Abiraterone, Radiotherapy and Short-Term Androgen Deprivation in Unfavorable Localized Prostate Cancer

Study Description

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Brief Summary:

The addition of abiraterone acetate to standard treatment of radiotherapy and short-term androgen deprivation will increase the frequency of undetectable PSA.

Condition or disease	Intervention/treatment	Phase
Prostate Cancer	Drug: Abiraterone acetate; Drug: Androgen deprivation; Radiation: Radiation Therapy; Drug: Prednisone	Phase 2

Detailed Description:

This is a single arm two-site study of 37 men with unfavorable prostate cancer (defined as having a single high risk factor). Patients will concurrently initiate 6 months of standard-of-care GNRH agonist therapy and once daily abiraterone acetate/prednisone. After 2 months of lead-in hormonal treatment, definitive standard-of-care prostate/seminal vesicle radiotherapy will be delivered, to a total dose of 75-80 Gy.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	37 participants
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	A Phase II Trial of Abiraterone Acetate, Radiotherapy and Short-Term Androgen Deprivation in Men With Unfavorable Risk Localized Prostate Cancer
Actual Study Start Date :	January 17, 2014
Actual Primary Completion Date :	August 24, 2017
Estimated Study Completion Date :	August 2021

Arms and Interventions

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Arm

Intervention/treatment

Experimental: Abiraterone acetate; Abiraterone Acetate, Radiotherapy and Short Term Androgen Deprivation. Prednisone will be prescribed concurrently with Abiraterone acetate.

Drug: Abiraterone acetate; 1000 mg orally once a day for 6 months.; Other Name: Zytiga Drug: Androgen deprivation; LHRH analog (at discretion of treating physician) will be administered over 6 months (for example, leuprolide acetate 22.5mg IM or goserelin acetate 10.8mg SC given every 3 months for 2 doses). Radiation: Radiation Therapy; Daily (Monday-Friday) for 8 weeks, final dose of 75-80 Gy Drug: Prednisone; 5 mg tablet once daily for 6 months.

Outcome Measures

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Primary Outcome Measures :

1. Rate of undetectable PSA (<0.1 ng/ml) [ Time Frame: 1 year ]
   Undetectable PSA at 1 year from treatment initiation

Secondary Outcome Measures :

1. PSA nadir value [ Time Frame: 1 year, 2 years ]
   PSA nadir values at 1 and 2 years
2. Time to PSA nadir [ Time Frame: 1 year ]
3. Biochemical progression-free survival [ Time Frame: up to 2.5 years ]
   Disease progression defined as Phoenix RTOG definition of nadir + 2ng/ml or initiation of salvage therapy
4. Metastasis or systemic therapy [ Time Frame: up to 2.5 years ]
   Time to metastasis or systemic therapy
5. Testosterone recovery [ Time Frame: up to 2.5 years ]
   Time to testosterone recovery
6. PSA < 1.5ng/ml in setting of non-castrate testosterone [ Time Frame: 1 year, 2 years, 3 years, 4 years, 5 years ]
   Proportion of men with 1, 2, 3, 4 and 5 year PSA < 1.5ng/ml in setting of non-castrate testosterone
7. Safety and tolerability [ Time Frame: up to 7 months ]
   To evaluate the short and long term safety and tolerability of 6 months of abiraterone acetate with prednisone and ADT combined with standard RT in men with intermediate/lower high risk localized prostate cancer

Eligibility Criteria

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Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	Male
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• One of the following high risk criteria:
• Gleason Score 7 with PSA ≤ 20 ng/ml and clinical T1-2, or
• Gleason Score 8-10, PSA ≤ 20 ng/ml and clinical T1-2a, or
• PSA 10.1-40 ng/ml with GS < 7 and clinical T1-2, or
• Clinical T3 with Gleason Score < 7 and PSA ≤ 10 ng/ml.
• ECOG Performance Status ≤ 1
• Digital rectal exam within 90 days of registration on study
• CBC with differential with adequate bone marrow function defined as follows:
• Absolute neutrophil count (ANC) ≥ 1,500 cells/mm3, Platelets > 100,000/µL and Hemoglobin ≥ 9g/dL
• Serum potassium ≥ 3.5 mEq/L
• Serum albumin > 3.0 g/dl
• Total bilirubin < 1.5 X of institutional upper limit of normal (ULN)
• AST(SGOT)/ALT(SGPT) < 1.5 X ULN
• Calculated creatinine clearance > 60 mL/min
• Age > 18 years
• Able to swallow a whole tablet and take abiraterone acetate on an empty stomach (defined as no food for two hours before and one hour after abiraterone acetate ingestion)
• Ability to understand and sign a written informed consent document
• Written authorization for use and release of health and research study information has been obtained
• Be willing/able to adhere to the prohibitions and restrictions specified in this protocol
• Subjects who have partners of childbearing potential must be willing to use a method of birth control with adequate barrier protections as determined acceptable by the principal investigator during the study and for 1 week after the last dose of abiraterone acetate.

Exclusion Criteria:

• Bone, visceral or soft tissue metastasis, including lymph nodes (>2 cm in longest diameter)
• Prior therapy for prostate cancer [Exceptions: LHRH agonist or antagonist may have been initiated within 30 days prior to enrollment. Bicalutamide may have been given within 60 days of enrollment as long as it has been stopped at least 7 days before enrollment and total duration was no longer than 30 days. This is to allow enrollment of those who have been given bicalutamide as a bridge for LHRH agonist/antagonist. It is highly unlikely a short non-overlapping course of bicalutamide will interact with abiraterone acetate in a measurable way. Previous alpha-reductase inhibitor use allowed IF patient has not been taking for at least 30 days prior to abiraterone acetate initiation, OR if alpha reductase inhibitor was not used as a primary treatment of prostate cancer and the PSA on alpha-reductase inhibitor remains within eligibility when doubled. ]
• Known serum testosterone ≤ 150 ng/dl or symptoms of hypogonadism (fatigue, hot flashes, hair loss, loss of muscle mass, osteoporosis, low libido, depression) prior to ADT initiation not explained by other medical co-morbidity OR history of testosterone supplement. If questionable, serum testosterone level greater than 150 ng/dl can be used to exclude hypogonadism.
• Previous malignancy within 3 years other than non-melanomatous skin cancer and non-muscle invasive bladder cancer
• Previous pelvic radiotherapy that would prevent prostate/SV irradiation
• Uncontrolled hypertension (systolic BP ≥ 160 mmHg or diastolic BP ≥ 95 mmHg). Patients with a history of hypertension are allowed provided blood pressure is controlled by anti-hypertensive therapy
• History of gastrointestinal disorders that may interfere with the absorption of study drug (including gastric bypass surgery)
• Concurrent spironolactone use
• Significant concurrent medical condition that would make prednisone/prednisolone use contraindicated or would interfere with the patient's ability to participate in the trial
• Receiving any investigational agents currently or within 30 days prior to study screening
• Prior demonstrated hypersensitivity, intolerance or allergy to abiraterone acetate, prednisone or their excipients

• Active co-morbidity, defined as follows:

  • Chronic liver disease with cirrhosis (Child-Pugh B or C) or active hepatitis B or C
  • History of pituitary or adrenal dysfunction
  • Poorly controlled diabetes mellitus (A1c >9% or history of complications including peripheral neuropathy, end organ damage, hospitalization, amputation)
  • Poorly controlled glaucoma
  • Clinically significant heart disease as evidenced by myocardial infarction, or arterial thrombotic events in the past 6 months, severe or unstable angina, or New York Heart Association (NYHA) Class III-IV heart disease or known cardiac ejection fraction measurement of < 50% at baseline.
  • Clinical evidence of active infection of any type, including active or symptomatic viral hepatitis.
  • Known immune deficiency and/or HIV-positive patients
  • Any medical condition that warrants long-term corticosteroid use in excess of study dose
• Patients taking strong CYP3A4 inducers (e.g., phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital)
• Any condition that in the opinion of the Principal Investigator, would compromise the well-being of the subject or the study or prevent the subject from meeting or performing the study requirements

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Locations

United States, North Carolina
Durham Regional Hospital
Durham, North Carolina, United States, 27704
Duke University Medical Center
Durham, North Carolina, United States, 27710
United States, Texas
MD Anderson Cancer Center
Houston, Texas, United States, 77030

Sponsors and Collaborators

Duke University

Janssen Pharmaceuticals

Investigators

Principal Investigator:	Bridget Koontz, MD	Duke University

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Responsible Party:	Duke University
ClinicalTrials.gov Identifier:	NCT01717053 History of Changes
Other Study ID Numbers:	Pro00044071
First Posted:	October 30, 2012
Last Update Posted:	September 19, 2017
Last Verified:	September 2017

Additional relevant MeSH terms:

Prostatic Neoplasms; Genital Neoplasms, Male; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Genital Diseases, Male; Prostatic Diseases; Prednisone; Methyltestosterone; Abiraterone Acetate; Estrogens, Conjugated (USP); Androgens; Ascorbic Acid; Anti-Inflammatory Agents; Glucocorticoids	Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Physiological Effects of Drugs; Antineoplastic Agents, Hormonal; Antineoplastic Agents; Antioxidants; Molecular Mechanisms of Pharmacological Action; Protective Agents; Vitamins; Micronutrients; Growth Substances; Estrogens; Anabolic Agents; Steroid Synthesis Inhibitors; Enzyme Inhibitors