Clinical Trials /

A Study of Apalutamide in Participants With High-Risk, Localized or Locally Advanced Prostate Cancer Who Are Candidates for Radical Prostatectomy

NCT03767244

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.

Related Conditions:
  • Prostate Adenocarcinoma
Recruiting Status:

Recruiting

Phase:

Phase 3

Trial Eligibility

Document

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

  • Prostatic Neoplasms

Interventions

DrugSynonymsArms
ApalutamideJNJ-56021927Apalutamide + ADT
Androgen Deprivation Therapy (ADT)Apalutamide + ADT
PlaceboPlacebo + 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

NameTypeDescriptionInterventions
Apalutamide + ADTExperimentalParticipants 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 + ADTExperimentalParticipants 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