Prostate Adenocarcinoma TransCutaneous Hormones (PATCH)
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.
|Anemia Cardiovascular Complications Hot Flashes Osteoporosis Prostate Cancer||Drug: Goserelin Drug: Estradiol||Phase 3|
|Study Design:||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|
- 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 ]
|Study Start Date:||March 2006|
|Estimated Study Completion Date:||August 2021|
|Estimated Primary Completion Date:||August 2021 (Final data collection date for primary outcome measure)|
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.
3.6mg implant, in pre-filled syringe
Other Name: Zoladex
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).
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
- 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.
- 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.
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
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00303784
|Burton-upon-Trent, England, United Kingdom, DE13 0RB|
|Contact: Contact Person 44-1283-566-333|
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|Contact: Helen Patterson, MD 44-122324-5151 ext. 2523 and 2|
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|Contact: Contact Person 44-24-7660-2020|
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|Contact: J. P. Logue, MD 44-1270-255-141|
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|Contact: P. Daruwala 44-1476-565-232|
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|Contact: Christopher Scrase, MD 44-147-370-4177|
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|Contact: Contact Person 44-190-576-0635|
|Leeds Cancer Centre at St. James's University Hospital||Recruiting|
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|St. Mary's Hospital||Recruiting|
|London, England, United Kingdom, W2 1NY|
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|Contact: Contact Person 44-162-362-2515|
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|George Eliot Hospital||Recruiting|
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|Contact: Contact Person 44-015-2750-3030|
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|Contact: Alvan J. Pope 44-1895-238-282|
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|Contact: Contact Person 44-141-211-2123|
|Velindre Cancer Center at Velindre Hospital||Recruiting|
|Cardiff, Wales, United Kingdom, CF14 2TL|
|Contact: J. Lester, MD 44-29-2031-6292|
|University Hospital of Wales||Recruiting|
|Cardiff, Wales, United Kingdom, CF14 4XW|
|Contact: Howard Kynaston 44-2920-745-094|
|Study Chair:||Paul D. Abel||Charing Cross Hospital|