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Radiologically Guided Biopsies of mCRPC

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT02432001
Recruitment Status : Recruiting
First Posted : May 1, 2015
Last Update Posted : July 22, 2019
Information provided by (Responsible Party):
University of California, San Francisco

Brief Summary:

The purpose of this study is to better understand how cancer treatment may affect cancer cells. The research will involve genetic, molecular, cellular, and immunologic experiments using blood and tumor specimens. It is hoped that the information gained from these studies will lead to a greater understanding of castrate-resistant prostate cancer and potentially, improvements in cancer treatment.

This is a tissue collection protocol requiring image-guided biopsies of metastatic, castration-resistant prostate cancer (mCRPC). The investigators will focus on enrolling patients with metastatic CRPC who have progressed while receiving novel AR-targeted therapeutics such as abiraterone and enzalutamide. This population of patients was selected because resistance develops relatively rapidly following potent inhibitors of AR activity and the mechanisms of resistance have to be better understood. Without comprehensive analysis of mCRPC tumor, the investigators will never gain a full understanding of the biology driving resistance in human disease and developing rational co-targeting approaches will not be possible.

Condition or disease Intervention/treatment
Prostate Cancer Procedure: Image-Guided Biopsies

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Study Type : Observational
Estimated Enrollment : 300 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Radiologically Guided Biopsies of Metastatic Castration Resistant Prostate Cancer (mCRPC) to Identify Adaptive Mechanisms of Resistance
Actual Study Start Date : February 1, 2013
Estimated Primary Completion Date : January 1, 2020
Estimated Study Completion Date : January 1, 2022

Resource links provided by the National Library of Medicine

Group/Cohort Intervention/treatment
Image-Guided Biopsies
Image-guided biopsies will be performed at the Dream Team Site enrolling the patient. Lesions will be chosen based upon the strength of the evidence suggesting the presence of metastasis and with the goal of minimizing patient risk. Soft tissue lesions and lesions with documented radiologic progression should be prioritized for biopsy. If the Radiologist in charge of the procedure cannot identify a lesion amenable for biopsy, the patient will be considered a screening failure.
Procedure: Image-Guided Biopsies

Primary Outcome Measures :
  1. Proportion of mCRPC patients with high androgren receptor activity [ Time Frame: Up to 2 years ]
    Determined by a gene-expression-based signature for Androgen Receptor activity having a probability of >0.50

Secondary Outcome Measures :
  1. Progression Free Survival [ Time Frame: Up to 2 years ]
    Determined by a gene expression-based signature for Androgen Receptor activity

  2. Overall Survival [ Time Frame: Up to 2 years ]
    Determined by a gene expression-based signature for Androgen Receptor activity

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
Sampling Method:   Non-Probability Sample
Study Population
Prostate Cancer

Inclusion Criteria:

  • History of histologically confirmed prostate cancer. Patients without histologically confirmed prostate cancer are eligible if both the treating physician and the study PI agree that the patient's history is unambiguously indicative of advanced prostate cancer (e.g. high PSA responsive to Androgen Deprivation Therapy.)
  • Radiographic evidence of metastatic disease amenable to image-guided biopsy of a metastatic site. Soft-tissue as well as bony metastatic lesions will be considered acceptable. Patients with locally advanced disease only (where the biopsy would be of a prostatic mass) are not eligible. Biopsy of newly emerging radiographic metastases is desired and preferable to the biopsy of previously existing lesions whenever possible.
  • Platelets >75,000/μl within 14 days prior to biopsy
  • PT or INR and a PTT < 1.5 times the institutional ULN within 14 days prior to biopsy.
  • Patients on warfarin, aspirin, or other anti-coagulants are eligible provided they are deemed able to tolerate discontinuation of anti-coagulation for one week prior to the biopsy. Conversion to low molecular weight heparin prior to biopsy is permitted per local standard operating procedures, provided there is agreement regarding the procedure between the treating physician, the interventional radiologist and the PI.
  • Castrate levels of testosterone (testosterone <50ng/dL) within 28 days prior to biopsy.
  • Patients with significant congenital or acquired bleeding disorders (eg von Wildebrand's disease, acquired bleeding factor inhibitors) are not eligible.
  • If no prior orchiectomy, medical castration therapy must continue while on study.
  • PSA level obtained within 28 days prior to biopsy.
  • Patients currently on first generation oral anti-androgens (flutamide, bicalutamide, nilutamide) must have progressed after at least 4 weeks of anti-androgen discontinuation.
  • Patient's disease is currently progressing (in setting of testosterone < 50 ng/dl), defined by any of the following criteria:
  • PSA Progression: PSA level of at least 2 ng/ml which has risen on at least 2 successive occasions, at least one week apart. If the confirmatory PSA (#3) value is less (i.e., #3b) than the screening PSA (#2) value, then an additional test for rising PSA (#4) will be required to document progression for the purposes of eligibility.
  • Soft tissue progression: by RECIST v1.1
  • Bone scan progression: the appearance of ≥ 2 new lesions. Symptomatic progression in an area of radiologically evident diseas
  • One of the following criteria must be met:
  • Evidence of disease progression (as defined above) following treatment with at least 2 months of abiraterone acetate, enzalutamide, or ARN509 - based therapy.
  • Enrollment on a high priority clinical trial conducted by the WCDT. Examples include trials with biopsy obtained before abiraterone or enzalutamide therapy, and following development of resistance to those agent(s). This list is maintained by the lead site.
  • Evidence of disease progression (as defined above) in patients with "aggressive phenotype" mCRPC with at least one of the following clinical features
  • Visceral or brain metastases
  • Known small cell or neuro-endocrine subtypes (by IHC or serum markers)
  • Primary ADT resistance defined as a nadir PSA of > 4 ng/dl after 7 months of primary androgen deprivation (with Testosterone < 50 ng/dl.)
  • Prior chemotherapy for Castration Resistant Prostate Cancer is not allowed
  • Age > 18 yrs
  • ECOG Performance status 0-3 (see appendix A)
  • Ability to understand and the willingness to sign a written informed consent document

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): NCT02432001

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Contact: Eric Small, MD 415-353-7095
Contact: Paula Dutton 415-885-7871

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United States, California
University of California, Davis Recruiting
Davis, California, United States, 95616
Contact: Primo Lara, MD         
University of California, Los Angeles Recruiting
Los Angeles, California, United States, 90095
Contact: Matthew Rettig, MD         
UCSF Helen Diller Family Comprehensive Cancer Center Recruiting
San Francisco, California, United States, 94115
Contact: Paula Dutton    415-885-7871   
United States, Oregon
Oregon Health & Science University Recruiting
Portland, Oregon, United States, 97239
Contact: Tomasz Beer, MD         
University of British Columbia Recruiting
Vancouver, Canada
Contact: Kim Chi, MD         
Sponsors and Collaborators
University of California, San Francisco
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Principal Investigator: Eric Small, MD University of California, San Francisco

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: University of California, San Francisco Identifier: NCT02432001     History of Changes
Other Study ID Numbers: 125519
First Posted: May 1, 2015    Key Record Dates
Last Update Posted: July 22, 2019
Last Verified: July 2019
Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Genital Diseases, Male
Prostatic Diseases