Description:
This is a randomized study to evaluate the efficacy and safety neoadjuvant androgen
deprivation therapy with goserelin and abiraterone with or without apalutamide prior to
radical prostatectomy for patients diagnosed with localized high-risk prostate cancer.
Title
- Brief Title: Neoadjuvant Androgen Deprivation Therapy Plus Abiraterone With or Without Apalutamide for High-Risk Prostate Cancer
- Official Title: Phase II Study of Neoadjuvant Androgen Deprivation Therapy Plus Abiraterone With or Without Apalutamide for Patients With High-Risk Localized Prostate Cancer Prior to Radical Prostatectomy
Clinical Trial IDs
- ORG STUDY ID:
NP 779/15
- NCT ID:
NCT02789878
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Goserelin | ADT | ADT and Abiraterone |
Prednisone | | ADT and Abiraterone |
Abiraterone | Zytiga | ADT and Abiraterone |
Apalutamide | ARN-509 | ADT, Abiraterone and Apalutamide |
Purpose
This is a randomized study to evaluate the efficacy and safety neoadjuvant androgen
deprivation therapy with goserelin and abiraterone with or without apalutamide prior to
radical prostatectomy for patients diagnosed with localized high-risk prostate cancer.
Detailed Description
In the prostate specific antigen (PSA) era, about 15% to 20% of patients are diagnosed with
high-risk localized disease and radical prostatectomy is a standard therapy for this subgroup
of patients. However, despite best local therapy, about 30-60% of high-risk patients will
eventually develop biochemical relapse and a significant proportion of these patients may
progress with metastatic disease and die from prostate cancer. Currently, there is no data
supporting the use of neoadjuvant therapy for patients with high-risk disease since studies
failed to demonstrate clinically significant benefit with standard androgen deprivation
therapy (ADT). Following improved outcomes in other malignancies with the use of neoadjuvant
therapy with active drugs in the metastatic setting, there is a growing interest in
evaluating new-generation androgen receptor (AR)-targeted therapy in earlier stages of
prostate cancer. Therefore, the goal of this study is to evaluate the efficacy and safety of
neoadjuvant therapy with ADT and abiraterone versus maximal androgen blockade using ADT,
abiraterone and apalutamide for patients with high-risk localized prostate cancer.
Trial Arms
Name | Type | Description | Interventions |
---|
ADT and Abiraterone | Experimental | Goserelin 10.8 mg, single dose, subcutaneously.
Abiraterone 1,000 mg, once daily, orally for 3 months.
Prednisone 5 mg, once daily, orally for 3 months. | - Goserelin
- Prednisone
- Abiraterone
|
ADT, Abiraterone and Apalutamide | Experimental | Goserelin 10.8 mg, single dose, subcutaneously.
Abiraterone 1,000 mg, once daily, orally for 3 months.
Prednisone 5 mg, once daily, orally for 3 months.
Apalutamide 240 mg, once daily, orally for 3 months. | - Goserelin
- Prednisone
- Abiraterone
- Apalutamide
|
Eligibility Criteria
Inclusion Criteria:
- Histologic confirmed prostatic adenocarcinoma
- Non-castrate levels of testosterone (> 150 ng/dL)
- High-risk localized prostate cancer, defined by either:
- Tumor stage T3 by digital rectal examination, or
- Primary tumor Gleason score ≥ 8, or
- PSA ≥ 20 ng/mL
- Willing to undergo prostatectomy as primary treatment for localized prostate cancer
- Adequate hematologic, renal and hepatic function:
- WBC > 3000/uL
- Platelets > 150,000/uL
- Creatinine < 2 mg/dL
- Bilirubin < 1.5 x upper limit of normal (ULN)
- AST/ALT < 2 x ULN
- Karnofsky Performance Status (KPS) ≥ 80%
- Able to swallow the study drugs whole as tablets
Exclusion Criteria:
- Pathological finding consistent with small cell, ductal or neuroendocrine carcinoma of
the prostate
- Current or prior hormonal therapy, radiation therapy or chemotherapy for prostate
cancer
- Evidence of metastatic disease (M1) on imaging studies
- Other prior malignancy less than or equal to 5 years prior to randomization with the
exception of squamous or basal cell skin carcinoma
- Abnormal cardiac function as manifested by NYHA (New York Heart Association) class III
or IV heart failure
- History of prior cardiac arrhythmia.
- Evidence of serious and/or unstable pre-existing medical, psychiatric or other
condition (including laboratory abnormalities) that could interfere with patient
safety or provision of informed consent to participate in this study.
Maximum Eligible Age: | 80 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Male |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Pathologic response |
Time Frame: | 3 months |
Safety Issue: | |
Description: | To compare the rate of pathologic complete response (pCR) or pathologic near complete response (pnCR), defined as less than 0,5 cm of residual tumor in the prostatectomy specimen after neoadjuvant therapy. |
Secondary Outcome Measures
Measure: | Residual cellularity rate |
Time Frame: | 3 months |
Safety Issue: | |
Description: | To compare the rate of residual cellularity ≤ 30% in the prostatectomy specimen after neoadjuvant therapy. |
Measure: | Pathologic downgrading |
Time Frame: | 3 months |
Safety Issue: | |
Description: | To compare the rate of pathologic downgrading to ≤ ypT2N0 in the prostatectomy specimen after neoadjuvant therapy. |
Measure: | PSA decline rate |
Time Frame: | 3 months |
Safety Issue: | |
Description: | To compare the rate of PSA decline ≥ 50% and 90% after 3 months of neoadjuvant therapy. |
Measure: | Rate of positive surgical margins |
Time Frame: | 3 months |
Safety Issue: | |
Description: | To compare the rate of positive surgical margins in the prostatectomy specimen after neoadjuvant therapy. |
Measure: | Rate of undetectable PSA |
Time Frame: | 12 months |
Safety Issue: | |
Description: | To compare the rate of patients with undetectable PSA 12 months after radical prostatectomy. |
Measure: | Rate of Grade ≥ 3 CTCAE adverse events |
Time Frame: | 3 months |
Safety Issue: | |
Description: | To compare the rate of CTCAE grade 3 or higher adverse events of the neoadjuvant therapy arms |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | Instituto do Cancer do Estado de São Paulo |
Trial Keywords
- Neoadjuvant therapy
- High-risk Prostate Cancer
Last Updated
May 17, 2021