Androgen Deprivation Therapy and High Dose Radiotherapy With or Without Whole-Pelvic Radiotherapy in Unfavorable Intermediate or Favorable High Risk Prostate Cancer: A Phase III Randomized Trial
OBJECTIVES:
Primary
- Demonstrate that prophylactic, neoadjuvant, androgen-deprivation therapy (NADT) and
whole-pelvic radiation therapy (WPRT) will result in improvement in overall survival
(OS) of patients with "unfavorable" intermediate-risk or "favorable" high-risk prostate
cancer compared to NADT and high-dose prostate (P) and seminal vesicle (SV) radiation
therapy (RT) using intensity-modulated RT (IMRT) or external-beam RT (EBRT) with a
high-dose rate (HDR) or a permanent prostate (radioactive seed) implant (PPI) boost.
Secondary
- Demonstrate that prophylactic WPRT improves biochemical control.
- Determine the distant metastasis (DM)-free survival.
- Determine the cause-specific survival (CSS).
- Compare acute and late treatment-adverse events between patients receiving NADT and
WPRT versus NADT, P, and SV RT.
- Determine whether health-related quality of life (HRQOL), as measured by the Expanded
Prostate Cancer Index Composite (EPIC), significantly worsens with increasing
aggressiveness of treatment (i.e., Arm 2, NADT + WPRT).
- Determine whether more aggressive treatment (Arm 2, NADT + WPRT) is associated with a
greater increase in fatigue (PROMIS Fatigue Short Form) from baseline to last week of
treatment, and a greater increase in circulating inflammatory markers (IL-1, IL-1ra,
IL-6, TNF-alpha, and C-reactive protein).
- Demonstrate an incremental gain in OS and CSS with more aggressive therapy that
outweighs any detriments in the primary generic domains of HRQOL (i.e., mobility,
self-care, usual activities, pain/discomfort, and anxiety/depression).
- Determine whether changes in fatigue from baseline to the next three time points (week
prior to RT, last week of treatment, and 3 months after treatment) are associated with
changes in circulating cytokines, mood, sleep, and daily activities across the same
time points.
- Collect paraffin-embedded tissue blocks, plasma, whole blood, and urine for planned and
future translational research analyses.
OUTLINE: This is a multicenter study. Patients are stratified according to moderate- to
high-risk groups as listed in the Disease Characteristics of this abstract, type of
radiotherapy boost (IMRT vs brachytherapy [LDR using PPI or HDR]), and duration of
androgen-deprivation therapy (short-term [6 months] vs long-term [32 months]). Patients are
randomized to 1 of 2 treatment arms.
All patients receive neoadjuvant androgen-deprivation therapy comprising bicalutamide orally
(PO) once daily or flutamide PO thrice daily for 6 months, and luteinizing hormone-releasing
hormone (LHRH) agonist/antagonist therapy comprising leuprolide acetate, goserelin acetate,
buserelin, triptorelin, or degarelix subcutaneously (SC) or intramuscularly (IM) every 1 to
3 months beginning 2 months prior to radiotherapy and continuing for 6 or 32 months.
Radiotherapy begins within 8 weeks after beginning LHRH agonist/antagonist injection.
- Arm I: Patients undergo high-dose radiotherapy of the prostate and seminal vesicles
using intensity-modulated radiotherapy (IMRT)* or 3D-conformal radiation therapy
(3D-CRT)* once daily, 5 days a week, for approximately 9 weeks. Patients may also
undergo permanent prostate implant (PPI) brachytherapy or high-dose rate brachytherapy
(iodine I 125 or palladium Pd 103 may be used as the radioisotope).
- Arm II: Patients undergo whole-pelvic radiotherapy (WPRT)* (3D-CRT or IMRT) once daily,
5 days a week, for approximately 9 weeks. Patients may also undergo brachytherapy as in
arm I.
NOTE: * Patients undergoing brachytherapy implant receive 5 weeks of IMRT, 3D-CRT, or WPRT.
Patients may undergo blood and urine sample collection for correlative studies. Primary
tumor tissue samples may also be collected.
Patients may complete the Expanded Prostate Cancer Index Composite (EPIC), the
PROMIS-Fatigue Short Form, and the EuroQol (EQ-5D) quality-of-life (QOL) questionnaires at
baseline and periodically during treatment. Patients who participate in the QOL portion of
the study must also agree to periodic blood collection.
After completion of study therapy, patients are followed up every 3 months for 1 year, every
6 months for 3 years, and then yearly thereafter.
Interventional
Allocation: Randomized, Masking: Open Label, Primary Purpose: Treatment
Overall survival of patients treated with NADT and RT vs NADT and WPRT
No
Mack Roach, MD
Principal Investigator
University of California, San Francisco
Unspecified
CDR0000701128
NCT01368588
July 2011
Name | Location |
---|---|
CCOP - Christiana Care Health Services | Wilmington, Delaware 19899 |
CCOP - MeritCare Hospital | Fargo, North Dakota 58122 |
Case Comprehensive Cancer Center | Cleveland, Ohio 44106-5065 |
Medical College of Wisconsin Cancer Center | Milwaukee, Wisconsin 53226 |
Veterans Affairs Medical Center - Long Beach | Long Beach, California 90822 |
Northwest Community Hospital | Arlington Heights, Illinois 60005 |
Cape Cod Hospital | Hyannis, Massachusetts 02601 |
New York Methodist Hospital | Brooklyn, New York 11215-3609 |
CCOP - Greenville | Greenville, South Carolina 29615 |
University of Texas Medical Branch | Galveston, Texas 77555-1329 |
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center | Lebanon, New Hampshire 03756-0002 |
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill | Chapel Hill, North Carolina 27599-7570 |
CCOP - Virginia Mason Research Center | Seattle, Washington 98101 |
Utah Valley Regional Medical Center - Provo | Provo, Utah 84604 |
Vince Lombardi Cancer Clinic at Aurora St. Luke's Medical Center | Milwaukee, Wisconsin 53201-2901 |
University of California Davis Cancer Center | Sacramento, California 95817 |
Kansas Masonic Cancer Research Institute at the University of Kansas Medical Center | Kansas City, Kansas 66160-7353 |
Josephine Ford Cancer Center at Henry Ford Hospital | Detroit, Michigan 48202 |
Hulston Cancer Center at Cox Medical Center South | Springfield, Missouri 65807 |
McDowell Cancer Center at Akron General Medical Center | Akron, Ohio 44307 |
Lake/University Ireland Cancer Center | Mentor, Ohio 44060 |
Long Island Jewish Medical Center | New Hyde Park, New York 11040 |
Winship Cancer Institute of Emory University | Atlanta, Georgia 30322 |
Wake Forest University Comprehensive Cancer Center | Winston-Salem, North Carolina 27157-1096 |
St. Vincent Hospital Regional Cancer Center | Green Bay, Wisconsin 54307-3508 |
St. Mary's Hospital Medical Center - Green Bay | Green Bay, Wisconsin 54303 |
Bay Area Cancer Care Center at Bay Area Medical Center | Marinette, Wisconsin 54143 |
McKee Medical Center | Loveland, Colorado 80539 |
Baptist Cancer Institute - Jacksonville | Jacksonville, Florida 32207 |
Adena Regional Medical Center | Chillicothe, Ohio 54601 |
Utah Cancer Specialists at UCS Cancer Center | Salt Lake City, Utah 84106 |
Greenebaum Cancer Center at University of Maryland Medical Center | Baltimore, Maryland 21201 |
Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center | Los Angeles, California 90048-1865 |
UCSF Helen Diller Family Comprehensive Cancer Center | San Francisco, California 94115 |
Lucille P. Markey Cancer Center at University of Kentucky | Lexington, Kentucky 40536-0093 |
Tulane Cancer Center Office of Clinical Research | Alexandria, Louisiana 71315-3198 |
Butterworth Hospital at Spectrum Health | Grand Rapids, Michigan 49503-2560 |
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis | St. Louis, Missouri 63110 |
Oklahoma University Cancer Institute | Oklahoma City, Oklahoma 73104 |
Gundersen Lutheran Center for Cancer and Blood | La Crosse, Wisconsin 54601 |
Rosenfeld Cancer Center at Abington Memorial Hospital | Abington, Pennsylvania 19001 |
Fox Chase Cancer Center - Philadelphia | Philadelphia, Pennsylvania 19111-2497 |
Kaiser Permanente Medical Center - Roseville | Roseville, California 95661 |
Kaiser Permanente Medical Center - South San Francisco | South San Francisco, California 94080 |
Ella Milbank Foshay Cancer Center at Jupiter Medical Center | Jupiter, Florida 33458 |
Piedmont Hospital | Atlanta, Georgia 30309 |
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center | Boise, Idaho 83706 |
Mary Bird Perkins Cancer Center - Baton Rouge | Baton Rouge, Louisiana 70809 |
Hickman Cancer Center at Bixby Medical Center | Adrian, Michigan 49221 |
Forsyth Regional Cancer Center at Forsyth Medical Center | Winston-Salem, North Carolina 27103 |
Providence Cancer Center at Providence Portland Medical Center | Portland, Oregon 97213-2967 |
Providence St. Vincent Medical Center | Portland, Oregon 97225 |
Dixie Regional Medical Center - East Campus | Saint George, Utah 84770 |
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital | Yakima, Washington 98902 |
Regional Cancer Center at Singing River Hospital | Pascagoula, Mississippi 39581 |
Cancer Treatment Center | Wooster, Ohio 44691 |
West Allis Memorial Hospital | West Allis, Wisconsin 53227 |
John B. Amos Cancer Center | Columbus, Georgia 31904 |
McFarland Clinic, PC | Ames, Iowa 50010 |
Cotton-O'Neil Cancer Center | Topeka, Kansas 66606 |
St. Mary Mercy Hospital | Livonia, Michigan 48154 |
Seton Cancer Institute at Saint Mary's - Saginaw | Saginaw, Michigan 48601 |
Frederick R. and Betty M. Smith Cancer Treatment Center | Sparta, New Jersey 07871 |
Summa Center for Cancer Care at Akron City Hospital | Akron, Ohio 44309-2090 |
Barberton Citizens Hospital | Barberton, Ohio 44203 |
Flower Hospital Cancer Center | Sylvania, Ohio 43560 |
St. Anne Mercy Hospital | Toledo, Ohio 43623 |
Penn State Hershey Cancer Institute at Milton S. Hershey Medical Center | Hershey, Pennsylvania 17033-0850 |
McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center | Reading, Pennsylvania 19612-6052 |
York Cancer Center at Apple Hill Medical Center | York, Pennsylvania 17405 |
Jon and Karen Huntsman Cancer Center at Intermountain Medical Center | Murray, Utah 84157 |
Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center | Green Bay, Wisconsin 54311 |
Vince Lombardi Cancer Clinic - Sheboygan | Sheboygan, Wisconsin 53081 |
Aurora Medical Center | Summit, Wisconsin 53066 |
FirstHealth Moore Regional Community Hospital Comprehensive Cancer Center | Pinehurst, North Carolina 28374 |
St. Vincent's Medical Center | Bridgeport, Connecticut 06606 |
Queen's Cancer Institute at Queen's Medical Center | Honolulu, Hawaii 96813 |
Lowell General Hospital | Lowell, Massachusetts 01854 |
Dubs Cancer Center at Rogue Valley Medical Center | Medford, Oregon 97504 |
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center | Spartanburg, South Carolina 29303 |
Theda Care Cancer Institute | Appleton, Wisconsin 54911 |
Duke Cancer Institute | Durham, North Carolina 27710 |
Cancer Institute at St. John's Hospital | Springfield, Illinois 62701 |
Sentara Cancer Institute at Sentara Norfolk General Hospital | Norfolk, Virginia 23507 |
Providence Cancer Center | Anchorage, Alaska 99508 |
Lacks Cancer Center at Saint Mary's Health Care | Grand Rapids, Michigan 49503 |
Baptist Medical Center South | Jascksonville, Florida 32258 |
Florida Cancer Center - Palatka | Palatka, Florida 32177 |
Memorial Medical Center | Modesto, California 95355 |
United States Air Force Medical Center - Wright-Patterson | Wright-Patterson AFB, Ohio 45433-5529 |
Franciscan Skemp Healthcare - La Crosse Campus | La Crosse, Wisconsin 54601 |
Fountain Valley, California 92708 | |
Cancer Care Center, Incorporated | Salem, Ohio 44460 |
Providence Cancer Center at PMCC | Medford, Oregon 97504 |
Veterans Affairs Medical Center - Milwaukee | Milwaukee, Wisconsin 53295 |
Albert Lea Cancer Center at Albert Lea Medical Center | Albert Lea, Minnesota 56007 |
Central Maryland Oncology Center | Columbia, Maryland 21044 |
Hudner Oncology Center at Saint Anne's Hospital - Fall River | Fall River, Massachusetts 02721 |
Immanuel St. Joseph's | Mankato, Minnesota 56002 |
Luther Midlelfort Hospital | Eau Claire, Wisconsin 54702 |
Columbia Saint Mary's Hospital - Ozaukee | Mequon, Wisconsin 53097 |
Columbia-Saint Mary's Cancer Care Center | Milwaukee, Wisconsin 53211 |
Emory Crawford Long Hospital | Atlanta, Georgia 30308 |
Santa Clara Valley Medical Center | San Jose, California 95128 |
Kaiser Permanente - Division of Research - Oakland | Oakland, California 94611 |
Kaiser Permanente Medical Center - Rancho Cordova | Rancho Cordova, California 95670 |
Rohnert Park Cancer Center | Rohnert Park, California 94928 |
South Sacramento Cancer Center | Sacramento, California 95823 |
St. Agnes Hospital Cancer Center | Baltimore, Maryland 21229 |
Siteman Cancer Center at Barnes-Jewish St. Peters Hospital - St. Peters | Saint Peters, Missouri 63376 |
Renown Institute for Cancer at Renown Regional Medical Center | Reno, Nevada 89502 |
Coleman Radiation Oncology Center at Carter General Hospital | Morehead City, North Carolina 28557 |
South Atlantic Radiation Oncology, LLC | Supply, North Carolina 28462 |
Coastal Carolina Radiation Oncology Center | Wilmington, North Carolina 28401 |
Norris Cotton Cancer Center - North | Saint Johnsbury, Vermont 05819 |
Southwest General Health Center | Middleburgh Heights, Ohio 44130 |
UHHS Chagrin Highlands Medical Center | Orange Villager, Ohio 44122 |
UHHS Westlake Medical Center | Westlaker, Ohio 44145 |
Kansas City Cancer Centers - Southwest | Overland Park, Kansas 66210 |
Clackamas Radiation Oncology Center | Clackamas, Oregon 97015 |
North Broward Medical Center | Dearfield Beach, Florida 33064-3596 |
Arizona Center for Cancer Care - Peoria | Peoria, Arizona 85381 |
Radiation Oncology Associates Southwest | Fort Wayne, Indiana 46804 |
Kansas City Cancer Centers - North | Kansas City, Missouri 64154 |
Upper Delaware Valley Cancer Center | Milford, Pennsylvania 18337 |
Rocky Mountain Cancer Centers - Aurora | Aurora, Colorado 80012 |
Kansas City Cancer Centers - South | Kansas City, Missouri 64131 |
Door County Cancer Center at Door County Memorial Hospital | Sturgeon Bay, Wisconsin 54235-1495 |
Kansas City Cancer Centers - East | Lee's Summit, Missouri 64064 |
Adams Cancer Center | Gettysburg, Pennsylvania 17325 |
Cherry Tree Cancer Center | Hanover, Pennsylvania 17331 |
Tate Cancer Center at Baltimore Washington Medical Center | Glen Burnie, Maryland 21061 |
Saint Agnes Cancer Center at Saint Agnes Medical Center | Fresno, California 93720 |
Coastal Cancer Center at Sentara Virginia Beach General Hospital | Virginia Beach, Virginia 23454 |
21st Century Oncology - Plantation | Plantation, Florida 33324 |
Zangmeister Center | Columbus, Ohio 43219 |
RMH Regional Cancer Center at Rockingham Memorial Hospital | Harrisonburg, Virginia 22801 |