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Phase III Trial of Dose Escalated Radiation Therapy and Standard Androgen Deprivation Therapy (ADT) With a GNRH Agonist vs. Dose Escalated Radiation Therapy and Enhanced ADT With a GNRH Agonist and TAK-700 For Men With High Risk Prostate Cancer


Phase 3
18 Years
N/A
Open (Enrolling)
Male
Prostate Cancer

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Trial Information

Phase III Trial of Dose Escalated Radiation Therapy and Standard Androgen Deprivation Therapy (ADT) With a GNRH Agonist vs. Dose Escalated Radiation Therapy and Enhanced ADT With a GNRH Agonist and TAK-700 For Men With High Risk Prostate Cancer


OBJECTIVES:

Primary

- To evaluate the difference in overall survival of patients with clinically localized
prostate cancer with unfavorable prognostic features between a) standard treatment
(androgen-deprivation therapy [ADT] + radiotherapy) and b) standard treatment with the
addition of 24 months of steroid 17alpha-monooxygenase TAK-700 (TAK-700).

Secondary

- To characterize differences between the treatment groups with respect to incidence of
unexpected grade ≥ 3 adverse events and/or clinically significant decrement in
patient-reported quality of life (QOL) among subjects treated with TAK-700.

- To compare rates and cumulative incidence of biochemical control (freedom from PSA
failure), local/regional progression, and distant metastases.

- To compare rate and cumulative incidence of clinical failure, defined as
prostate-specific antigen (PSA) > 25 ng/mL, documented local disease progression,
regional or distant metastasis, or initiation of ADT.

- To compare prostate cancer-specific survival and other-cause mortality.

- To compare the change in severity of fatigue as measured by the Patient-Reported
Outcome Measurement Information System (PROMIS) fatigue short form.

- To compare changes in patient-reported QOL as measured by Expanded Prostate Cancer
Index Composite (EPIC).

- To assess quality-adjusted survival using the EQ-5D.

- To compare nadir and average serum testosterone at 12 and 24 months during treatment.

- To compare changes in hemoglobin A1C, fasting glucose, and fasting insulin during 24
months of systemic treatment and during the first three years of follow-up.

- To compare changes in fasting lipid levels during 24 months of treatment and during the
first three years of follow-up.

- To compare changes in body mass index (BMI) during 24 months of treatment and during
the first three years of follow-up.

- To compare the incidence of adverse events ascertained via CTCAE version 4.

- To compare the rate of recovery of testosterone to > 230 ng/dL (accepted threshold for
supplementation) after 12 and 24 months of follow-up.

- To compare the median time to recovery of testosterone to > 230 ng/dL during the first
five years of follow-up.

- To assess cumulative incidence of relevant clinical survivorship endpoints including
new diagnosis of type 2 diabetes, coronary artery disease, myocardial infarction,
stroke, pulmonary embolism, deep vein thrombosis, or osteoporotic fracture.

OUTLINE: This is a multicenter, randomized study. Patients are stratified according to risk
group (see Disease Characteristics) and type of radiation therapy (RT) boost
(intensity-modulated RT [IMRT] vs brachytherapy). Patients are randomized to 1 of 2
treatment arms.

- Arm I: Patients receive standard androgen suppression (AS) with a luteinizing
hormone-releasing hormone (LHRH) agonist (such as leuprolide, goserelin, buserelin, or
triptorelin) for 24 months from initiation and oral (PO) antiandrogen (such as
flutamide or bicalutamide) beginning 2 months prior and for the duration of radiation
therapy (RT).

- Arm II: Patients receive the same standard AS with LHRH agonist and oral antiandrogen
as in arm 1. Patients also receive steroid 17alpha-monooxygenase TAK-700 (TAK-700) PO
twice daily (BID) for 2 years.

In both arms, patients undergo IMRT or 3D-conformal RT to the whole pelvis once daily, 5
days a week, for 6-8 weeks. Some patients also receive brachytherapy.

Quality of life is assessed via the Patient-Reported Outcome Measurement Information System
(PROMIS) Fatigue Scale, the Expanded Prostate Cancer Index Composite (EPIC-26), and the
EuroQol (EQ-5D) assessments at baseline and periodically during the study.

Serum may be collected from some patients for correlative studies.

After completion of study therapy, patients are followed every 3 months for 2 years, every 6
months for 1 year, and then annually thereafter.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed diagnosis of adenocarcinoma of the prostate within 180 days
prior to registration at high risk for recurrence as determined by one of the
following combinations (risk group):

- Gleason Score (GS) ≥ 9, PSA ≤ 150 ng/mL, any T stage

- GS ≥ 8, PSA < 20 ng/mL, T stage ≥ T2

- GS ≥ 8, PSA ≥ 20-150 ng/mL, any T stage

- GS ≥ 7, PSA ≥ 20-150 ng/mL, any T stage

- Baseline serum PSA value performed with an FDA-approved assay (e.g., Abbott,
Hybritech), obtained prior to any luteinizing hormone-releasing hormone (LHRH)
agonist or antiandrogen therapy, within 180 days of randomization

- Study entry PSA obtained during the following time frames:

- 10-day period following prostate biopsy

- Following initiation of hormonal therapy

- Clinically negative lymph nodes as established by imaging (abdominal and pelvic CT or
abdominal and pelvic MRI), nodal sampling, or dissection within 90 days prior to
registration

- Patients with lymph nodes equivocal or questionable by imaging are eligible if
the nodes are < 2.0 cm

- No distant metastases (M0) on bone scan within 90 days prior to registration

- Equivocal bone scan findings are allowed if plain films are negative for
metastasis

- No definite evidence of metastatic disease

- Any patient undergoing brachytherapy must have transrectal ultrasound confirmation of
prostate volume < 60 cc, American Urological Association (AUA) score ≤ 15 within 60
days of registration, and no history of prior transurethral resection of the prostate
(TURP)

- Prior TURP is permitted for patients who receive external-beam radiotherapy
(EBRT) only

PATIENT CHARACTERISTICS:

- Height, weight, Zubrod performance status 0-1

- Absolute neutrophil count (ANC) ≥ 1,800 cells/mm^3

- Platelets ≥ 100,000 cells/mm^3

- Hemoglobin ≥ 8.0 g/dL (The use of transfusion or other intervention to achieve Hgb ≥
8.0 g/dL is acceptable)

- Serum creatinine < 2.0 mg/dL

- Creatinine clearance > 40 mL/minute

- Bilirubin < 1.5 x upper limit of normal (ULN)

- ALT or AST < 2.5 x ULN

- No PSA > 150 ng/mL

- Screening calculated ejection fraction ≥ ULN by multiple-gated acquisition (MUGA)
scan or by echocardiogram

- Patients, even if surgically sterilized (i.e., status post vasectomy), must agree to
practice effective barrier contraception during the entire study treatment period and
for 4 months (120 days) after the last dose of study drug

- No prior invasive malignancy (except non-melanoma skin cancer) unless disease-free or
not requiring systemic therapy for a minimum of 3 years

- No known hypersensitivity to TAK-700 or related compounds

- No history of adrenal insufficiency

- No history of myocardial infarction, unstable symptomatic ischemic heart disease,
ongoing arrhythmias of grade > 2 (NCI CTCAE, version 4.02) thromboembolic events
(e.g., deep vein thrombosis, pulmonary embolism, or symptomatic cerebrovascular
events), or any other cardiac condition (e.g., pericardial effusion restrictive
cardiomyopathy) within 6 months prior to registration

- Chronic stable atrial fibrillation on stable anticoagulant therapy is allowed

- No New York Heart Association Class III or IV heart failure

- No ECG abnormalities of Q-wave infarction, unless identified 6 or more months prior
to screening, or QTc interval > 460 msec

- No prior allergic reaction to the drugs involved in this protocol

- No Cushing syndrome

- No severe chronic renal disease or chronic liver disease

- No uncontrolled hypertension despite appropriate medical therapy within 21 days prior
to registration (blood pressure of greater than 150 mm Hg systolic and 90 mm Hg
diastolic at 2 separate measurements no more than 60 minutes apart during screening
visit)

- No serious infection within 14 days prior to registration

- No uncontrolled nausea, vomiting, or diarrhea (CTCAE grade ≥ 3) despite appropriate
medical therapy at the time of registration

- No known gastrointestinal (GI) disease or GI procedure that could interfere with the
oral absorption or tolerance of TAK-700, including difficulty swallowing tablets

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- Prior testosterone administration is allowed if last administered at least 90 days
prior to registration

- No prior radical prostatectomy, cryosurgery for prostate cancer, or bilateral
orchiectomy for any reason

- No prior systemic chemotherapy for prostate cancer

- Prior chemotherapy for a different cancer is allowed

- No prior radiotherapy, including brachytherapy, to the region of the prostate that
would result in overlap of radiation therapy fields

- No previous hormonal therapy, such as LHRH agonists (e.g., goserelin, leuprolide),
anti-androgens (e.g., flutamide, bicalutamide), estrogens (e.g., DES), or surgical
castration (orchiectomy)

- No chronic treatment with glucocorticoids within one year

- No major surgery within 14 days prior to registration

- No other investigational agent

- No other anticancer therapy

- No concurrent hormonal therapies including estrogens or herbal products

- No concurrent ketoconazole or aminoglutethimide

- No chronic use of systemic corticosteroids, such as oral prednisone

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Overall survival

Safety Issue:

No

Principal Investigator

M. Dror Michaelson, MD, PhD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Massachusetts General Hospital

Authority:

Unspecified

Study ID:

CDR0000727326

NCT ID:

NCT01546987

Start Date:

May 2012

Completion Date:

Related Keywords:

  • Prostate Cancer
  • adenocarcinoma of the prostate
  • stage I prostate cancer
  • stage IIA prostate cancer
  • stage IIB prostate cancer
  • stage III prostate cancer
  • stage IV prostate cancer
  • Prostatic Neoplasms

Name

Location

Natalie Warren Bryant Cancer Center at St. Francis Hospital Tulsa, Oklahoma  74136
Holden Comprehensive Cancer Center at University of Iowa Iowa City, Iowa  52242-1002
Maine Center for Cancer Medicine and Blood Disorders - Scarborough Scarborough, Maine  04074
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
David C. Pratt Cancer Center at St. John's Mercy St. Louis, Missouri  63141
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
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis St. Louis, Missouri  63110
Gundersen Lutheran Center for Cancer and Blood La Crosse, Wisconsin  54601
All Saints Cancer Center at Wheaton Franciscan Healthcare Racine, Wisconsin  53405
Delaware County Regional Cancer Center at Delaware County Memorial Hospital Drexel Hill, Pennsylvania  19026
Missouri Baptist Cancer Center St. Louis, Missouri  63131
York Cancer Center at Apple Hill Medical Center York, Pennsylvania  17405
Jon and Karen Huntsman Cancer Center at Intermountain Medical Center Murray, Utah  84157
Radiological Associates of Sacramento Medical Group, Incorporated Sacramento, California  95815
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Solano Radiation Oncology Center Vacaville, California  95687
Auburn Radiation Oncology Auburn, California  95603
Radiation Oncology Centers - Cameron Park Cameron Park, California  95682
Radiation Oncology Center - Roseville Roseville, California  95661
Mercy Cancer Center at Mercy San Juan Medical Center Carmichael, California  95608
St. Agnes Hospital Cancer Center Baltimore, Maryland  21229
Klabzuba Cancer Center at Harris Methodist Fort Worth Hospital Fort Worth, Texas  76104
Adams Cancer Center Gettysburg, Pennsylvania  17325
Cherry Tree Cancer Center Hanover, Pennsylvania  17331