Description:
The primary objective of the trial is to assess if GnRH antagonists in combination with
external beam radiation therapy improve progression free survival (progression that can be
biological, clinical, or death) compared to GnRH agonists in combination with external beam
radiation therapy.
Secondary objectives include:
- documentation of effect of GnRH antagonists on clinically significant cardiovascular
events in the subgroup of patients at high risk of such events at baseline;
- documentation of side effects and quality of life, I-PSS and urinary tract infections;
- assessment of relative treatment effect on secondary efficacy endpoints (clinical
progression, time to next line of systemic therapy, time on therapy, overall and cancer
specific survival) and on PSA at 6 months after end of RT.
Title
- Brief Title: Trial Comparing Irradiation Plus Long Term Adjuvant Androgen Deprivation With GnRH Antagonist Versus GnRH Agonist Plus Flare Protection in Patients With Very High Risk Localized or Locally Advanced Prostate Cancer
- Official Title: Phase IIIb Randomized Trial Comparing Irradiation Plus Long Term Adjuvant Androgen Deprivation With GnRH Antagonist Versus GnRH Agonist Plus Flare Protection in Patients With Very High Risk Localized or Locally Advanced Prostate Cancer. A Joint Study of the EORTC ROG and GUCG
Clinical Trial IDs
- ORG STUDY ID:
EORTC-1414
- NCT ID:
NCT02799706
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Degarelix | | GnRH antagonist + radiation therapy (RT) |
approved GnRH agonist | | GnRH agonist + radiation therapy (RT) |
Purpose
The primary objective of the trial is to assess if GnRH antagonists in combination with
external beam radiation therapy improve progression free survival (progression that can be
biological, clinical, or death) compared to GnRH agonists in combination with external beam
radiation therapy.
Secondary objectives include:
- documentation of effect of GnRH antagonists on clinically significant cardiovascular
events in the subgroup of patients at high risk of such events at baseline;
- documentation of side effects and quality of life, I-PSS and urinary tract infections;
- assessment of relative treatment effect on secondary efficacy endpoints (clinical
progression, time to next line of systemic therapy, time on therapy, overall and cancer
specific survival) and on PSA at 6 months after end of RT.
Detailed Description
Phase IIIb randomized stratified open-label comparative 2-arm superiority study with a
pre-set non-inferiority boundary.
Registered GnRH antagonists, degarelix, will be given at the dose of 240 mg given as two
subcutaneous injections of 120 mg at a concentration of 40 mg/mL on day 1, followed by 80 mg
given as one subcutaneous injection at a concentration of 20 mg/mL every 28 days (±2 days).
External beam radiotherapy (EBRT) to a total dose of 78-80 Gy, delivered as one daily
fraction, five days a week, started between d1 and months 6 of the androgen deprivation
therapy as per institution policy. The irradiation is the same as in the reference therapy
arm.
The minimum duration of androgen deprivation with GnRH agonist or antagonist therapy is 18
months.
For each patient, the duration of therapy must be elected upfront by the treating physician
among three possible options: 18, 24 or 36 months. The institution shall also declare upfront
the duration of the neoadjuvant treatment they intend to deliver to each patient (between 0
and 6 months).
The primary endpoint is progression-free survival defined as the time in days from
randomization to death, clinical or biochemical progression, whichever comes first.
Where
- PSA progression based on Phoenix definition, i.e. a rise by 2 ng/mL or more above the
nadir PSA (Ref. 17) confirmed by a second value measured minimum 3 months later
- Clinical progression is defined as onset of obstructive symptoms requiring local
treatment and demonstrated to be caused by cancer progression or evidence of metastases
detected by clinical symptoms and confirmed by imaging
- Start of another line of systemic therapy in absence of progression
- Death due to any cause
Secondary endpoints:
- Clinical progression-free survival
- Time to next systemic anticancer therapy (including secondary hormonal manipulation)
- Proportion of patients switching from GnRH antagonists to GnRH agonists and total
effective duration of treatment with the originally allocated drug.
- Overall survival
- Cancer specific survival
- PSA at six months after completion of RT Safety will be scored by the CTCAE version 4.0.
The major safety endpoints in this study are
- the incidence of clinical cardiovascular events - CCE (i.e. arterial embolic or
thrombotic events, hemorrhagic or ischemic cerebrovascular conditions, myocardial
infarction, and other ischemic heart disease) in patients who had cardiovascular events
before entering the trial and in those without such events.
- Incidence of urinary tract infection
Trial Arms
Name | Type | Description | Interventions |
---|
GnRH agonist + radiation therapy (RT) | Active Comparator | As the study investigates the effect of a drug given concomitantly to radiotherapy, all patients will be treated with the same treatment technique and target dose. The preferred treatment technique is intensity modulated radiotherapy (IMRT) + A GnRH-agonist will be given for the duration selected for each patient.
A non-steroidal anti-androgen (e. g. flutamide, bicalutamide) will be given orally one week before the first injection of the GnRH agonist and will be continued for no longer than 8 weeks to protect against flare.
Dose may vary due to availability of different brand names and pharmaceutical forms The start of antiandrogen must be registered as day 1 of treatment in the GnRH agonist arm. | |
GnRH antagonist + radiation therapy (RT) | Experimental | As the study investigates the effect of two drugs given concomitantly to radiotherapy, all patients will be treated with the same treatment technique and target dose. The preferred treatment technique is intensity modulated radiotherapy (IMRT) +a GnRH antagonist will be given for a predefined duration of 18, 24, or 36 months as per institution policy.
Each institution has to adhere to the chosen duration of treatment for all patients throughout the study | |
Eligibility Criteria
Inclusion Criteria:
- Histologically confirmed diagnosis of prostate adenocarcinoma
- PSA ≥ 10 ng/ml and two of the following 4 criteria:
- PSA ≥ 20 ng/ml,
- Gleason sum ≥ 8,
- cN1 (regional LN with a short axis length >10mm by CT scan or MRI) or pathologically
confirmed lymph nodes (pN1),
- cT3-T4 (by MRI or core biopsy) (i.e. If PSA≥ 20 ng/ml then only one of the other 3
risk factors is needed)
- M0 by standard imaging work-up (see chapter 6.1.1.1)
- Testosterone ≥ 200 ng/dl
- Adequate renal function: calculated creatinine clearance ≥ 50 mL/min (Appendix D)
Magnesium and potassium within normal limits of the institution or corrected to within
normal limits prior to the first dose of treatment.
- Patients with prolonged QT-intervals due to prescribed Class IA (quinidine,
procainamide) or Class III (amiodarone, sotalol) antiarrhythmic medication must be
carefully evaluated for GnRH-agonist or GnRH antagonist use, because these drugs may
prolong the QT-interval.
- WHO Performance status 0-1
- Age ≥ 18 and ≤ 80 years
- Participants who have partners of childbearing potential must use adequate birth
control measures, as defined by the investigator, during the study treatment period
and for at least 3 months after last dose of study treatment. A highly effective
method of birth control is defined as those which result in low failure rate (i.e.
less than 1% per year) when used consistently and correctly
- Before patient registration/randomization, written informed consent must be given
according to ICH/GCP, and national/local regulations.
Exclusion Criteria:
- Previous use of androgen deprivation therapy (ADT), antiandrogens. 5-alpha reductase
inhibitors are allowed if interrupted for more than 6 months prior to entering the
study
- History of severe untreated asthma, anaphylactic reactions or severe urticaria and/or
angioedema.
- Hypersensitivity towards the investigational drug
- The following biological parameters :AST, ALT, total bilirubin, prothrombin time,
serum albumin above upper level of normal range No severe hepatic impairment (Child
Pugh C)
- History of gastro-intestinal disorders (medical disorder or extensive surgery) that
may interfere with the absorption of the protocol treatment.
- History of pituitary or adrenal dysfunction
- Uncontrolled diabetes mellitus
- History of ulcerative colitis, Crohn's Disease, ataxia, telangiectasia, systemic lupus
erythematous, or Fanconi anemia.
- Clinically significant heart disease as evidence myocardial infarction, or arterial
thrombotic events in the past 6 months, severe or unstable angina, or New York Heart
Association (NYHA) class III or IV heart disease or cardiac ejection fraction
measurement of < 50 % at baseline
- Coronary revascularization (PCI or multivessel CABG), carotid artery or iliofemoral
artery revascularization (percutaneous or surgical procedure) within the last 30 days
prior to entering the trial
- Certain risk factors for abnormal heart rhythms/QT prolongation: torsade de pointes
ventricular arrhythmias (e.g, heart failure, hypokalemia, or a family history of a
long QT syndrome), a QT or corrected QT (QTc) interval >450 ms at baseline, or intake
of medications that prolong the QT/QTc interval
- Uncontrolled hypertension (systolic BP ≥ 160 mmHg or diastolic BP ≥ 95 mmHg); patients
with a history of hypertension are allowed provided blood pressure is controlled by
anti-hypertensive treatment.
- Prior history of malignancies other than prostate adenocarcinoma (except patients with
basal cell, squamous cell carcinoma of the skin), or the patient has been free of
malignancy for a period of 3 years prior to first dose of study drug(s). Prior history
of bladder cancer excludes the patient.
- Prior radical prostatectomy (TURP or suprapubic adenomectomy for benign prostatic
hyperplasia is allowed)
- Prior brachytherapy or other radiotherapy that would result in an overlap of
radiotherapy fields
- Any contraindication to external beam radiotherapy
- Patients with significantly altered mental status prohibiting the understanding of the
study or with psychological, familial, sociological or geographical condition
potentially hampering compliance with the study protocol and follow-up schedule or any
condition which, in the opinion of the investigator, would preclude participation in
this trial
Maximum Eligible Age: | 80 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Male |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Progression free survival |
Time Frame: | through study completion, an average of 1 year |
Safety Issue: | |
Description: | The primary endpoint is progression-free survival defined as the time in days from randomization to death, clinical or biochemical progression, whichever comes first.
Where
PSA progression based on Phoenix definition, i.e. a rise by 2 ng/mL or more above the nadir PSA (Ref. 17) confirmed by a second value measured minimum 3 months later
Clinical progression is defined as onset of obstructive symptoms requiring local treatment and demonstrated to be caused by cancer progression or evidence of metastases detected by clinical symptoms and confirmed by imaging
Start of another line of systemic therapy in absence of progression
Death due to any cause |
Secondary Outcome Measures
Measure: | Clinical progression-free survival |
Time Frame: | through study completion, an average of 1 year |
Safety Issue: | |
Description: | |
Measure: | Time to next systemic anticancer therapy (including secondary hormonal manipulation) |
Time Frame: | through study completion, an average of 1 year |
Safety Issue: | |
Description: | |
Measure: | ♦ Proportion of patients switching from GnRH antagonists to GnRH agonists |
Time Frame: | through study completion, an average of 1 year |
Safety Issue: | |
Description: | |
Measure: | ♦ Overall survival |
Time Frame: | through study completion, an average of 1 year |
Safety Issue: | |
Description: | |
Measure: | Incidence of clinical cardiovascular events |
Time Frame: | through study completion, an average of 1 year |
Safety Issue: | |
Description: | ♦ the incidence of clinical cardiovascular events - CCE (i.e. arterial embolic or thrombotic events, hemorrhagic or ischemic cerebrovascular conditions, myocardial infarction, and other ischemic heart disease) in patients who had cardiovascular events before entering the trial and in those without such events. |
Measure: | ♦ Incidence of urinary tract infection |
Time Frame: | through study completion, an average of 1 year |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 3 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | European Organisation for Research and Treatment of Cancer - EORTC |
Trial Keywords
- Prostate cancer
- GnRH antagonist
- GnRH agonist
- radiation therapy
- very high risk localized prostate cancer
- locally advanced prostate cancer
Last Updated
November 12, 2019