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Radium-223 in Combination With Enzalutamide

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02225704
Recruitment Status : Active, not recruiting
First Posted : August 26, 2014
Last Update Posted : February 21, 2021
Information provided by (Responsible Party):
Cancer Trials Ireland

Brief Summary:
This study aims to determine the safety and tolerability of Radium-223 when administered in combination with enzalutamide in progressive metastatic castrate-resistant prostate cancer.

Condition or disease Intervention/treatment Phase
Prostate Cancer Drug: Radium-223 and enzalutamide Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 44 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II Study of Radium-223 in Combination With Enzalutamide in Progressive Metastatic Castrate-Resistant Prostate Cancer
Study Start Date : June 2015
Actual Primary Completion Date : July 2017
Estimated Study Completion Date : December 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Prostate Cancer

Arm Intervention/treatment
Experimental: Radium-223 and enzalutamide
Radium-223 50kBq/kg by intravenous injection on day 1 of every 4 week cycle for maximum of 6 cycles Enzalutamide 160mg orally daily
Drug: Radium-223 and enzalutamide

Primary Outcome Measures :
  1. To determine safety [ Time Frame: approximately 6 to 9 months ]
    To record the incidence of grade 3 or higher adverse events during the period of combination therapy; graded according to the NCI CTCAE version 4

Secondary Outcome Measures :
  1. Time to clinical and Prostate Specific Antigen (PSA) progression [ Time Frame: Approximately 2 years ]
  2. PSA response [ Time Frame: approximately 2 years ]
  3. Time to first skeletal-related event [ Time Frame: approximately 2 years ]
    Time to first skeletal-related event will be analysed using the Kaplan-Meier method, presenting estimated of median PFS with 95% confidence intervals, also estimates of PFS and 95% confidence intervals at 12 months

  4. Pain assessment [ Time Frame: approximately 6 - 9 months ]
    The Brief Pain Inventory - Short Form questionnaire will be used to gather this data

  5. Measure overall survival [ Time Frame: approximately 2 years ]

Information from the National Library of Medicine

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

Inclusion Criteria:

  1. Written informed consent obtained prior to any study-related procedures
  2. Age ≥18 years and male.
  3. ECOG performance status ≤ 2.
  4. Histologically/cytologically confirmed adenocarcinoma of the prostate, and without neuroendocrine differentiation or small cell histology.
  5. Metastatic disease as confirmed by Computed tomography (CT)/ Magnetic resonance imaging (MRI) or bone scan.
  6. 6. Patients must have documented Progressive disease (PD) either by radiographic or PSA criteria as defined in a) and b) below:

    1. For the Radiographic PD assessment, 2 sets of scans using the same imaging modality (ie CT/MRI or bone scan) and taken at separate time points are required to document radiographic disease progression during or following the patient's most recent anti-neoplastic therapy, (note: the 1st bone scan can be from before most recent therapy but the 2nd scan must show disease progression during or after the most recent therapy).

      For patients with bone disease, progression will be assessed following recommendations by the Prostate Cancer Working Group (PCWG2, see Appendix FC): appearance of 2 or more new lesions on bone scan, confirmed, if necessary, by other imaging modalities (such as CT scan or MRI), if results of the bone scans are ambiguous).

      For patients with soft tissue lesions progression will be assessed using RECIST 1.1 criteria, (see Appendix GD). Patients may have measurable or non-measurable disease according to RECIST criteria version 1.1 (see Appendix GD)

    2. PSA progression is defined as an increase in PSA, as determined by 2 separate measurements taken at least 1 week apart and confirmed by a third. If the third measurement is not greater than the second measurement, then a fourth measurement must be taken and must be greater than the second measurement for the patient to be eligible for the study. Furthermore, the confirmatory PSA measurement (i.e. the third or, if applicable, fourth PSA measurement) must be defined. If a patient has received prior anti-androgen therapy (e.g. bicalutamide), PSA progression must be evident and documented after discontinuation of anti-androgen therapy, (note: The 1st PSA reading taken to document disease progression when the patient presents can be while the patient is on Casodex or other ADT).
  7. Prior surgical castration or concurrent use of an agent for medical castration with testosterone at screening less than 50ng/dL.
  8. Screening PSA ≥ 2 ng/mL.
  9. Patients, even if surgically sterilized who (i.e. status post-vasectomy):

    • will abstain from intercourse
    • or must agree to use barrier contraception during and for 6 months after discontinuation of study treatment.
    • If the patient engages in sexual intercourse with a woman of childbearing potential, a condom and another form of birth control must be used during and for 6 months after treatment.
  10. Stable medical condition
  11. Life expectancy of 12 months or more based on general health and prostate cancer disease status as judged by the investigator.
  12. Documented presence of osseous metastases with or without visceral involvement / lymph nodes.
  13. Able to swallow study drug as whole tablet.
  14. Adequate haematological, hepatic, and renal function.
  15. Continuous daily use of oral prednisone, oral dexamethasone, or other systemic corticosteroids is allowed prior to study entry but must be discontinued a minimum of 2 weeks prior to start of study treatment.

Exclusion Criteria:

  1. Patients should not be receiving any other investigational agents (within 30 days prior to registration)
  2. Patients with Gastrointestinal (GI) tract disease resulting in an inability to take oral medication, malabsorption syndrome, a requirement for IV alimentation, prior surgical procedures affecting absorption, uncontrolled inflammatory GI disease (e.g. Crohn's disease, ulcerative colitis).
  3. Have current active hepatic or biliary disease
  4. Prior therapy with orteronel, ketoconazole, aminoglutethimide, abiraterone or enzalutamide
  5. All anti-androgen therapy (including bicalutamide) is excluded within 6 weeks prior to first dose of study drug. Any other therapies for prostate cancer, other than GnRH analogue therapy, such as progesterone, medroxyprogesterone, progestins (megesterol), or 5-alpha reductase inhibitors (eg, finasteride or dutasteride), must be discontinued 2 weeks before the first dose of study drug. [Bisphosphonates and Denosumab are allowed concomitant medications].
  6. Prior chemotherapy for prostate cancer with the exception of:

    • neoadjuvant/ adjuvant therapy as part of initial primary treatment for local disease that was completed 2 or more years prior to screening.
    • Patients who received prior docetaxol for castrate sensitive metastatic prostate cancer commencing with 120 days of ADT initation where total dose received did not exceed 450mg/m2
  7. Prior exposure to bone directed radioisotope therapy, eg samarium 153, strontium 90;
  8. Exposure to external beam radiation within 4 weeks prior to receiving the first dose of study drug. In patients with untreated imminent or established spinal cord compression, treatment with standard of care, as clinically indicated, should be completed before starting treatment with Ra-223 dichloride (Xofigo®).
  9. Diagnosis of or treatment for another systemic malignancy within 2 years before the first dose of study drug, or previously diagnosed with another malignancy and have any evidence of residual disease.
  10. History of myocardial infarction, unstable symptomatic ischemic heart disease/ unstable angina, uncontrolled on-going arrhythmias of Grade >2 , pulmonary embolism, or any other cardiac condition within 6 months prior to first dose of study drug.
  11. New York Heart Association Class III or IV heart failure.
  12. History of seizure, underlying brain injury with loss of consciousness, stroke, transient ischaemic attack (TIA), cerebral vascular accident, primary brain tumours or brain metastases, brain arteriovenous malformation, alcoholism., or the use of concomitant medications that may lower the seizure threshold.
  13. Known human immunodeficiency virus (HIV) infection, active chronic hepatitis B or C, life-threatening illness unrelated to cancer, or any ongoing serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with participation in this study. Patients will be tested for hepatitis B or C or HIV infection during screening if they are considered by the investigator to be at higher risk for these infections and have not been previously tested, or if testing is required by the independent ethics committee or institutional review board.
  14. Prohibited medications, including drugs that may affect exposure to enzalutamide i.e. study drugs that induce or inhibit CYP3A4, CYP2C8, and CYP2C9

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 identifier (NCT number): NCT02225704

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Cork University Hospital
Cork, Ireland
Mater Misericordiae University Hospital
Dublin 7, Ireland
Mater Private Hospital
Dublin 7, Ireland
SLRON, St James's Hospital
Dublin, Ireland
St Vincents University Hospital / AMNCH
Dublin, Ireland
Tallaght Hospital
Dublin, Ireland
Galway University Hospital
Galway, Ireland
Sponsors and Collaborators
Cancer Trials Ireland
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Principal Investigator: Ray McDermott, Prof St Vincent's University Hospital / AMNCH
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Responsible Party: Cancer Trials Ireland Identifier: NCT02225704    
Other Study ID Numbers: CTRIAL (ICORG) 13-21
First Posted: August 26, 2014    Key Record Dates
Last Update Posted: February 21, 2021
Last Verified: February 2021
Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Prostatic Diseases