Description:
The purpose of this study is to determine if treatment with apalutamide plus androgen
deprivation therapy (ADT) before and after radical prostatectomy (RP) with pelvic lymph node
dissection (pLND) in participants with high-risk localized or locally advanced prostate
cancer results in an improvement in pathological complete response (pCR) rate and
metastasis-free survival (MFS) based on conventional imaging, as compared to placebo plus
ADT.
Title
- Brief Title: A Study of Apalutamide in Participants With High-Risk, Localized or Locally Advanced Prostate Cancer Who Are Candidates for Radical Prostatectomy
- Official Title: A Randomized, Double-blind, Placebo-controlled, Phase 3 Study of Apalutamide in Subjects With High-risk, Localized or Locally Advanced Prostate Cancer Who Are Candidates for Radical Prostatectomy
Clinical Trial IDs
- ORG STUDY ID:
CR108535
- SECONDARY ID:
56021927PCR3011
- SECONDARY ID:
2018-001746-34
- NCT ID:
NCT03767244
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Apalutamide | JNJ-56021927 | Apalutamide + ADT |
Androgen Deprivation Therapy (ADT) | | Apalutamide + ADT |
Placebo | | Placebo + ADT |
Purpose
The purpose of this study is to determine if treatment with apalutamide plus androgen
deprivation therapy (ADT) before and after radical prostatectomy (RP) with pelvic lymph node
dissection (pLND) in participants with high-risk localized or locally advanced prostate
cancer results in an improvement in pathological complete response (pCR) rate and
metastasis-free survival (MFS) based on conventional imaging, as compared to placebo plus
ADT.
Detailed Description
High-risk prostate cancer accounts for approximately 15 percent (%) of newly diagnosed
prostate cancers. A systemic therapy that eradicates micrometastatic disease is needed to
improve survival in high-risk participants undergoing RP with pLND. It is hypothesized that
androgen blockade prior to and after RP with pLND may improve outcomes for participants at
the highest risk for recurrence. This study is designed to evaluate if androgen blockade
administered prior to and after RP with pLND will increase the rate of pathological complete
response (pCR) and lead to better overall outcomes. ERLEADA (apalutamide, also known as
JNJ-56021927 and ARN-509) is an orally available, non-steroidal small molecule, which acts as
a potent and selective antagonist of the androgen receptor (AR), currently being developed
for the treatment of prostate cancer. The study includes screening phase (approximately up to
35 days before randomization), treatment phase (the planned Treatment Phase will include a
total of 12 treatment cycles of apalutamide or placebo; 6 cycles prior to RP with pLND (Cycle
1 through Cycle 6) and 6 cycles after RP with pLND (Cycle 7 through Cycle 12). Cycle 1 Day 1
will start within 3 days after randomization) and follow-up phase. The end of study (study
completion) is defined as last participant assessment at study site with approximate study
duration of 8 years. Participants will undergo efficacy, pharmacokinetics and biomarker
evaluations. The safety will be monitored throughout the study.
Trial Arms
Name | Type | Description | Interventions |
---|
Apalutamide + ADT | Experimental | Participants will receive androgen deprivation therapy (ADT) plus oral administration of apalutamide 240 milligram (mg) (4 tablets of 60 mg each) daily in each cycle (each cycle of 28 days). Participants will receive six cycles of treatment, followed by radical prostatectomy (RP) with pelvic lymph node dissection (pLND), followed by an additional six cycles of treatment. | - Apalutamide
- Androgen Deprivation Therapy (ADT)
|
Placebo + ADT | Experimental | Participants will receive ADT with oral administration of matching placebo treatment daily in each cycle (each cycle of 28 days). Participants will receive six cycles of placebo treatment, followed by RP with pLND, followed by an additional six cycles of placebo treatment. | - Androgen Deprivation Therapy (ADT)
- Placebo
|
Eligibility Criteria
Inclusion Criteria:
- Histologically confirmed adenocarcinoma of the prostate
- High-risk disease defined by a total Gleason Sum Score greater than equal to (>=) 4+3
(=Grade Groups [GG] 3 5) and >=1 of the following 4 criteria: a) Any combination of
Gleason Score 4+3 (= 3) and Gleason Score 8 (4+4 or 5+3) in >= 6 systematic cores
(with >=1 core Gleason Score 8 [4+4 or 5+3] included); b) Any combination of Gleason
Score 4+3 (=GG 3) and Gleason Score 8 (4+4 or 5+3) in >=3 systematic cores and
Prostate-specific antigen (PSA) >=20 ng/mL (with >= 1 core Gleason Score 8 [4+4 or
5+3] included); c) Gleason Score >=9 (=GG 5) in at least 1 systematic or targeted
core; d) At least 2 systematic or targeted cores with continuous Gleason Score >=8
(=GG 4), each with > 80 percent (%) involvement
- Candidate for radical prostatectomy with pelvic lymph node dissection as per the
investigator
- Eastern Cooperative Oncology Group (ECOG) Performance Status score of 0 or 1
- Contraceptive use by men and female partners of men enrolled in the study who are of
childbearing potential or are pregnant) should be consistent with local regulations
regarding the use of contraceptive methods for participants participating in clinical
studies
- Able to receive androgen deprivation therapy (ADT) for at least 13 months
Exclusion Criteria:
- Distant metastasis based on conventional imaging (clinical stage M1). Nodal disease
below the iliac bifurcation (clinical stage N1) is not an exclusion. Diagnosis of
distant metastasis (clinical M stage; M0 versus M1a, M1b, M1c) and pelvic nodal
disease (clinical N stage; N1 versus N0) will be assessed by central radiological
review. Participants are considered eligible only if the central radiological review
confirms clinical stage M0
- (a) Prior treatment with androgen receptor antagonists; (b) Treatment with
gonadotropin-releasing hormone analog (GnRHa) prior to informed consent form (ICF)
signature
- History of prior systemic or local therapy for prostate cancer, including pelvic
radiation for prostate cancer
- Use of any investigational agent less than or equals to (<=)4 weeks prior to
randomization or any therapeutic procedure for prostate cancer at any time
- Major surgery <=4 weeks prior to randomization
- Any of the following within 12 months prior to first dose of study drug: severe or
unstable angina, myocardial infarction, symptomatic congestive heart failure, arterial
or venous thromboembolic events (example, pulmonary embolism, cerebrovascular accident
including transient ischemic attacks), or clinically significant ventricular
arrhythmias or New York Heart Association Class II to IV heart disease; uncomplicated
deep vein thrombosis is not considered exclusionary
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Male |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Percentage of Participants with Pathologic complete response (pCR) |
Time Frame: | Approximately 4 years |
Safety Issue: | |
Description: | pCR is assessed by a pathology blinded independent central radiology review (BICR) as defined in the pathology charter. |
Secondary Outcome Measures
Measure: | Prostate Specific Antigen (PSA)-Free Survival |
Time Frame: | Approximately 4 years |
Safety Issue: | |
Description: | PSA-free survival with testosterone recovery defined as the time from randomization to the first detectable serum PSA level with recovered testosterone levels after undetectable PSA post-radical prostatectomy with pelvic lymph node dissection or death, whichever occurs first. |
Measure: | Progression-Free Survival (PFS) |
Time Frame: | Approximately 8 years |
Safety Issue: | |
Description: | PFS is defined as the time from randomization to first documentation of BICR confirmed radiographic progressive disease or death due to any cause (whichever occurs first) plus 1 day. Progressive disease will be determined based on Response Evaluation Criteria in Solid Tumors (RECIST) v.1.1. As per RECIST v1.1. Unequivocal local-regional progression/recurrence or the distant metastasis observed on CT or MRI scans or identified by biopsy will be considered progression. Local-regional progression/recurrence is defined as local tumor recurrence in the prostate bed or occurrence of at least one new regional lymph node. |
Measure: | Number of Participants with Adverse Events |
Time Frame: | Up to 30 days after last dose of study drug (Approximately 8 years) |
Safety Issue: | |
Description: | An adverse event is any untoward medical event that occurs in a participant administered an investigational product, and it does not necessarily indicate only events with clear causal relationship with the relevant investigational product. |
Measure: | Number of Participants with Laboratory Abnormalities as a Measure of Safety and Tolerability |
Time Frame: | Up to 30 days after last dose of study drug (Approximately 8 years) |
Safety Issue: | |
Description: | Blood samples for serum chemistry and hematology will be collected at predefined time points for clinical laboratory testing. |
Measure: | Number of Participants with Vital Signs Abnormalities as a Measure of Safety and Tolerability |
Time Frame: | Up to 30 days after last dose of study drug (Approximately 8 years) |
Safety Issue: | |
Description: | Number of participants with vital signs (including body temperature, heart rate, respiratory rate, and blood pressure) abnormalities will be reported. |
Measure: | Number of Participants with Physical Examinations Abnormalities as a Measure of Safety and Tolerability |
Time Frame: | Up to 30 days after last dose of study drug (Approximately 8 years) |
Safety Issue: | |
Description: | Number of participants with physical examinations (including general appearance of the subject, height, weight, and examination of the skin, ears, nose, throat, lungs, heart, abdomen, extremities, musculoskeletal system, lymphatic system, and nervous system) abnormalities will be reported. |
Measure: | Number of Participants with Treatment Compliance Rate |
Time Frame: | Up to 30 days after last dose of study drug (Approximately 8 years) |
Safety Issue: | |
Description: | Number of participants who are complaint with study treatment will be assessed. |
Details
Phase: | Phase 3 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Janssen Research & Development, LLC |
Last Updated
August 20, 2021