A Phase III Study for Patients With Metastatic Hormone-naïve Prostate Cancer (PEACE1)
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| ClinicalTrials.gov Identifier: NCT01957436 |
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Recruitment Status :
Active, not recruiting
First Posted : October 8, 2013
Last Update Posted : November 8, 2022
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Sponsor:
UNICANCER
Collaborators:
Janssen-Cilag Ltd.
European Organisation for Research and Treatment of Cancer - EORTC
Ipsen
Sanofi
Information provided by (Responsible Party):
UNICANCER
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Brief Summary:
This is a multi-center phase III study to compare the clinical benefit of androgen deprivation therapy with or without docetaxel with or without local radiotherapy with or without abiraterone acetate and prednisone in patient with metastatic hormone-naïve prostate cancer.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Metastatic Prostate Cancer | Drug: abiraterone acetate Radiation: radiotherapy Other: Androgen Deprivation Therapy Drug: Docetaxel | Phase 3 |
Eligible patients can be randomize in the trial after his consent form has been signed, and after all inclusion and non-inclusion criteria have been checked.
The randomisation will result in the allocation of arm A (ADT +docetaxel), arm B (ADT +docetaxel +Abiraterone), arm C (ADT +docetaxel +radiotherapy) or arm D (ADT +docetaxel +Abiraterone +radiotherapy) in a 1:1:1:1 ratio.
The randomization will be stratified (by minimization) according to:
- enrolment center,
- performance status (0 vs. 1-2)
- disease extent: lymph nodes only vs. bone (with or without lymph nodes) vs. presence of visceral metastases.
CRPC is defined by cancer progression (either a confirmed PSA rise or a radiological progression) with serum testosterone being at castrated levels (<0.50 ng/mL).
When the CRPC stage is reached, castration (either LHRH agonist or LHRH antagonist) will be maintained in all patients.
Investigators will be free to manage patients reaching CRPC at their discretion (using for example docetaxel, zoledronic acid, denosumab, sipuleucel-T, radium-223, cabazitaxel, etc) according to local uses and guidelines.
Abiraterone may be used in arm A and C if abiraterone has become the standard treatment for CRPC when this stage is reached.
| Study Type : | Interventional (Clinical Trial) |
| Estimated Enrollment : | 1173 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | A Prospective Randomised Phase III Study Of Androgen Deprivation Therapy With Or Without Docetaxel With Or Without Local Radiotherapy With Or Without Abiraterone Acetate And Prednisone In Patients With Metastatic Hormone-Naïve Prostate Cancer |
| Actual Study Start Date : | November 13, 2013 |
| Actual Primary Completion Date : | August 18, 2021 |
| Estimated Study Completion Date : | December 2032 |
Resource links provided by the National Library of Medicine
MedlinePlus Genetics related topics:
Prostate cancer
| Arm | Intervention/treatment |
|---|---|
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Active Comparator: Arm A
androgen deprivation therapy + docetaxel
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Other: Androgen Deprivation Therapy
The ADT must consist in either LHRH agonist, LHRH antagonist or orchiectomy Drug: Docetaxel 6 cycles at 75mg/m²/cycle, one cycle every 3 weeks |
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Experimental: Arm B
androgen deprivation therapy + docetaxel + abiraterone acetate + prednisone
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Drug: abiraterone acetate
abiraterone 1000mg/day (4 tablets of 250 mg (PO) per day) + prednisone 5mg bid
Other Name: Zytiga Other: Androgen Deprivation Therapy The ADT must consist in either LHRH agonist, LHRH antagonist or orchiectomy Drug: Docetaxel 6 cycles at 75mg/m²/cycle, one cycle every 3 weeks |
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Experimental: Arm C
Arm A + radiotherapy
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Radiation: radiotherapy
74 Gy in 37 fractions 3D-Conformal RT or Intensity Modulated RT (IMRT) Other: Androgen Deprivation Therapy The ADT must consist in either LHRH agonist, LHRH antagonist or orchiectomy Drug: Docetaxel 6 cycles at 75mg/m²/cycle, one cycle every 3 weeks |
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Experimental: Arm D
Arm B + radiotherapy
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Drug: abiraterone acetate
abiraterone 1000mg/day (4 tablets of 250 mg (PO) per day) + prednisone 5mg bid
Other Name: Zytiga Radiation: radiotherapy 74 Gy in 37 fractions 3D-Conformal RT or Intensity Modulated RT (IMRT) Other: Androgen Deprivation Therapy The ADT must consist in either LHRH agonist, LHRH antagonist or orchiectomy Drug: Docetaxel 6 cycles at 75mg/m²/cycle, one cycle every 3 weeks |
Primary Outcome Measures :
- Survival [ Time Frame: 7.5 years after the first inclusion ]Overall and radiographic progression-free survival in patients with metastatic hormone-naïve prostate cancer treated by androgen deprivation therapy and docetaxel
- Survival [ Time Frame: 9.5 years after the first inclusion ]Overall and radiographic progression-free survival in hormone-naïve prostate cancer patients with low metastatic burden whatever the standard of care received
Secondary Outcome Measures :
- Castration resistance-free survival (CRFS) [ Time Frame: 9.5 years after the first inclusion ]
- Serious Genitourinary event-free survival (S-GU-EFS) [ Time Frame: 9.5 years after the first inclusion ]
- Prostate cancer specific survival [ Time Frame: 9.5 years after the first inclusion ]
- Time to next skeletal-related event [ Time Frame: 9.5 years after the first inclusion ]
- PSA response rate [ Time Frame: 9.5 years after the first inclusion ]
- Prospective correlative study of PSA response/progression at 8 months after initation of ADT [ Time Frame: 9.5 years after the first inclusion ]
- Time to pain progression [ Time Frame: 9.5 years after the first inclusion ]will be evaluated by questionnaires
- Time to chemotherapy for CRPC [ Time Frame: 9.5 years after the first inclusion ]
- Quality of life questionnaire - Core 30 (QLQ-C30) [ Time Frame: At baseline, 6 months, 18 months, and at the end of treatment (up to 9.5 years) ]
Developed by the EORTC, this self-reported questionnaire assesses the health-related quality of life of cancer patients in clinical trials.
The questionnaire includes five functional scales (physical, everyday activity, cognitive, emotional, and social), three symptom scales (fatigue, pain, nausea and vomiting), a health/quality of life overall scale, and a number of additional elements assessing common symptoms (including dyspnea, loss of appetite, insomnia, constipation, and diarrhea), as well as, the perceived financial impact of the disease.
All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level.
- Functional Assessment of Cancer Therapy - Prostate (FACT-P) [ Time Frame: At baseline, 6 months, 12 months, 18 months, and at the end of treatment (up to 9.5 years) ]The FACT-P is a self-assessment questionnaire to estimate the health-related quality of life in men with prostate cancer. This questionnaire, composed of 39 items consists of four subscales: Physical Well-Being (7 items), Social/Family Well-Being (7 items), Emotional Well-Being (6 items), Functional Well-Being (7 items), and prostate cancer subscale (12 items). Subscales are rated on 5-point Likert-type scale (from 0 = "Not at all" to 4 = "Very much"). For all subscales, a higher score represents better quality of life.
- Toxicity (with a specific focus on the use of long-term low-dose steroids) [ Time Frame: Throughout study completion, up to 9.5 years ]The National Cancer Institute-Common Terminology Criteria for Adverse Events version 4.0 (NCI-CTCAE v4.0) is widely accepted in the community of oncology research as the leading rating scale for adverse events. This scale, divided into 5 grades (1 = "mild", 2 = "moderate", 3 = "severe", 4 = "life-threatening", and 5 = "death") determined by the investigator, will make it possible to assess the severity of the disorders.
- Changes in bone mineral density [ Time Frame: At baseline, 6 months, 12 months, and 24 months ]X-rays are used to measure how many grams of calcium and other bone minerals are packed into a segment of bone
- Correlation of biomarkers with outcome [ Time Frame: 9.5 years after the first inclusion ]Correlation of biomarkers with outcome, including the prognostic and predictive value on OS, rPFS and CRFS of a neuro-endocrine differentiation of the prostate cancer in the pathological specimen.
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | Male |
| Accepts Healthy Volunteers: | No |
Criteria
Inclusion criteria:
- Histologically or cytologically confirmed adenocarcinoma of the prostate,
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Metastatic disease documented by a positive bone scan (any technique) or CT scan or an MRI. For patients with nodal metastases only, only patients with extra-pelvic enlarged lymph nodes (lymph nodes located above the iliac bifurcation) can be included if they have either:
o At least one extra-pelvic lymph node ≥ 2 cm or extra-pelvic lymph node (s) ≥ 1 cm if the patients also have at least one pelvic lymph node ≥ 2 cm
- Patients with ECOG ≤ 1 (patient with PS 2 due to bone pain can be accrued in the trial),
- Life expectancy of at least 6 months,
- Male aged ≥ 18 years old and ≤ 80 years old ,
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Hematology values:
- Hemoglobin ≥ 10.0 g/dL,
- Platelet count ≥ 100,000/mL,
- Neutrophil ≥ 1500 cells/mm³
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Biochemistry values:
- Renal function: Serum creatinine < 1.5 x ULN or a calculated creatinine clearance ≥ 60 mL/min,
- Serum potassium ≥ 4 mmol/L,
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Liver function:
- Serum bilirubin ≤ 1.5 x ULN (except for patients with documented Gilbert's disease),
- AST and ALT ≤ 1.5 x ULN (and ≤ 5 ULN in case of liver metastases),
- ALK-P ≤ 2.5 x ULN (in case of bone metastasis, ALK-P<1000U/L if bilirubin is normal)
- Patients must have received ADT for a maximum of 3 months before randomization and there must be a minimum of 6 weeks between the start of ADT and the start of Docetaxel,
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Patients willing and clinically fit to receive Docetaxel which is defined by the following :
- Patients respecting all inclusion and exclusion criteria And
- Patients with no contraindication to docetaxel according to the SmPC of the drug And
- Patients presenting all medical requirements to receive docetaxel according to the investigator's opinion.
- Patients might have received previous radiation therapy directed to bone lesions,
- Patients able to take oral medication,
- Patients who have received the information sheet and signed the informed consent form,
- Male patients who will receive Docetaxel and/or Abiraterone acetate and have partners of childbearing potential and/or pregnant partners must use a method of birth control in addition to an adequate barrier protection (condoms) as determined to be acceptable by the study doctor during the treatment period and for 4 weeks after the last dose of abiraterone acetate and/or for 6 months after the last dose of Docetaxel
- Patients must be willing and able to comply with scheduled visits, treatment plan, laboratory tests and other study procedures,
- Patients with a public or a private health insurance coverage, according to local laws for participation in clinical trials.
Exclusion Criteria:
- Patients with previous definitive local treatment directed to the prostate primary cancer (radiotherapy, brachytherapy, radical prostatectomy, ultrasound, cryotherapy, or other). A previous trans-urethral resection of the prostate (TURP) and previous local treatments of metastases are allowed,
- Prior cytotoxic chemotherapy or biological therapy for the treatment of prostate cancer,
- Any chronic medical condition requiring a higher dose of corticosteroid than 5 mg prednisone/prednisolone twice daily,
- Active infection or other medical condition for which prednisone/prednisolone (corticosteroid) use would be contra-indicated,
- Previously treated with ketoconazole for prostate cancer for more than 7 days,
- Prior systemic treatment with an azole drug (e.g. fluconazole, itraconazole) within 4 weeks of randomization,
- Hypertension not controlled by an anti-hypertensive treatment (systolic BP ≥ 160 mmHg or diastolic BP ≥ 95 mmHg; 3 consecutive measures taken 5 minutes apart),
- Severe or moderate hepatic impairment (Child - Pugh class C or B)
- Active or symptomatic viral hepatitis or chronic liver disease (except Gilbert's disease),
- History of pituitary or adrenal dysfunction,
- Clinically known significant heart disease in the past 6 months as evidenced by myocardial infarction, or arterial thrombotic events, severe or unstable angina, or New York Heart association (NYHA) Class II-IV heart disease or cardiac ejection fraction measurement of < 50% at baseline,
- Atrial Fibrillation, or other cardiac arrhythmia requiring therapy,
- Patient with unstable pulmonary disease (eg. Pulmonary embolism)
- Pathological finding consistent with small cell carcinoma of the prostate,
- History of malignancy, except non-melanoma skin cancer, with a ≥ 30% probability of recurrence within 24 months,
- Known allergies, hypersensitivity or intolerance to the study drugs or excipients or docetaxel
- Administration of an investigational therapeutic within 30 days of randomization,
- Patients already included in another therapeutic trial involving an experimental drug (patient in a non-experimental trial with no modification of the patient's care can be included),
- Patients with significantly altered mental status prohibiting the understanding of the study or with psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule or any condition which, in the opinion of the investigator, would preclude participation in this trial. Those conditions should be discussed with the patient before registration in the trial,
- Individual deprived of liberty or placed under the authority of a tutor.
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Patients with impaired vision should undergo a prompt and complete ophthalmologic examination.
Patients with Cystoid Macular Oedema cannot be included due to a potential risk of deterioration associated with docetaxel.
- Concomitant use of strong CYP3A4 inhibitors (clarithromycin, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin.)
Information from the National Library of Medicine
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): NCT01957436
Locations
Show 77 study locations
Sponsors and Collaborators
UNICANCER
Janssen-Cilag Ltd.
European Organisation for Research and Treatment of Cancer - EORTC
Ipsen
Sanofi
Investigators
| Study Chair: | Karim FIZAZI, Professor | Gustave Roussy, Cancer Campus Grand Paris - Paris | |
| Study Chair: | Alberto BOSSI, Doctor | Gustave Roussy, Cancer Campus Grand Paris - Paris |
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | UNICANCER |
| ClinicalTrials.gov Identifier: | NCT01957436 |
| Other Study ID Numbers: |
UC-0160/1105 GETUG AFU-21 |
| First Posted: | October 8, 2013 Key Record Dates |
| Last Update Posted: | November 8, 2022 |
| Last Verified: | November 2022 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | No |
| Plan Description: | Individual Participant Data will not be shared at an individual level. Those data will be part of the study database including all enrolled patients. |
| Studies a U.S. FDA-regulated Drug Product: | No |
| Studies a U.S. FDA-regulated Device Product: | No |
Keywords provided by UNICANCER:
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prostate cancer metastatic hormone-naive |
radiotherapy abiraterone acetate docetaxel |
Additional relevant MeSH terms:
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Prostatic Neoplasms Genital Neoplasms, Male Urogenital Neoplasms Neoplasms by Site Neoplasms Genital Diseases, Male Genital Diseases Urogenital Diseases Prostatic Diseases Male Urogenital Diseases Docetaxel Abiraterone Acetate Androgens |
Antineoplastic Agents Tubulin Modulators Antimitotic Agents Mitosis Modulators Molecular Mechanisms of Pharmacological Action Steroid Synthesis Inhibitors Enzyme Inhibitors Hormone Antagonists Hormones, Hormone Substitutes, and Hormone Antagonists Physiological Effects of Drugs Cytochrome P-450 Enzyme Inhibitors Hormones |