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PSMA PET/CT Guided Intensification of Therapy in Patients at Risk of Advanced Prostate Cancer (PATRON)

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ClinicalTrials.gov Identifier: NCT04557501
Recruitment Status : Recruiting
First Posted : September 21, 2020
Last Update Posted : July 21, 2021
Sponsor:
Collaborators:
Canadian Cancer Society (CCS)
Lantheus Medical Imaging
British Columbia Cancer Agency
London Health Sciences Centre
Princess Margaret Hospital, Canada
Tom Baker Cancer Centre
McMaster University
Institute of Health Economics, Canada
Kingston Health Sciences Centre
Information provided by (Responsible Party):
Centre hospitalier de l'Université de Montréal (CHUM)

Brief Summary:

Through the conduct of a Phase III randomized controlled trial, investigators plan to: 1) determine if PSMA PET/CT guided intensification of radiotherapy or surgery improves cancer outcomes compared to conventional imaging-guided therapy in patients at risk of advanced disease, 2) evaluate its impact on toxicity and quality of life, and 3) measure the cost-effectiveness of the PSMA PET/CT guided approach.

Participants with high-risk prostate cancer planned for curative-intent standard-of-care radiotherapy or surgery, or with biochemical failure after radical prostatectomy planned for salvage radiotherapy will be enrolled over 3 years (n=776). Those randomized to the investigational arm will have PSMA PET/CT prior to therapy. Based on the imaging results, treating physicians will intensify radiotherapy or surgery unless widely metastatic disease is found, in which case systemic therapy will be intensified.


Condition or disease Intervention/treatment Phase
Prostate Cancer Diagnostic Test: PSMA PET/CT guided intensification of therapy Other: Control Arm Phase 3

Detailed Description:

PSMA PET/CT, particularly with the new generation [18F]DCFPyL radiotracer, has substantially improved our ability to detect sites of prostate cancer compared with conventional imaging alone. When combined with innovative radiotherapeutic and surgical techniques that can now safely target and ablate such disease sites, next generation imaging is now poised to transform the therapeutic paradigm for patients at risk of advanced cancer.

Investigators postulate that intensification of radiotherapy or surgery based on the results of PSMA PET/CT will improve cancer control outcomes in a cost-effective manner, with minimal toxicity, and an overall improvement in quality of life in the longer term.

Investigators expect to show that PSMA PET/CT will have a direct and profound impact on radiotherapy and surgery practice, translating to improved failure-free survival outcomes in patients at risk of advanced prostate cancer. The subset of patients potentially impacted is broad, including patients recurring after prostatectomy and newly presenting patients with high-risk features. Although PSMA PET/CT is increasingly making its way into clinical practice around the world, Canadian provinces will need to make an informed decision of whether to fund this imaging for our patients. The high-level evidence gathered in this trial is desperately needed to assess the impact on patient outcomes and, in doing so, justify broad access and reimbursement for patients with prostate cancer.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 776 participants
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: PSMA PET/CT Guided Intensification of Therapy in Patients at Risk of Advanced Prostate Cancer
Actual Study Start Date : January 6, 2021
Estimated Primary Completion Date : October 2028
Estimated Study Completion Date : October 2028

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Prostate Cancer

Arm Intervention/treatment
Active Comparator: Control - SOC Treatment
Participants to receive surgery or radiotherapy (+/- hormone therapy) as planned per SOC.
Other: Control Arm
Control - Treatment without PSMA PET/CT

Experimental: Experimental - PSMAiTx
Participants undergo PSMA PET/CT prior to treatment, and treated intensified based on image findings.
Diagnostic Test: PSMA PET/CT guided intensification of therapy
PSMA PET/CT prior to treatment.




Primary Outcome Measures :
  1. To determine if PSMA PET/CT guided intensification of therapy is superior to standard of care (SOC) therapy as measured by improved failure-free survival (FFS). [ Time Frame: 5 years ]

Secondary Outcome Measures :
  1. Rates of toxicity (CTCAE) [ Time Frame: 5 years ]
  2. Time to subsequent next-line therapy [ Time Frame: 5 years ]
  3. Quality of Life (EPIC 26) [ Time Frame: 5 years ]
  4. New lesion detection yield (on PSMA PET/CT) [ Time Frame: 3 years ]
  5. Impact of PMSA PET/CT on RT or surgical management (rate of treatment intensification) [ Time Frame: 3 years ]
  6. Cost-effectiveness (EQ5D5L) [ Time Frame: 5 years ]


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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:

  • Histological diagnosis of adenocarcinoma of the prostate planned for curative-intent standard-of-care radiotherapy (primary or salvage post prostatectomy) or radical prostatectomy with lymph node dissection.
  • Age ≥ 18
  • High risk of regional or distant metastases as defined by any of:
  • Newly diagnosed and untreated prostate cancer with CAPRA score 6-10, or stage cN1.
  • Prior history of radical prostatectomy and biochemical failure (PSA>0.1ng/mL).
  • Patients must provide study-specific informed consent prior to study entry.
  • Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2

Exclusion Criteria:

  • Active or prior androgen deprivation therapy (except 5-alpha reductase inhibitor) terminated < 12 months prior to enrollment.
  • Prior or planned PSMA PET/CT scan outside of this clinical trial.
  • Charlson Comorbidity Index > 5 (see Appendix 2).
  • Prior curative intent treatment for prostate cancer with local therapy other than surgery (primary radiotherapy or ablative therapies)
  • Evidence of extra-pelvic nodal disease (M1a) on conventional imaging (if performed)
  • Evidence of metastatic disease (M1b bone, M1c viscera/soft tissue) on conventional imaging (if performed)

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): NCT04557501


Contacts
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Contact: Cindy Prie 514-890-8254 cindy.prie.chum@ssss.gouv.qc.ca
Contact: Cynthia Ménard cynthia.menard@umontreal.ca

Locations
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Canada, Quebec
CHU de Québec Recruiting
Québec, Quebec, Canada
Contact: Josee Allard       josee.allard@chudequebec.ca   
Contact: Sophie Pouliot       sophie.pouliot@chudequebec.ca   
Principal Investigator: Eric Vigneault, MD         
CHUS Recruiting
Sherbrooke, Quebec, Canada, J1H 5H3
Contact: Elsie Morneau    819-346-1110 x12827    elsie.morneau.ciussse-chus@ssss.gouv.qc.ca   
Contact: Sophie Couture    819-346-1110 x14311    sophie.couture.ciussse-chus@ssss.gouv.qc.ca   
Principal Investigator: Patrick Richard, MD         
Canada
CHUM Recruiting
Montréal, Canada
Contact: Cindy Prie    514-655-0390    cindy.prie.chum@ssss.gouv.qc.ca   
Principal Investigator: Cynthia Menard, MD         
Sponsors and Collaborators
Centre hospitalier de l'Université de Montréal (CHUM)
Canadian Cancer Society (CCS)
Lantheus Medical Imaging
British Columbia Cancer Agency
London Health Sciences Centre
Princess Margaret Hospital, Canada
Tom Baker Cancer Centre
McMaster University
Institute of Health Economics, Canada
Kingston Health Sciences Centre
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Responsible Party: Centre hospitalier de l'Université de Montréal (CHUM)
ClinicalTrials.gov Identifier: NCT04557501    
Other Study ID Numbers: 20.208
First Posted: September 21, 2020    Key Record Dates
Last Update Posted: July 21, 2021
Last Verified: September 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Prostatic Diseases