cabazitaxel | Experimental | Participants randomized to this arm will receive abiraterone acetate (1000 mg/day), prednisone (5 mg twice daily), leuprolide (22.5 mg every 3 months), and cabazitaxel (20 mg/m2, with 6 mg pegfilgrastim administered 24 h following cabazitaxel) prior to radical prostatectomy. | - Abiraterone acetate with prednisone
- Leuprolide
- Cabazitaxel with peg-filgrastim
|
Abiraterone acetate + prednisone + leuprolide | Active Comparator | Participants randomized to this arm will receive abiraterone acetate (1000 mg/day) , prednisone (5 mg twice daily), and leuprolide (22.5 mg every 3 months) prior to radical prostatectomy. | - Abiraterone acetate with prednisone
- Leuprolide
|
Eligibility Criteria
Inclusion Criteria:
- Willing and able to provide informed consent;
- Histologically confirmed adenocarcinoma of the prostate without neuroendocrine
differentiation or small cell features with a minimum of 3 cores positive for tumour;
- Tumour biopsy tissue accessible for downstream evaluation;
- Must be candidates for radical prostatectomy and considered surgically resectable by
urologic evaluation;
- High Risk D'Amico score defined as either PSA > 20, Gleason score ≥ 8 as determined by
the local pathologist; or T2c-3 based on DRE, pathologic review +/- imaging;
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1;
- No evidence of metastatic disease or nodal disease as determined by radionuclide bone
scans and computed tomography (CT)/magnetic resonance imaging (MRI); non-pathological
lymph nodes must be less than 15 mm in the short (transverse) axis;
- Able to swallow the study drug(s) as prescribed and comply with study requirements;
- Required initial laboratory values:
- Absolute neutrophil count (ANC) ≥ 1500/μL;
- Platelet count ≥ 100,000/μL;
- Hemoglobin ≥ 90 g/L;
- Creatinine ≤ 175 μmol/L;
- Bilirubin ≤ upper limit of institutional normal (ULN);
- AST/ALT ≤ 1.5 × ULN.
Exclusion Criteria:
- Received an investigational agent within 4 weeks prior to screening;
- Stage T4 prostate cancer by clinical examination or radiologic evaluation;
- Hypogonadism or severe androgen deficiency as defined by screening serum testosterone
below the normal range for the institution;
- Prior androgen deprivation, chemotherapy, surgery, or radiation for prostate cancer;
- Receiving concurrent androgens, estrogens, or progestational agents, or received any
of these agents within the 6 months prior to randomization;
- History of another malignancy within the previous 5 years other than curatively
treated nonmelanomatous skin cancer and non-muscle invasive bladder cancer;
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, cardiovascular disease, unstable angina pectoris, cardiac arrhythmia that
is symptomatic or requires active therapy; deep venous thrombosis within 3 months
prior to randomization;
- Previous use, or participation in a clinical trial, of an investigational agent that
blocks androgen synthesis (e.g., abiraterone acetate, TAK-700, TAK-683, TAK-448) or
targets the androgen receptor (e.g., enzalutamide, BMS 641988);
- Liver injury or disease (e.g., viral hepatitis, liver failure Child-Pugh Class C).
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Male |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Pathological complete response |
Time Frame: | 24 weeks from start of treatment. |
Safety Issue: | |
Description: | |
Secondary Outcome Measures
Measure: | Pre-operative PSA levels |
Time Frame: | 24 weeks of treatment |
Safety Issue: | |
Description: | The effect of neoadjuvant leuprolide, and abiraterone acetate and prednisone with and without cabazitaxel on pre-operative PSA will be evaluated. |
Measure: | Mean nadir PSA levels |
Time Frame: | 24 weeks of treatment |
Safety Issue: | |
Description: | The effect of neoadjuvant leuprolide, abiraterone acetate, and prednisone with and without cabazitaxel on mean nadir PSA levels will be evaluated. |
Measure: | Percentage of participants achieving a PSA < 0.2 ng/mL |
Time Frame: | 24 weeks of treatment |
Safety Issue: | |
Description: | The percentage of participants achieving a PSA < 0.2 ng/mL following treatment with neoadjuvant leuprolide, abiraterone acetate, and prednisone with and without cabazitaxel will be evaluated. |
Measure: | Percentage of participants achieving a 50 and 90% decrease in PSA levels |
Time Frame: | up to 24 weeks of treatment |
Safety Issue: | |
Description: | The percentage of participants achieving a 50 and 90% decrease in PSA levels following treatment with neoadjuvant leuprolide, abiraterone acetate, and prednisone with and without cabazitaxel will be evaluated. |
Measure: | Rate of positive surgical margins |
Time Frame: | up to 24 weeks of treatment |
Safety Issue: | |
Description: | The rate of positive surgical margins following treatment with neoadjuvant leuprolide, abiraterone acetate, and prednisone with and without cabazitaxel will be evaluated. |
Measure: | Rate of near-complete response (<5 mm tumour) |
Time Frame: | up to 24 weeks of treatment |
Safety Issue: | |
Description: | The rate of near-complete response (<5 mm tumour) following treatment with neoadjuvant leuprolide, abiraterone acetate, and prednisone with and without cabazitaxel will be evaluated. |
Measure: | Rate of extracapsular extension |
Time Frame: | up to 24 weeks of treatment |
Safety Issue: | |
Description: | The rate of extracapsular extension following treatment with neoadjuvant leuprolide, abiraterone acetate, and prednisone with and without cabazitaxel will be evaluated. |
Measure: | Rate of positive seminal vesicle involvement |
Time Frame: | up to 24 weeks of treatment |
Safety Issue: | |
Description: | The rate of positive seminal vesicle involvement following treatment with neoadjuvant leuprolide, abiraterone acetate, and prednisone with and without cabazitaxel will be evaluated. |
Measure: | Rate of nodal involvement |
Time Frame: | up to 24 weeks of treatment |
Safety Issue: | |
Description: | The rate of nodal involvement following treatment with neoadjuvant leuprolide, abiraterone acetate, and prednisone with and without cabazitaxel will be evaluated. |
Measure: | Tumour proliferation (Ki-67 index) |
Time Frame: | up to 24 weeks of treatment |
Safety Issue: | |
Description: | Tumour proliferation, indexed using Ki-67 immunohistochemistry, following treatment with neoadjuvant leuprolide, abiraterone acetate, and prednisone with and without cabazitaxel will be evaluated. |
Measure: | Androgen receptor expression |
Time Frame: | up to 24 weeks of treatment |
Safety Issue: | |
Description: | Androgen receptor expression will be evaluated using immunohistochemistry following treatment with neoadjuvant leuprolide, abiraterone acetate, and prednisone with and without cabazitaxel. |
Measure: | Incidence of adverse events |
Time Frame: | up to 24 weeks of treatment |
Safety Issue: | |
Description: | Incidence of adverse events will be evaluated for the duration of the study. |
Measure: | Severity of adverse events |
Time Frame: | Aup to 24 weeks of treatment |
Safety Issue: | |
Description: | Severity of adverse events will be evaluated for the duration of the study. |
Measure: | Androgen levels (if optional biopsy tissue is available) |
Time Frame: | up to 24 weeks of treatment |
Safety Issue: | |
Description: | If the participants agrees to optional pre-treatment biopsy, androgen levels will be compared between the pre-treatment tissue samples and prostatectomy tissue. |
Measure: | Genomic alterations between pre- and post-treatment tissue |
Time Frame: | up to 24 weeks of treatment |
Safety Issue: | |
Description: | If the participants agrees to optional pre-treatment biopsy, genomic alterations between the pre-treatment tissue samples and prostatectomy tissue will be evaluated. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | University Health Network, Toronto |
Trial Keywords
Last Updated
April 19, 2021