Description:
The purpose of this study is to determine the efficacy and safety of relugolix 120 milligrams
(mg) orally once daily for 48 weeks on maintaining serum testosterone suppression to castrate
levels (< 50 nanograms/deciliter [ng/dL]) in participants with androgen-sensitive advanced
prostate cancer.
Title
- Brief Title: A Study to Evaluate the Safety and Efficacy of Relugolix in Men With Advanced Prostate Cancer
- Official Title: HERO: A Multinational Phase 3 Randomized, Open-label, Parallel Group Study to Evaluate the Safety and Efficacy of Relugolix in Men With Advanced Prostate Cancer
Clinical Trial IDs
- ORG STUDY ID:
MVT-601-3201
- SECONDARY ID:
2017-000160-15
- NCT ID:
NCT03085095
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Relugolix | TAK-385, MVT-601, RVT-601, T-1331285 | Relugolix |
Leuprolide Acetate | Leuprolide | Leuprolide Acetate |
Purpose
The purpose of this study is to determine the efficacy and safety of relugolix 120 milligrams
(mg) orally once daily for 48 weeks on maintaining serum testosterone suppression to castrate
levels (< 50 nanograms/deciliter [ng/dL]) in participants with androgen-sensitive advanced
prostate cancer.
Detailed Description
This is a phase 3, multinational, randomized, open-label, parallel group study to evaluate
the efficacy and safety of oral daily relugolix 120 mg in participants with
androgen-sensitive advanced prostate cancer who require at least 1 year of continuous
androgen-deprivation therapy. Relugolix 120 mg orally once daily or leuprolide acetate depot
suspension, 22.5 mg (or 11.25 mg in Japan and Taiwan based on local labels), every 3 months
by subcutaneous injection will be administered to participants.
There are 2 analyses for this study, a primary analysis and a final analysis.
Primary Analysis:
The primary analysis of efficacy and safety has been completed (N=934). Participants were
randomized 2:1 to receive relugolix or leuprolide for 48 weeks, followed by a 30-day safety
follow-up visit or early termination 30-day safety follow-up.
Final Analysis:
The final analysis will occur after additional participants with metastatic disease
(approximately 130) have been enrolled and randomized from any sites to the study, and have
completed the 48-week treatment period. A cohort of participants enrolled in China and Taiwan
will be analyzed separately once they have completed treatment to support registration in
China.
Eligible participants were randomized 2:1 to relugolix or leuprolide arm and will attend
visits monthly (every 4 weeks) where serum testosterone and prostate-specific antigen will be
assessed. Safety will be assessed throughout the study by monitoring adverse events, vital
signs, physical examinations, clinical laboratory tests, and 12-lead electrocardiograms.
Castration resistance-free survival will be assessed up to Week 49, Day 1 of the study and
reported as part of the final analysis.
The study enrolled 1134 participants, including 139 participants with metastatic advanced
prostate cancer to support the analysis of the secondary endpoint of castration
resistance-free survival and 93 Chinese participants (enrolled in China and Taiwan) to
support registration in China.
Trial Arms
Name | Type | Description | Interventions |
---|
Relugolix | Experimental | Relugolix for 48 weeks | |
Leuprolide Acetate | Active Comparator | Leuprolide acetate for 48 weeks | |
Eligibility Criteria
Key Inclusion Criteria:
1. Has histologically or cytologically confirmed diagnosis of adenocarcinoma of the
prostate.
2. Is a candidate for, in the opinion of the investigator, at least 1 year of continuous
androgen deprivation therapy for the management of androgen-sensitive advanced
prostate cancer with 1 of the following clinical disease state presentations:
1. Evidence of biochemical (PSA) or clinical relapse following local primary
intervention with curative intent, such as surgery, radiation therapy,
cryotherapy, or high-frequency ultrasound and not a candidate for salvage
treatment by surgery; or
2. Newly diagnosed androgen-sensitive metastatic disease; or
3. Advanced localized disease unlikely to be cured by local primary intervention
with either surgery or radiation with curative intent.
3. Has a serum testosterone at the Screening visit of ≥ 150 ng/dL (5.2 nanomoles
[nmol]/liter [L]).
4. Has a serum PSA concentration at the Screening visit of > 2.0 ng/milliliter (mL) (2.0
microgram [μg]/L), or, when applicable, post radical prostatectomy of > 0.2 ng/mL (0.2
μg/L) or post radiotherapy, cryotherapy, or high frequency ultrasound > 2.0 ng/mL (2.0
μg/L) above the post interventional nadir.
5. Has an Eastern Cooperative Oncology Group performance status of 0 or 1 at initial
screening and at baseline.
Key Exclusion Criteria:
1. In the investigator's opinion, is likely to require chemotherapy or surgical therapy
for symptomatic disease management within 2 months of initiating androgen deprivation
therapy.
2. Previously received gonadotropin-releasing hormone analog or other form of androgen
deprivation therapy (estrogen or antiandrogen) for > 18 months total duration. If
androgen deprivation therapy was received for ≤ 18 months total duration, then that
therapy must have been completed at least 3 months prior to baseline. If the dosing
interval of the depot is longer than 3 months, then the prior androgen deprivation
therapy must have been completed at least as long as the dosing interval of the depot.
3. Previous systemic cytotoxic treatment for prostate cancer (for example, taxane-based
regimen).
4. Metastases to brain per prior clinical evaluation.
5. Participants with myocardial infarction, unstable symptomatic ischemic heart disease,
cerebrovascular events, or any significant cardiac condition within the prior 6
months.
6. Active conduction system abnormalities.
7. Uncontrolled hypertension.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Male |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Sustained Castration Rate |
Time Frame: | From Week 5 Day 1 (Day 29) to Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | Sustained castration rate defined as the cumulative probability of testosterone suppression to < 50 nanogram (ng)/deciliter (dL). The rate was estimated for each treatment group using the Kaplan-Meier method and reported as percentage of participants.
The lower bound of the 95% confidence interval (CI) for the cumulative probability of sustained testosterone suppression in the relugolix treatment group must have been ≥ 90% to meet evaluation criteria for efficacy. |
Secondary Outcome Measures
Measure: | Castration Rate At Week 1 Day 4 |
Time Frame: | Week 1 Day 4 (Day 4) |
Safety Issue: | |
Description: | Castration rate was defined as the cumulative probability of testosterone suppression to < 50 ng/dL. The rate was estimated for each treatment group using the Kaplan-Meier method and reported as percentage of participants. |
Measure: | Castration Rate At Week 3 Day 1 |
Time Frame: | Week 3 Day 1 (Day 15) |
Safety Issue: | |
Description: | Castration rate was defined as the cumulative probability of testosterone suppression to < 50 ng/dL. The rate was estimated for each treatment group using the Kaplan-Meier method and reported as percentage of participants. |
Measure: | Confirmed Prostate-specific Antigen (PSA) Response Rate |
Time Frame: | Week 3 Day 1 (Day 15) and Week 5 Day 1 (Day 29) |
Safety Issue: | |
Description: | Confirmed PSA response defined as > 50% reduction in PSA from baseline at Week 3 Day 1 followed with confirmation at Week 5 Day 1. |
Measure: | Profound Castration Rate At Week 3 Day 1 (Day 15) |
Time Frame: | Week 3 Day 1 (Day 15) |
Safety Issue: | |
Description: | Castration rate defined as the cumulative probability of testosterone suppression to < 20 ng/dL. The rate was estimated for each treatment group using the Kaplan-Meier method and reported as percentage of participants. |
Measure: | Follicle-stimulating Hormone (FSH) Level |
Time Frame: | Week 25 Day 1 (Day 169) |
Safety Issue: | |
Description: | To evaluate the effect of relugolix and leuprolide acetate on FSH suppression. |
Measure: | PSA Response Rate At Week 3 Day 1 |
Time Frame: | Week 3 Day 1 (Day 15) |
Safety Issue: | |
Description: | PSA response defined as > 50% reduction in PSA from baseline. The rate was estimated for each treatment group using the Kaplan-Meier method and reported as percentage of participants. |
Measure: | PSA Response Rate At Week 5 Day 1 |
Time Frame: | Week 5 Day 1 (Day 29) |
Safety Issue: | |
Description: | PSA response defined as > 50% reduction in PSA from baseline. The rate was estimated for each treatment group using the Kaplan-Meier method and reported as percentage of participants. |
Measure: | Testosterone Recovery Rate |
Time Frame: | Day 90 follow-up |
Safety Issue: | |
Description: | The cumulative probability of testosterone recovery back to > 280 ng/dL (lower limit of the normal range), back to ≥ 50 ng/dL (definition of castration), and back to > 280 ng/dL or baseline at 90 days after drug discontinuation was assessed. The rate was estimated for each treatment group using the Kaplan-Meier method and reported as percentage of participants. |
Measure: | Sustained Profound Castration Rate From Week 5 Day 1 Through Week 49 Day 1 |
Time Frame: | Week 5 Day 1 (Day 29) through Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | Sustained profound castration rate was defined as the cumulative probability of testosterone suppression to < 20 ng/dL. The rate was estimated by the Kaplan-Meier method and reported as percentage of participants. |
Measure: | Profound Castration Rate At Week 1 Day 4 (Day 4) |
Time Frame: | At Week 1 Day 4 (Day 4) |
Safety Issue: | |
Description: | Castration rate defined as the cumulative probability of testosterone suppression to < 20 ng/dL. The rate was estimated for each treatment group using the Kaplan-Meier method and reported as percentage of participants. |
Measure: | Sustained Profound Castration Rate From Week 25 Day 1 Through Week 49 Day 1 |
Time Frame: | Week 25 Day 1 (Day 169) through Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | Sustained profound castration rate was defined as the cumulative probability of testosterone suppression to < 20 ng/dL. The rate was estimated by the Kaplan-Meier method and reported as percentage of participants. |
Measure: | Undetectable PSA Rate |
Time Frame: | Week 25 Day 1 (Day 169) |
Safety Issue: | |
Description: | Defined as the proportion of participants with PSA concentration < 0.02 ng/milliliter (mL).The rate was estimated by the Kaplan-Meier method and reported as percentage of participants. |
Measure: | Rate Of PSA Progression-free Survival |
Time Frame: | Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | PSA progression was defined as the first increase in PSA of 25% or greater and 2 ng/mL or greater above the nadir with confirmation by a second consecutive PSA measurement at least 3 weeks later. For participants without declining PSA from baseline, a PSA increase of ≥ 25% and ≥ 2 ng/mL from baseline beyond 12 weeks was considered PSA progression. The rate of progression-free survival was estimated using the Kaplan-Meier method and reported as percentage of participants. |
Measure: | Change From Baseline In Quality Of Life (QoL) Total Score As Assessed By The Global Health Domain Of The European Organisation Of Research And Treatment Of Cancer (EORTC)-Quality Of Life Questionnaire (QLQ)-C30 |
Time Frame: | Baseline, Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | The EORTC QLQ-C30 core measurement was used to capture distal outcomes, including physical, social functioning, and overall health-related quality of life. The questionnaire incorporates 30 questions comprising nine multi-item scales: 5 functional scales (physical, role, cognitive, emotional, and social); 3 symptom scales (fatigue, pain, and nausea and vomiting); and a global health and quality of life scale. All raw domain scores are linearly transformed to a 0-100 scale. The global health and quality of life domain is presented. An increase in activity or functioning scores indicates improvement (higher/healthier level of functioning) and a decrease in symptom scores indicates improvement (lower level of symptoms/problems). |
Measure: | Change From Baseline In QoL Total Score For Remaining Domain Scores As Assessed By The EORTC-QLQ-C30 |
Time Frame: | Baseline, Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | The EORTC QLQ-C30 core measurement was used to capture distal outcomes, including physical, social functioning, and overall health-related quality of life. The questionnaire incorporates 30 questions comprising nine multi-item scales: 5 functional scales (physical, role, cognitive, emotional, and social); 3 symptom scales (fatigue, pain, and nausea and vomiting); and a global health and quality of life scale. All raw domain scores are linearly transformed to a 0-100 scale. All domains except for the global health and quality are presented. An increase in activity or functioning scores indicates improvement (higher/healthier level of functioning) and a decrease in symptom scores indicates improvement (lower level of symptoms/problems). |
Measure: | Change From Baseline In QoL Total Score As Assessed By The EORTC-QLQ-PR25 Sexual Activity And Functioning And Hormonal-Treatment-Related Symptom Subdomains |
Time Frame: | Baseline, Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | Subscales for assessment of hormonal treatment-related symptoms (6 items) and sexual activity and function (6 items) from the EORTC-QLQ-PR25 25-item prostate cancer module of the EORTC are presented. Questions used 4 point scale (1 'Not at all' to 4 'Very much'). All raw domain scores are linearly transformed to a 0-100 scale. An increase in activity or functioning scores indicates improvement (higher/healthier level of functioning) and a decrease in symptom scores indicates improvement (lower level of symptoms/problems). |
Measure: | Change From Baseline In QoL Total Score For Urinary And Bowel Symptoms Domains As Assessed By The EORTC-QLQ-PR25 |
Time Frame: | Baseline, Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | Subscale assessments of urinary symptoms (9 items) and bowel symptoms (4 items) from the EORTC-QLQ-PR25 25-item prostate cancer module of the EORTC are presented. Questions used 4 point scale (1 'Not at all' to 4 'Very much'). All raw domain scores are linearly transformed to a 0-100 scale. A decrease in symptom scores indicates improvement (lower level of symptoms/problems). |
Measure: | Change From Baseline In QoL Total Score As Assessed By The European Quality Of Life 5-Dimension 5-Level Questionnaire (EuroQoL EQ-5D-5L) |
Time Frame: | Baseline, Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | The EuroQoL EQ-5D-5L comprises 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Each dimension has 5 levels: no problems (1 as numerical score), slight problems (2 as numerical score), moderate problems (3 as numerical score), severe problems (4 as numerical score), and extreme problems (5 as numerical score). The total score ranges from 0 to 100. A decrease in score indicates improvement. |
Measure: | Percent Change From Baseline In Serum Concentrations Of Luteinizing Hormone |
Time Frame: | Week 1 Day 4 (Day 4), Week 5 Day 1 (Day 29), Week 25 Day 1 (Day 169), and Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | Blood samples were collected from participants for hormonal measurements. |
Measure: | Percent Change From Baseline In Serum Concentrations Of FSH |
Time Frame: | Week 1 Day 4 (Day 4), Week 5 Day 1 (Day 29), Week 25 Day 1 (Day 169), and Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | Blood samples were collected from participants for hormonal measurements. |
Measure: | Percent Change From Baseline In Serum Concentrations Of Dihydrotestosterone |
Time Frame: | Week 5 Day 1 (Day 29), Week 25 Day 1 (Day 169), and Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | Blood samples were collected from participants for hormonal measurements. |
Measure: | Percent Change From Baseline In Serum Concentrations Of Sex Hormone-Binding Globulin |
Time Frame: | Week 5 Day 1 (Day 29), Week 25 Day 1 (Day 169), and Week 49 Day 1 (Day 337) |
Safety Issue: | |
Description: | Blood samples were collected from participants for hormonal measurements. |
Measure: | Maximum Observed Plasma Concentration (Cmax) Of Relugolix |
Time Frame: | Predose and 0.5, 1, 2, 4, 6, 8, 12, and 24 hours postdose on Day 1 and Week 2 |
Safety Issue: | |
Description: | The Cmax of relugolix was determined for single and repeat doses in subsets of participants from Japan. Single dose pharmacokinetics (PK) was assessed on Day 1 following an initial 360 mg dose of relugolix. Repeat dose PK was assessed following repeat dosing of relugolix 120 mg once daily for 2 weeks. |
Measure: | Area Under The Concentration-Time Curve (AUC0-τ) Of Relugolix |
Time Frame: | Predose and 0.5, 1, 2, 4, 6, 8, 12, and 24 hours postdose on Day 1 and Week 2 |
Safety Issue: | |
Description: | The AUC0-τ of relugolix was determined for single and repeat doses in subsets of participants from Japan. Single dose PK was assessed on Day 1 following an initial 360 mg dose of relugolix. Repeat dose PK was assessed following repeat dosing of relugolix 120 mg once daily for 2 weeks. |
Measure: | Time To Maximum Observed Plasma Concentration (Tmax) Of Relugolix |
Time Frame: | Predose and 0.5, 1, 2, 4, 6, 8, 12, and 24 hours postdose on Day 1 and Week 2 |
Safety Issue: | |
Description: | The Tmax of relugolix was determined for single and repeat doses in subsets of participants from Japan. Single dose PK was assessed on Day 1 following an initial 360 mg dose of relugolix. Repeat dose PK was assessed following repeat dosing of relugolix 120 mg once daily for 2 weeks. |
Details
Phase: | Phase 3 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | Myovant Sciences GmbH |
Last Updated
August 26, 2021