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A Phase III Study for Patients With Metastatic Hormone-naïve Prostate Cancer (PEACE1)

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ClinicalTrials.gov Identifier: NCT01957436
Recruitment Status : Active, not recruiting
First Posted : October 8, 2013
Last Update Posted : January 25, 2019
Sponsor:
Collaborators:
Janssen-Cilag Ltd.
European Organisation for Research and Treatment of Cancer - EORTC
Ipsen
Sanofi
Information provided by (Responsible Party):
UNICANCER

Brief Summary:
This is a multi-center phase III study to compare the clinical benefit of androgen deprivation therapy (+ 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

Detailed Description:

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 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
Estimated Primary Completion Date : May 2019
Estimated Study Completion Date : December 2032

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: Arm A
androgen deprivation therapy + docetaxel
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

Experimental: Arm B
androgen deprivation therapy + docetaxel + abiraterone acetate + prednisone
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

Experimental: Arm C
Arm A + radiotherapy
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

Experimental: Arm D
Arm B + radiotherapy
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 :
  1. Survival [ Time Frame: 5.5 years after the first inclusion ]
    Overall and progression-free survival


Secondary Outcome Measures :
  1. PSA response rate [ Time Frame: 8 months ]
    The PSA response rate will be defined by an undetectable serum PSA level at 8 months

  2. Prospective correlative study of PSA response/progression at 8 months after initation of ADT [ Time Frame: 8 months ]
  3. Prostate cancer specific survival [ Time Frame: 5.5 years ]
  4. Time to pain progression [ Time Frame: 5.5 years ]
    will be evaluated by questionnaires

  5. Time to next skeletal-related event [ Time Frame: 5.5 years ]
  6. Time to chemotherapy for CRPC [ Time Frame: 5.5 years ]
  7. Time to severe local symptoms [ Time Frame: 5.5 years ]
    The time to severe local symptoms (grade 3 and 4 events) related to tumor progression and/or radiotherapy long term side effects will be evaluated according to NCI-CTCAE v4.0

  8. Toxicity of the study treatment [ Time Frame: 5.5 years ]
    Toxicity (with a specific focus on the use of long-term low-dose steroids) will be evaluated according to NCI-CTCAE v4.0

  9. The radiological progression-free survival [ Time Frame: 5.5 years ]
  10. Changes in bone mineral density [ Time Frame: 5.5 years ]
  11. Correlation of biomarkers with outcome [ Time Frame: 5.5 years ]


Information from the National Library of Medicine

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

Inclusion criteria:

  1. Histologically or cytologically confirmed adenocarcinoma of the prostate,
  2. 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

  3. Patients with ECOG ≤ 1 (patient with PS 2 due to bone pain can be accrued in the trial),
  4. Life expectancy of at least 6 months,
  5. Male aged ≥ 18 years old and ≤80 years old ,
  6. Hematology values:

    • Hemoglobin ≥ 10.0 g/dL,
    • Platelet count ≥ 100,000/mL,
    • Neutrophil ≥ 1500 cells/mm3
  7. Biochemistry values:

    • Renal function: Serum creatinine < 1.5 x ULN or a calculated creatinine clearance ≥ 60 mL/min,
    • Serum potassium ≥ 4 mmol/L,
    • 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)
  8. 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,
  9. 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.
  10. Patients might have received previous radiation therapy directed to bone lesions,
  11. Patients able to take oral medication,
  12. Patients who have received the information sheet and signed the informed consent form,
  13. 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
  14. Patients must be willing and able to comply with scheduled visits, treatment plan, laboratory tests and other study procedures,
  15. Patients with a public or a private health insurance coverage, according to local laws for participation in clinical trials.

Exclusion Criteria:

  1. 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 metastase are allowed,
  2. Prior cytotoxic chemotherapy or biological therapy for the treatment of prostate cancer,
  3. Any chronic medical condition requiring a higher dose of corticosteroid than 5 mg prednisone/prednisolone twice daily,
  4. Active infection or other medical condition for which prednisone/prednisolone (corticosteroid) use would be contra-indicated,
  5. Previously treated with ketoconazole for prostate cancer for more than 7 days,
  6. Prior systemic treatment with an azole drug (e.g. fluconazole, itraconazole) within 4 weeks of randomization,
  7. Hypertension not controlled by an anti-hypertensive treatment (systolic BP ≥ 160 mmHg or diastolic BP ≥ 95 mmHg; 3 consecutive measures taken 5 minutes apart),
  8. Severe or moderate hepatic impairment (Child - Pugh class C or B)
  9. Active or symptomatic viral hepatitis or chronic liver disease (except Gilbert's disease),
  10. History of pituitary or adrenal dysfunction,
  11. Clinically known 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 II-IV heart disease or cardiac ejection fraction measurement of < 50% at baseline,
  12. Atrial Fibrillation, or other cardiac arrhythmia requiring therapy,
  13. Patient with unstable pulmonary disease (eg. Pulmonary embolism)
  14. Pathological finding consistent with small cell carcinoma of the prostate,
  15. History of malignancy, except non-melanoma skin cancer, with a ≥ 30% probability of recurrence within 24 months,
  16. Known allergies, hypersensitivity or intolerance to the study drugs or excipients or docetaxel
  17. Administration of an investigational therapeutic within 30 days of randomization,
  18. 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),
  19. 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,
  20. Individual deprived of liberty or placed under the authority of a tutor.
  21. Patients with impaired vision should undergo a prompt and complete ophtalmologic examination.

    Patients with Cystoid Macular Oeadema cannot be included due to a potential risk of deterioration associated with docetaxel.

  22. Concomitant use of strong CYP3A4 inhibitors ( clarithromyin, 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


  Show 80 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

Responsible Party: UNICANCER
ClinicalTrials.gov Identifier: NCT01957436     History of Changes
Other Study ID Numbers: UC-0160/1105 GETUG AFU-21
First Posted: October 8, 2013    Key Record Dates
Last Update Posted: January 25, 2019
Last Verified: January 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Keywords provided by UNICANCER:
prostate
cancer
metastatic hormone-naive
radiotherapy
abiraterone acetate
docetaxel

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Docetaxel
Prednisone
Abiraterone Acetate
Hormones
Androgens
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Anti-Inflammatory Agents
Glucocorticoids
Antineoplastic Agents, Hormonal
Steroid Synthesis Inhibitors
Enzyme Inhibitors
Hormone Antagonists
Cytochrome P-450 Enzyme Inhibitors