Prostate Adenocarcinoma TransCutaneous Hormones (PATCH)
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| ClinicalTrials.gov Identifier: NCT00303784 |
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Recruitment Status :
Recruiting
First Posted : March 17, 2006
Last Update Posted : November 27, 2020
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RATIONALE: The increasingly prolonged and extended use of androgen deprivation therapy (ADT) in the treatment of prostate cancer, usually achieved through the administration of LHRH agonists, has raised concerns about long-term toxicities, in particular osteoporosis and adverse metabolic changes which may be associated with type II diabetes and increased cardiovascular risk. An alternative approach is to investigate other methods of ADT. Oral oestrogen has been shown to be as effective as LHRH and surgical orchidectomy in achieving castrate levels of testosterone and has equivalent or improved prostate cancer outcomes but is not used routinely as first-line therapy because of the risk of cardiovascular system (CVS) complications. The CVS complications have been attributed to first-pass hepatic metabolism. Administering oestrogen parenterally avoids the entero-hepatic circulation and so is expected to mitigate the risk of CVS toxicity whilst still effectively suppressing testosterone to castrate levels. This hypothesis has been supported by results from the early stages of this trial which have provided sufficient indication of the safety and efficacy of the patches to warrant further investigation of the treatment in this setting, as recommended by the IDMC..
PURPOSE: This randomized phase III trial is studying how well the estrogen skin patch works compared with luteinizing hormone-releasing hormone agonist injections in treating patients with locally advanced or metastatic prostate cancer.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Anemia Cardiovascular Complications Hot Flashes Osteoporosis Prostate Cancer | Drug: Goserelin Drug: Estradiol | Phase 3 |
OBJECTIVES:
Primary
- Compare the progression-free survival and overall survival of patients with locally advanced or metastatic prostate cancer treated with transcutaneous estrogen patches vs luteinizing hormone-releasing hormone analogues.
Secondary
- Compare the cardiovascular system-related morbidity and mortality in patients treated with these regimens
- Compare the activity of these treatments, in terms of castrate level of hormones, failure-free survival, and biochemical failure, in these patients.
- Compare other toxicities, including osteoporosis, hot flushes, gynecomastia, and anemia, in patients treated with these regimens.
- Compare the quality of life of patients treated with these regimens.
OUTLINE: This is a randomized, controlled, multicenter study. Patients are randomized to 1 of 2 treatment arms at 1(control):1 (patch) ratio.
- Arm I (control): Patients receive luteinizing hormone-releasing hormone agonists as per local practice in the absence of unacceptable toxicity.
- Arm II (patch): Patients receive 4 transcutaneous estrogen patches, changing twice weekly for 4 weeks. Patients' testosterone levels are measured at week 4. Patients whose testosterone level is > 1.7 nmol/L continue to receive patch as before and have their testosterone level measured every 2 weeks. Patients whose testosterone level is < 1.7 nmol/L at week 4 or any other point receive 3 transcutaneous estrogen patches changed twice weekly in the absence of unacceptable toxicity.
Quality of life is assessed at baseline; at weeks 4, 8, and 12; every 3 months for 24 months.
After completion of study treatment, patients are followed periodically.
Peer Reviewed and Funded or Endorsed by Cancer Research UK
PROJECTED ACCRUAL: A total of 2200 patients will be accrued for this study.
| Study Type : | Interventional (Clinical Trial) |
| Estimated Enrollment : | 2200 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | A Randomized-Controlled Trial of Transcutaneous Oestrogen Patches Versus LHRH Agonists in Prostate Cancer |
| Actual Study Start Date : | March 2006 |
| Estimated Primary Completion Date : | August 2021 |
| Estimated Study Completion Date : | August 2021 |
| Arm | Intervention/treatment |
|---|---|
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Active Comparator: LHRH agonists
Patients randomised to the control arm will receive continuous treatment with LHRH agonists as per local practice. Treatment should continue for at least 3 years. LHRH antagonists, such as degarelix, are not allowed on the trial. The recommended "anti-flare" medication is bicalutamide and should be prescribed according to local practice. Control arm medication should be obtained from the hospital pharmacy or GP as per local practice.
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Drug: Goserelin
3.6mg implant, in pre-filled syringe
Other Name: Zoladex |
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Experimental: Oestrogen Patches
Patients randomised to the investigational arm will receive transcutaneous oestrogen patches (100 micrograms/24 hours). Treatment should be planned to continue for at least 3 years. For patients prescribed bicalutamide or flutamide prior to randomisation, this treatment should be discontinued before treatment with the patches can commence (no washout period is needed).
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Drug: Estradiol
Each patch contains 3 mg of estradiol hemihydrate in a patch size of 30 cm2, releasing 100 micrograms of estradiol per 24 hours.
Other Name: FemSeven |
- Progression-Free Survival [ Time Frame: Up to 180 months ]
- Overall Survival [ Time Frame: Up to 180 months ]
- Hormone activity by castrate levels of hormones [ Time Frame: Up to 180 months ]
- Other toxicity [ Time Frame: Up to 180 months ]
- Cardiovascular morbidity [ Time Frame: Up to 180 months ]
- Cardiovascular mortality [ Time Frame: Up to 180 months ]
- Quality of Life [ Time Frame: Up to 24 months ]will be measured using patient-completed questionnaires, EORTC QLQ-C30 and PR25 which is prostate specific
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
| Ages Eligible for Study: | up to 120 Years (Child, Adult, Older Adult) |
| Sexes Eligible for Study: | Male |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
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Must meet 1 of the following criteria:
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Newly diagnosed patients with any of the following:
- Stage T3 or T4, NX, M0 histologically confirmed prostate adenocarcinoma with prostate-specific antigen (PSA) ≥ 20 ng/mL or Gleason score ≥ 6
- Any T, N+, M0, or any T, any N, M+ histologically confirmed prostate adenocarcinoma
- Multiple sclerotic bone metastases with a PSA ≥ 50 ng/mL without histological confirmation
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Patients with histologically confirmed prostate adenocarcinoma previously treated with radical surgery or radiotherapy who are currently in relapse with on of the following:
- PSA ≥ 4 ng/mL and rising with doubling time less than 6 months
- PSA ≥ 20 ng/mL
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- Must have written informed consent
- Intention to treat with long-term androgen-deprivation therapy
- Normal testosterone level prior to hormonal treatment
PATIENT CHARACTERISTICS:
- WHO performance status 0-2
- No other prior or current malignant disease or cardiovascular system disease that is likely to interfere with study treatment or assessment
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No cardiovascular disease, including any of the following:
- History of cerebral ischemia (e.g., stroke or transient ischemic attack) within the past 2 years
- History of deep vein thrombosis or pulmonary embolism confirmed radiologically
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History of myocardial infarction (MI) within the past 6 months OR MI more than 6 months ago with evidence of q-wave anterior infarct on ECG
- ECHO or MUGA required for patients with history of ischemic heart disease
- Left Ventricular Ejection Fraction ≤ 40%
- No condition or situation that could preclude protocol treatment or compliance with follow-up schedule
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- At least 12 months since prior adjuvant or neoadjuvant hormonal therapy for localized prostate cancer AND therapy lasted ≤ 12 months in duration
- No prior systemic therapy for locally advanced or metastatic prostate cancer
- No concurrent participation in another clinical trial of prostate cancer treatment that would preclude study therapy or outcome measures
- Concurrent prophylactic radiotherapy to prevent gynecomastia allowed
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00303784
Show 32 study locations
| Study Chair: | Paul D. Abel | Charing Cross Hospital |
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | University College, London |
| ClinicalTrials.gov Identifier: | NCT00303784 |
| Other Study ID Numbers: |
CDR0000455583 MRC-PATCH ( Other Grant/Funding Number: MRC ) EU-205106 ( Other Identifier: EU ) MRC-PR09 ( Other Identifier: MRC ) ISRCTN70406718 ( Registry Identifier: ISRCTN70406718 ) 2005-001030-33 ( EudraCT Number ) |
| First Posted: | March 17, 2006 Key Record Dates |
| Last Update Posted: | November 27, 2020 |
| Last Verified: | November 2020 |
| Studies a U.S. FDA-regulated Drug Product: | No |
| Studies a U.S. FDA-regulated Device Product: | No |
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hot flashes anemia osteoporosis cardiovascular complications |
recurrent prostate cancer stage III prostate cancer stage IV prostate cancer adenocarcinoma of the prostate |
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Prostatic Neoplasms Osteoporosis Hot Flashes Genital Neoplasms, Male Urogenital Neoplasms Neoplasms by Site Neoplasms Prostatic Diseases Bone Diseases, Metabolic Bone Diseases |
Musculoskeletal Diseases Metabolic Diseases Goserelin Estradiol Estrogens Hormones Hormones, Hormone Substitutes, and Hormone Antagonists Physiological Effects of Drugs Antineoplastic Agents, Hormonal Antineoplastic Agents |