A Phase 2 Study of Radium-223 and Radiotherapy in Hormone-Naïve Men With Oligometastatic Prostate Cancer to Bone

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A Phase 2 Study of Radium-223 and Radiotherapy in Hormone-Naïve Men With Oligometastatic Prostate Cancer to Bone

Condition: Prostate Cancer Metastatic to Bone

Intervention:

  • Drug: Radium Ra 223 Dichloride
  • Radiation: Radiation

Purpose: This is a phase IIa, open label, single arm, and prospective study of hormone therapy-naïve men with oligometastatic prostate cancer to the bone. The study will test if treating the primary tumor sites and 5 or fewer sites of bone-only metastasis with external beam radiation with concomitant systemic Radium-223 will reduce the utilization of androgen deprivation therapy, improve QOL and improve OS over a the comparator cohort of SWOG intermittent ADT historic cohort.

Study Type: Interventional

Clinical Trials Identifier NCT 8-digits: NCT03304418

Sponsor: University of Utah

Primary Outcome Measures:

  • Measure: Time to Androgen Deprivation Therapy (ADT) Use
  • Time Frame: 15 months
  • Safety Issue:

Secondary Outcome Measures:

  • Measure: Time from start of study therapy to start of ADT.
  • Time Frame: 2 years
  • Safety Issue:
  • Measure: Evaluate health related quality of life (QOL)
  • Time Frame: This questionnaire will be given every 3 months for 2 years
  • Safety Issue:
  • Measure: Evaluate changes in general function and well being
  • Time Frame: This questionnaire will be given every 3 months for 2 years
  • Safety Issue:
  • Measure: Evaluate time to first skeletal related event (SRE)
  • Time Frame: 2 years
  • Safety Issue:
  • Measure: Evaluate the PSA doubling time
  • Time Frame: 2 years, assessed at every visit in that time period
  • Safety Issue:
  • Measure: Evaluate Overall Surival
  • Time Frame: 2 years
  • Safety Issue:

Estimated Enrollment: 20

Study Start Date: February 12, 2018

Phase: Phase 2

Eligibility:

  • Age: minimum 18 Years maximum N/A
  • Gender: Male

Inclusion Criteria:

  • Asymptomatic or symptomatic hormone naïve men with testosterone levels ≥100 ng/dL with previously treated localized prostate cancer who now have rising PSA’s and five or fewer bone metastases.
  • Subjects who have been previously treated with definitive and/or adjuvant/salvage radiotherapy to the primary site and/or regional lymph nodes with concurrent ADT are allowed if the last hormone therapy delivered > 6 months prior. Subjects who have had fewer than 6 weeks of bicalutamide monotherapy for any reason within the 6 months prior to enrollment are eligible for the study, providing they have been off of the drug for at least 30 days prior to enrollment.
  • Histologic confirmation of Prostate Adenocarcinoma diagnosis.
  • Age ≥ 18 years.
  • Life expectancy of at least 2 years.
  • Acceptable hematology and serum biochemistry screening values:
  • White Blood Cell Count (WBC) ≥ 3,000/mm3
  • Absolute Neutrophil Count (ANC) ≥ 1,500/mm3
  • Platelet (PLT) count ≥ 100,000/mm3
  • Hemoglobin (HGB) ≥ 10 g/dl
  • Total bilirubin level ≤ 1.5 x institutional upper limit of normal (ULN)
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 x ULN
  • Creatinine ≤ 1.5 x ULN
  • Albumin > 2.5 mg/dL
  • Willing and able to comply with the protocol, including follow-up visits and examinations.
  • Karnofsky Performance Score >60 or ECOG equivalent.
  • Radiographic confirmation of oligometastatic diagnosis via Bone Scan validated by either CT scan or MRI or PET/CT with Fluciclovine within the past 90 days.
  • Subjects who have not had surgical removal of their prostate and have a partner of child bearing potential must agree to use condoms beginning at the signing of the ICF until at least 6 months after the last dose of study drug. Because of the potential side effect on spermatogenesis associated with radiation, female partners of childbearing potential must agree to use a highly effective contraceptive method during and for 6 months after completing treatment
  • Able to provide informed consent and willing to sign an approved consent form that conforms to federal and institutional guidelines.

Exclusion Criteria:

  • Men with known brain or visceral metastases (except regional lymph nodes as defined by section 5.2.5) defined by CT or MRI Imaging of the abdomen or pelvis.
  • Men who have had LHRH agonist or antagonist hormone therapy in the prior six months.
  • Men with >5 bony metastases.
  • Men with baseline serum Testosterone <100 ng/dL.
  • Men with new or progressing lymphadenopathy clearly consistent with prostate metastasis on imaging or proven by pathologic biopsy at any time three months or later following their initial definitive therapy.
  • Prior or concurrent invasive malignancy (except non-melanomatous skin cancer) or lymphomatous/hematogenous malignancy unless continually disease free for a minimum of 3 years. All patients with in situ carcinoma are eligible for this study (for example, carcinoma in situ of the oral cavity is eligible) except patients with carcinoma of the bladder (including in situ bladder cancer or superficial bladder cancer).
  • Use of finasteride within 30 days prior to therapy PSA should not be obtained prior to 30 days after stopping finasteride.
  • Use of dutasteride within 90 days prior to therapy. PSA should not be obtained prior to 90 days after stopping dutasteride.
  • Previous or concurrent cytotoxic chemotherapy for prostate cancer.
  • Received systemic therapy with radionuclides (e.g., strontium-89, samarium-153, rhenium-186, or rhenium-188, or Radium Ra 223 dichloride) for the treatment of bony metastases.
  • Men who will receive radical prostatectomy to the primary site.
  • Imminent spinal cord compression based on clinical findings and/or magnetic resonance imaging (MRI). Spinal Cord compression will be defined as 360 degree circumferential obliteration of T2 cerebrospinal fluid signal around the spinal cord. Treatment should be completed for spinal cord compression.
  • Severe, active co-morbidity, defined as follows:
  • Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months
  • Transmural myocardial infarction within the last 6 months
  • Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
  • Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of registration
  • Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; note, however, that laboratory tests for liver function and coagulation parameters are not required for entry into this protocol. (Patients on Coumadin or other blood thinning agents are eligible for this study.)
  • Acquired Immune Deficiency Syndrome (AIDS) based upon current CDC definition; note, however, that HIV testing is not required for entry into this protocol. The need to exclude patients with AIDS from this protocol is necessary because the treatments involved in this protocol may be significantly immunosuppressive.
  • Cardiac failure New York Heart Association (NYHA) III or IV Crohn’s disease or ulcerative colitis.
  • Bone marrow dysplasia.
  • Fecal incontinence.
  • Any condition which, in the investigator’s opinion, makes the subject unsuitable for trial participation.

Contact:

  • Brett Johnson
  • 801-587-4429

Location:

  • Huntsman Cancer Institute
  • Salt Lake City Utah 84112 United States

View trial on ClinicalTrials.gov

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