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Conventional ADT w/ or w/Out Abiraterone Acetate + Prednisone and Apalutamide Following a Detectable PSA After Radiation and ADT

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ClinicalTrials.gov Identifier: NCT03777982
Recruitment Status : Recruiting
First Posted : December 18, 2018
Last Update Posted : October 16, 2019
Sponsor:
Collaborator:
Janssen Scientific Affairs, LLC
Information provided by (Responsible Party):
Anthony V. D'Amico, MD, PhD, Dana-Farber Cancer Institute

Brief Summary:

This research study is being offered to those patients who have already received radiation therapy and who are receiving long-term hormonal therapy for their prostate cancer and whose PSA remains detectable (greater than 0.1) despite having received at least 6, but no more than 8 months of hormonal therapy.

The name of the study drugs involved in this study is:

  • LHRHA (luteinizing hormone-releasing hormone agonist or antagonist)
  • Abiraterone Acetate
  • Apalutamide
  • Prednisone

Condition or disease Intervention/treatment Phase
Prostate Cancer Drug: Prednisone Drug: Apalutamide Drug: Abiraterone Acetate Drug: LHRH Agonist or Antagonist Phase 3

Detailed Description:

This research study is a Phase III clinical trial. Phase III clinical trials test the effectiveness of an investigational intervention to learn whether the intervention works in treating a specific disease. "Investigational" means that an intervention is being studied. In this study, the investigational agents are apalutamide and abiraterone acetate. Abiraterone acetate (used in combination with prednisone) is an FDA (the U.S. Food and Drug Administration) approved drug for prostate cancer, but is approved in patients that have prostate cancer spread to other parts of their body and have been previously treated with ADT. Apalutamide has also been approved by the FDA for men whose cancer does not respond to hormone therapy but it is still investigational for this type of cancer.

In this research study, the investigators are looking at two methods of androgen deprivation therapy (ADT), also known as hormonal therapy, to determine which method is better for improving long term cure rates. ADT blocks the function of hormones, including testosterone which prostate cancer uses to grow and spread. The first method of ADT includes prednisone, apalutamide, and abiraterone acetate plus standard ADT and the second method of ADT is standard ADT alone for men with this type of prostate cancer. Currently, the best standard treatment for men with this type of prostate cancer includes standard ADT. All participants in this study will receive the main standard form of ADT called a luteinizing hormone-releasing hormone agonist or antagonist (LHRHA).


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 400 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomized Phase III Study - Conventional Androgen Deprivation Therapy With or Without Abiraterone Acetate + Prednisone and Apalutamide Following a Detectable PSA After Radiation and Androgen Deprivation Therapy
Estimated Study Start Date : October 25, 2019
Estimated Primary Completion Date : December 31, 2026
Estimated Study Completion Date : December 31, 2034

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: LHRH Agonist or Antagonist
-LHRH agonist or antagonist should be prescribed per standard of care
Drug: LHRH Agonist or Antagonist
Luteinizing hormone-releasing hormone (LHRH) agonists (also called LHRH analogs or GnRH agonists) are drugs that lower the amount of testosterone made by the testicles
Other Name: GnRH

Experimental: Prednisone+Apalutamide+Abiraterone Acetate +LHRH Agonist
  • LHRH agonist or antagonist should be prescribed per standard of care
  • Abiraterone acetate will be taken once daily
  • Prednisone will be taken twice daily
  • Apalutamide will be taken once daily
Drug: Prednisone
Taking advantage of the anti-inflammatory properties of the medication, corticosteroids are used to decrease the swelling around tumors.
Other Name: Deltasone

Drug: Apalutamide
Apalutamide also prevents the androgens from working within the prostate cancer cells, and can ultimately lead to cancer cell death.
Other Name: ARN-509

Drug: Abiraterone Acetate
Abiraterone acetate interferes with an enzyme that is expressed in testicular, adrenal, and prostatic tumor tissues and is required as part of the body's androgen producing process. Because of this interference the amount of androgens produced are decreased. Abiraterone acetate, blocks androgen production at three sources; the testes, the adrenal glands, as well as from the tumor itself
Other Name: Zytiga

Drug: LHRH Agonist or Antagonist
Luteinizing hormone-releasing hormone (LHRH) agonists (also called LHRH analogs or GnRH agonists) are drugs that lower the amount of testosterone made by the testicles
Other Name: GnRH




Primary Outcome Measures :
  1. Metastasis Free Survival [ Time Frame: 2 years ]
    the composite of metastasis or any cause death


Secondary Outcome Measures :
  1. PSA nadir [ Time Frame: 2 years ]
    PSA nadir is defined as the lowest PSA after RT completion

  2. Castrate Resistant PSA Failure Free Survival [ Time Frame: 2 years ]
    Castrate resistant PSA failure is defined as the first PSA increase that is ≥ 25% and 2 ng/mL above the nadir, which is confirmed by a second value 3 or more weeks later, while the serum total testosterone level is < 50 ng/dl (per the PCWG2 criteria).

  3. Prostate Cancer Specific Survival [ Time Frame: 2 years ]
    Prostate cancer specific survival is defined the time from randomization to death from prostate cancer where death due to other causes are considered as competing risk, or censored at the last date of follow up in living patients.

  4. Overall Survival [ Time Frame: 2 years ]
    Overall survival is defined as the time from randomization to death from any cause with men censored at time of last follow up if alive.

  5. Disease Free Survival [ Time Frame: 2 years ]
    Disease free survival is measured from the date of randomization to the first recorded disease recurrence consisting of castrate resistant PSA failure and/or local, regional or distant failure and death from any cause, whichever comes first, or censored at the date of last disease assessment for those alive and disease recurrence free.

  6. Toxicity as measured by CTCAE [ Time Frame: 2 years ]
    We will measure Grade 1-5 toxicities at study visits and follow-up using the CTCAE v.5 forms and determine attribution.



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
Criteria

Inclusion Criteria:

  • In order to ensure a homogenous population at study entry, a bone scan and not a PET will be used to ensure M0 high risk prostate cancer. A bone scan is to be done up to 6 months prior to the start of initial ADT therapy or up to one month after initiation of ADT to rule out bony metastatic disease.
  • Histologically confirmed prostate cancer
  • PSA> 0.1 after radiation and at least 6, but not more than 8 months of conventional ADT (LHRH agonist or antagonist with or without oral anti-androgens, excluding abiraterone acetate and apalutamide) in patients with non-metastatic high risk or N1 prostate cancer

    • High risk is defined per the NCCN guidelines - clinical or radiographic T3, Gleason 8-10, or PSA > 20 ng/mL, and can be N0 or N1
    • A month is defined as 28 days
  • Written informed consent and HIPAA authorization for release of personal health information prior to registration. NOTE: HIPAA authorization may be included in the informed consent or obtained separately. Subject must have the ability to understand and willingness to sign the written informed consent document.
  • Age ≥18 at the time of consent
  • ECOG Performance Status ≤ 2 (Appendix A)
  • Demonstrate adequate organ function as defined in the table below. All screening labs to be obtained within 3 months of registration.
  • System Laboratory Value
  • Hematological:

    • Platelet count (plt)1 ≥ 100,000/ µL
    • Hemoglobin (Hgb)1 ≥ 9 g/dL
    • Absolute neutrophil count (ANC) ≥ 1000 cells/µL
  • Renal:

    --CrCl2 ≥ 45 mL/min

  • Hepatic and Other:

    • Bilirubin3 ≤ 1.5 × upper limit of normal (ULN)
    • Aspartate aminotransferase (AST) < 2.5 × ULN
    • Alanine aminotransferase (ALT) < 2.5 × ULN
    • Serum Albumin > 3.0 g/dL
    • Serum potassium ≥ 3.5 mmol/L
  • Coagulation:

    --International Normalized Ratio (INR) or Prothrombin Time (PT)

  • Activated Partial Thromboplastin Time
  • (aPTT) ≤ 1.5 × ULN (unless on prophylactic or therapeutic dosing with low molecular weight heparin)

    • Independent of transfusion and/or growth factors within 3 months prior to randomization
    • Cockcroft-Gault formula will be used to calculate creatinine clearance
    • In subjects with Gilbert's syndrome, if total bilirubin is >1.5 × ULN, measure direct and indirect bilirubin; if direct bilirubin is ≤1.5 × ULN, subject may be eligible
  • Agrees to use a condom (even men with vasectomies) and another effective method of birth control if he is having sex with a woman of childbearing potential OR agrees to use a condom if he is having sex with a woman who is pregnant while on study drug and for 3 months following the last dose of study drug. Must also agree not to donate sperm during the study and for 3 months after receiving the last dose of study drug.
  • Ability to understand and comply with study procedures for the entire length of the study as determined by the site investigator or protocol designee
  • Medications known to lower the seizure threshold (section 5.4.4) must be discontinued or substituted prior to C1D1 of study treatment for patients on Arm 2
  • Able to swallow pills

Exclusion Criteria:

  • Prior radical prostatectomy (excluding TURP and simple prostatectomy)
  • History of any of the following:

    • Seizure or known condition that may predispose to seizure (e.g., prior stroke within 1 year of randomization, brain arteriovenous malformation, Schwannoma, meningioma, or other benign CNS or meningeal disease which may require treatment with surgery or radiation therapy)
    • Severe or unstable angina, myocardial infarction, symptomatic congestive heart failure, arterial or venous thromboembolic events (eg, pulmonary embolism, cerebrovascular accident including transient ischemic attacks), or clinically significant ventricular arrhythmias within 6 months prior to randomization
  • Known current evidence of any of the following:

    • Uncontrolled hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg). Participants with a history of hypertension are allowed provided blood pressure is controlled by anti-hypertensive therapy
    • Gastrointestinal disorder affecting absorption
    • Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome.
    • Known active or chronic hepatitis B infection (defined as having a positive hepatitis B surface antigen (HBsAg) test at screening). Subject with past or resolved hepatitis B infection (defined as having a negative HBsAg test and positive antibody to hepatitis B core antigen test) are eligible. Hepatitis B viral DNA must be obtained in subjects with positive hepatitis B core antibody prior to first treatment start.
    • Active hepatitis C infection. Subjects positive hepatitis C antibody test are eligible if PCR is negative for hepatitis C viral DNA.
    • Pre-existing condition that warrants long-term corticosteroid use greater than the equivalent of 10 mg prednisone daily. Physiologic replacement is permitted. Topical, intra-articular steroids or inhaled corticosteroids are permitted.
    • Any condition that, in the opinion of the site investigator, would preclude participation in this study
    • Baseline moderate or severe hepatic impairment (ChildPugh Class B or C)
  • Avoid concomitant strong CYP3A4 inducers during abiraterone acetate treatment (section 5.4.3). If a strong CYP3A4 inducer must be co-administered, increase the abiraterone acetate dosing frequency.
  • Avoid co-administration of abiraterone acetate with CYP2D6 substrates that have a narrow therapeutic index. If an alternative treatment cannot be used, exercise caution and consider a dose reduction of the concomitant CYP2D6 substrate
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to study drugs
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, psychiatric illness or social situations that would limit compliance with study requirements
  • Individuals with a history of another malignancy are not eligible if the cancer is under active treatment or the cancer can be seen on radiology scans or if they are off cancer treatment but in the opinion of their oncologist have a high risk of relapse within 5 years.

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): NCT03777982


Contacts
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Contact: Anthony V. D'Amico, MD, PhD 857-215-1489 Adamico@bwh.harvard.edu

Locations
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United States, Massachusetts
Brigham and Women's Hospital Recruiting
Boston, Massachusetts, United States, 02215
Contact: Anthony D'Amico, MD, PhD    857-215-1489    adamico@bwh.harvard.edu   
Contact: Shana Medeiros    617-582-8309    smedeiros7@bwh.harvard.edu   
Principal Investigator: Anthony D'Amico, MD, PhD         
Dana Farber Cancer Institute Recruiting
Boston, Massachusetts, United States, 02215
Contact: Anthony D'Amico, MD, PhD    857-215-1489    adamico@bwh.harvard.edu   
Contact: Shana Medeiros    617-582-8309    shana_medeiros@dfci.harvard.edu   
Principal Investigator: Anthony D'Amico, MD, PhD         
Sponsors and Collaborators
Dana-Farber Cancer Institute
Janssen Scientific Affairs, LLC
Investigators
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Principal Investigator: Anthony D'Amico, MD, PhD Brigham and Women's Hospital

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Responsible Party: Anthony V. D'Amico, MD, PhD, Principal Investigator, Dana-Farber Cancer Institute
ClinicalTrials.gov Identifier: NCT03777982     History of Changes
Other Study ID Numbers: 18-530
First Posted: December 18, 2018    Key Record Dates
Last Update Posted: October 16, 2019
Last Verified: October 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor-Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Time Frame: Data can be shared no earlier than 1 year following the date of publication.
Access Criteria: Requests may be directed to: [contact information for Sponsor-Investigator or designee].

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Anthony V. D'Amico, MD, PhD, Dana-Farber Cancer Institute:
Prostate Cancer
Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Prednisone
Abiraterone Acetate
Androgens
Anti-Inflammatory Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Steroid Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Hormone Antagonists
Cytochrome P-450 Enzyme Inhibitors