Phase II Study of Pencil Beam Scanning Proton Stereotactic Body Radiation Therapy for Prostate Cancer

• ClinicalTrials.gov Identifier: NCT04842890
• Recruitment Status: Recruiting
• First Posted: April 13, 2021
• Last Update Posted: April 13, 2021
• Sponsor: The New York Proton Center
• Information provided by (Responsible Party): The New York Proton Center

Study Description

Brief Summary:

This is a single arm phase II study of image-guided pencil beam scanning proton SBRT (40Gy RBE in 5 fractions delivered every other day) for patients with low- and intermediate-risk prostate cancer. The primary aim is to assess GU/GI toxicity of proton SBRT and compare this to historic outcomes associated with photon-based prostate SBRT. The primary endpoint is 2-year grade 3+ GU/GI toxicity free rate by CTCAE v5.0, which is expected to be ≥95%. Toxicity will be evaluated by the treating radiation oncologist at least once during SBRT, then following SBRT at 1, 3, 6, 12, 18, and 24 months. The treatment will be considered safe if grade 3 or higher GU/GI toxicity free rate at 2 years is >85% (95% rate expected with a 10% non-inferiority margin). The accrual goal is 61 patients over 3 years. To ensure that unexpected significant toxicity is identified, all grade 3 or higher toxicities will be reported to the study PI and the trial will stop accruing if at any point 4 or more patients experience a grade 3 or higher toxicity after completing SBRT. This is felt to be conservative given the vast experience with photon SBRT at this dose with an expected G3+ toxicity of ~5%.

Secondary objectives are to examine patient-reported urinary, gastrointestinal, sexual, and financial outcomes using IPSS, EPIC-26, and COST questionnaires at the same follow-up timepoints as above. Baseline measures of these domains will be obtained prior to treatment as well. Clinical outcomes will also be evaluated with PSA measured at each follow-up, as well as prostate MRI and biopsies at 2 years. Patients will be followed for at least 2 years to determine rates of PSA relapse, salvage treatment, development of metastases, death from prostate cancer, and overall survival. A dosimetric comparison will be performed where each patient will be planned for proton and photon SBRT to determine possible advantages of proton SBRT.

Condition or disease	Intervention/treatment	Phase
Prostate Cancer	Radiation: Pencil Beam Scanning Proton SBRT	Phase 2

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 61 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Phase II Study of Pencil Beam Scanning Proton Stereotactic Body Radiation Therapy for Prostate Cancer
• Actual Study Start Date: January 8, 2021
• Estimated Primary Completion Date: January 2023
• Estimated Study Completion Date: January 2026

Arms and Interventions

Arm	Intervention/treatment
Stereotactic body radiation therapy (SBRT) with Pencil Beam Scanning (PBS) proton therapy	Radiation: Pencil Beam Scanning Proton SBRT; The intervention being investigated is ultra-hypofractionated, image-guided, pencil beam scanning proton SBRT directed at the prostate gland and seminal vesicles to 40 Gy equivalent in 5 fractions, delivered every other day.

Outcome Measures

Primary Outcome Measures :

1. 1. Grade 3+ GU/GI toxicity-free rate determined by CTCAE v5.0 grading. [ Time Frame: 2 years ]
   The NCI Common Terminology Criteria for Adverse Events v5.0 is a descriptive terminology which can be utilized for Adverse Event (AE) reporting. A grading (severity) scale is provided for each AE term.

Secondary Outcome Measures :

1. 1. Patient reported urinary symptoms determined by IPSS. [ Time Frame: 2 years ]
   The International Prostate Symptom Score (IPSS) was developed to assess the severity of lower urinary tract symptoms associated to Benign Prostatic Hyperplasia and has also been applied to other conditions that cause LUTS. The IPSS consists of a total of seven questions that deal with voiding symptoms (incomplete empty, intermittency, weak stream and straining to void) and storage symptoms (frequency, urgency and nocturia) and an additional question to measure quality of life. The score ranges from 0 to 35, with lower scores denoting a better health state.
2. 2. Patient reported urinary, bowel, and hormonal quality of life determined by EPIC-26. [ Time Frame: 2 years ]
   EPIC-26 is the "Expanded Prostate Cancer Index Composite" patient reported outcomes questionnaire. A clinical tool to assess urinary, bowel, sexual and vitality health. The score from each of the 5 domains runs from 0 (none) to 12 (severe) impact on quality of life. Each domain score when added together gives an overall score of zero (unaffected) to 60 (severely affected)
3. 3. Patient reported financial toxicity determined by COST [ Time Frame: 2 years ]
   Comprehensive Score for Financial Toxicity Functional Assessment of Chronic Illness Therapy (COST-FACIT) was developed as part of a series of questionnaires aimed at measuring different symptom indexes of health-related quality of life in patients with advance disease such as cancer. The survey contains 12 questions and each of them is rated from 0 (not at all) to 4 (very much). This survey focuses on financial distress caused by illness in patients with cancer. It takes about 5 minutes to complete.
4. 4. 2-year and 5-year biochemical progression free survival [ Time Frame: 2 years and 5 years ]
   Biochemical failure is defined as a sustained rise in PSA of 2 ng/mL or more above the nadir (the lowest PSA level after radiotherapy).
5. 5. 2-year local control determined by MRI and biopsies [ Time Frame: 2 years ]
6. 6. 2-year and 5-year metastasis free survival [ Time Frame: 2 years and 5 years ]
7. 7. 2-year and 5-year prostate cancer specific survival [ Time Frame: 2 years and 5 years ]
8. 8. 2-year and 5-year overall survival [ Time Frame: 2 years and 5 years ]
9. 9. Dosimetric advantages determined by target coverage, conformality, and normal tissue sparing [ Time Frame: 2 years ]

Eligibility Criteria

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

Criteria

Inclusion Criteria:

• Biopsy-proven NCCN low- or intermediate-risk prostate cancer, which includes patients with:
• Gleason score ≤7 disease
• PSA ≤20 ng/ml

• Clinical T1-T2c disease

  • Note: Patients who only have radiographic evidence of possible or probable T3 disease (i.e., extracapsular extension or seminal vesical invasion) will not be excluded.
• KPS ≥ 80%
• Prostate size as determined on MRI to be < 100 cc. Prostate size can be determined on CT scan if MRI is not available.
• Male 18 years of age or older
• IPSS ≤ 20
• Patient must be a candidate for and agree to placement of intraprostatic fiducial markers and a hydrogel rectal spacer
• Patient must be available for at least 2 years of follow-up

Exclusion Criteria:

• Prior prostate surgery (including cryosurgery)

  • Note: Patients who underwent TURP or greenlight PVP are eligible if it was > 12 weeks prior to the anticipated start date of SBRT
• Prior history of chronic prostatitis or urethral stricture
• Currently active cancer(s) other than non-melanoma skin cancers. Patients are not considered to have currently active cancers if they have completed therapy and are considered by their physicians to be at <5% risk of relapse within 2 years.
• Life expectancy of < 2 years

Contacts and Locations

Contacts

Contact: Shannon Webert, RN; 646-968-9005 ext 383; research@nyproton.com

Locations

United States, New York

The New York Proton Center; Recruiting

New York, New York, United States, 10035

Contact: Isabelle Choi, MD 646-968-9031 ext 303 ichoi@nyproton.com

Sponsors and Collaborators

The New York Proton Center

Investigators

• Principal Investigator: Daniel Gorovets, MD; The New York Proton Center
• Principal Investigator: Shaakir Hasan, DO; The New York Proton Center

More Information

• Responsible Party: The New York Proton Center
• ClinicalTrials.gov Identifier: NCT04842890
• Other Study ID Numbers: NYPC ERC# 2020-027
• First Posted: April 13, 2021
• Last Update Posted: April 13, 2021
• Last Verified: April 2021

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Undecided

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: Yes
• Product Manufactured in and Exported from the U.S.: No

Additional relevant MeSH terms:

Prostatic Neoplasms; Genital Neoplasms, Male; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Prostatic Diseases