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Randomized Salvage Radiation Therapy Plus Enzalutamide Post Prostatectomy

Primary Purpose

Adenocarcinoma of the Prostate

Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Enzalutamide
SRT
Sponsored by
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Adenocarcinoma of the Prostate focused on measuring Salvage Radiation Therapy (SRT), Enzalutamide

Eligibility Criteria

18 Years - 100 Years (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Willing and able to provide written informed consent and Health Insurance Portability and Accountability Act (HIPPA) authorization for the release of personal health information.
  • Males aged 18 years of age and above
  • Patients must have adenocarcinoma of the prostate gland
  • Patients must have received primary treatment with radical prostatectomy.
  • Patients must have evidence of biochemical (PSA) relapse after prostatectomy
  • Patients must have PSA within study range
  • Patients must have non-metastatic (M0) disease, as defined by a lack of metastases seen on CT scan of the chest/abdomen/pelvis and whole-body radionuclide 99Technetium (Tc) bone scan, (or sodium fluoride PET scan) taken within 3 months of study entry.
  • Patients must have had node negative (pN0) disease found at the time of surgery.
  • Patients must have non-castrate levels of serum testosterone levels within study range.
  • Patients must not have previously received hormonal therapy (LHRH agonist, antiandrogen, or both), with the exception of neoadjuvant or adjuvant hormones given in conjunction with prostatectomy.
  • Patients must have Eastern Cooperative Oncology Group (ECOG)performance status of 0-1, and life expectancy greater 3 years.
  • Patients must have laboratory test results within the certain ranges
  • Patients must be disease-free from prior malignancies for greater than 3 years, with the exception of non-melanoma skin cancers and superficial urothelial cancers.
  • Patients must have the ability to swallow the study drug whole as a tablet or capsule.
  • Throughout study, male patient and his female partner who is of childbearing potential must use 2 acceptable methods of birth control (1 of which must include a condom as a barrier method of contraception) starting at screening and continuing throughout the study period and for 3 months after final study drug administration or per local guidelines where these require additional description of contraceptive methods.
  • Throughout the study, patients must use a condom if having sex with a pregnant woman.

Exclusion Criteria:

  • Currently active second malignancy
  • Primary treatment with radiation therapy.
  • Radiographic or clinical evidence of local-regional tumor recurrence,
  • Concurrent use of other antiandrogens, estrogen-like agents, or 5a-reductase inhibitors.
  • Use of systemic corticosteroids equivalent to prednisone (inhaled corticosteroids are permitted).
  • Concurrent use of other anti-cancer agents or treatments.
  • Serious concurrent medical illnesses (including uncontrolled major cardiac, pulmonary, Child-Pugh C liver or psychiatric diseases) or active major infections (including HIV, Hepatitis A-C).
  • Clinically significant cardiovascular disease including:

    • Myocardial infarction within 6 months of Screening visit.
    • Uncontrolled angina within 3 months of Screening visit.
    • Congestive heart failure (within certain ranges)
    • History of clinically significant ventricular arrhythmias
    • Prolonged corrected QT interval
    • History of Mobitz II second degree or third degree heart block without a permanent pacemaker in place.
    • Hypotension within certain ranges
    • Uncontrolled hypertension within certain ranges
  • Medications which lowers seizure threshold.
  • History of seizure or any condition that may predispose to seizure including, but not limited to underlying brain injury, stroke, primary brain tumors, brain metastases, or alcoholism. Also, history of loss of consciousness or transient ischemic attack within 12months of enrollment (Day 1 visit).
  • Patients taking medications that may have adverse interactions with enzalutamide

Sites / Locations

  • Sibley Memorial Hospital
  • University of Chicago Medical Center
  • Indiana University
  • The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • Suburban Hospital
  • University of Michigan Health System
  • Karmanos Cancer Center
  • Oregon Health Sciences University
  • University of Utah - Huntsman Cancer Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

SRT plus Enzalutamide

SRT plus placebo

Arm Description

Arm 2 (experimental): (SRT) Salvage radiation therapy (Three dimensional conformal radiation therapy (3D-CRT)/IMRT [Intensity-modulated radiation therapy]) 66.6-70.2 Gy as 1.8 Gy M-F for 37-39 fx PLUS Enzalutamide (MDV3100) 160 mg PO once daily for 6 months (2 months prior to SRT, 2 months during SRT and 2 months following SRT)

Arm 1 (control): Salvage radiation therapy (3D-CRT (Three dimensional conformal radiation therapy)/IMRT (Intensity-modulated radiation therapy)) 66.6-70.2 Gy given 1.8 Gy M-F for 37 -39 fx PLUS Placebo PO daily for 6 months (2 months prior to SRT, 2 months during SRT and 2 months following SRT)

Outcomes

Primary Outcome Measures

Freedom of PSA (Prostate Specific Antigen) progression
The primary efficacy endpoint is the rate of Freedom-from-PSA-progression (FFPP) at 2-years. FFPP is defined as the time from randomization to the date of PSA progression. A subject who does not have PSA progression at the time of the analysis will be censored at the last date of PSA measurement.

Secondary Outcome Measures

Local recurrence
Local recurrence within the radiation field (confirmed pathologically) at 2-years
Metastatic free survival rate
Metastasis-free survival (MFS) rates at 2 years. Metastasis-free survival will be defined as the time from the date of registration to date of evidence of systemic disease on bone scan or cross sectional imaging or death, which occurs first.
Adverse Events Encountered
Safety as assessed by NCI Common Toxicity Scales (v4.0)
How well participants tolerate treatment
Quality of life (QoL) tools to be used to determine participant tolerability of treatment will include FACT-P, European Organization for the Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) -C30/QLQ-PR25, and SHIM.
Feasibility of achieving stated accrual
Compare anticipated accrual versus actual.

Full Information

First Posted
June 16, 2014
Last Updated
May 30, 2023
Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
Astellas Pharma Inc, Medivation, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02203695
Brief Title
Randomized Salvage Radiation Therapy Plus Enzalutamide Post Prostatectomy
Official Title
Phase II Randomized Placebo-Controlled Double-Blind Study of Salvage Radiation Therapy (SRT) Plus Placebo Versus SRT Plus Enzalutamide in Men With High-Risk PSA-Recurrent Prostate Cancer After Radical Prostatectomy
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 28, 2015 (Actual)
Primary Completion Date
December 31, 2022 (Actual)
Study Completion Date
December 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
Astellas Pharma Inc, Medivation, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The primary hypothesis of this study is that outcomes for patients with biochemically recurrent prostate cancer following radical prostatectomy will be improved by the addition of enzalutamide for 6-months compared to standard-of-care salvage radiation therapy to allow for further study in the definitive phase III setting. This study builds on the prior success of high-dose bicalutamide (for 24 months) when combined with salvage external radiation therapy (XRT), while using a newer more potent anti-androgen for a shorter duration of time (6 months) in an effort to minimize adverse effects.
Detailed Description
Enzalutamide is a second-generation androgen receptor signaling inhibitor that significantly prolongs survival in patients with metastatic castration-resistant prostate cancer who have received prior docetaxel chemotherapy 35,36. Enzalutamide has demonstrated activity in cells that overexpress the androgen receptor. Unlike previous androgen receptor blocker (ARB) agents, Enzalutamide does not display any agonist properties and blocks translocation of the ligand-receptor complex into the nucleus preventing DNA binding 33. Enzalutamide is an oral agent that is generally well tolerated and does not require concurrent steroid administration, which makes it an ideal candidate for combination with salvage radiation therapy (SRT). Finally, provocative preliminary Phase II data presented at the American Society of Clinical Oncology (ASCO) 2013 by M. Smith and colleagues assessed the efficacy and safety of 25-weeks (~6-mos) of enzalutamide alone in prostate cancer of all stages who had never received hormone therapy; presenting with non-castrate testosterone levels ( 230 ng/dL). Enzalutamide alone for 6-mos achieved a high PSA response rate with efficacy similar to castration, but .in contrast to castration, bone mineral density (BMD) remained stable and metabolic variables were not substantially impacted. The trial described here differs from Radiation Therapy Oncology Group (RTOG) 96-01, RTOG 05-34 and RADICALS in several ways. First, the eligibility criteria are stricter; less favorable patients have been selected. Second, short-term ARB is being tested, while in RTOG 96-01 and RADICALS long-term ARB of 2-years was examined. Finally, and most importantly, we are testing the second generation ARB agent, enzalutamide, alone in combination with SRT as opposed to RTOG 05-34 and RADICALS which use androgen deprivation (AD). This trial is not intended to address the efficacy of SRT alone over observation. The complete response rate (a drop in PSA to undetectable levels) after SRT is 70%-80% and durable responses are observed in 30%-40% of patients. For these reasons, it is not feasible or appropriate to randomize men between observation and SRT. The more important issue is whether the proportion of durable responses is increased by altering the therapeutic approach, such as the use of enhanced ARB using enzalutamide.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Adenocarcinoma of the Prostate
Keywords
Salvage Radiation Therapy (SRT), Enzalutamide

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
96 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
SRT plus Enzalutamide
Arm Type
Experimental
Arm Description
Arm 2 (experimental): (SRT) Salvage radiation therapy (Three dimensional conformal radiation therapy (3D-CRT)/IMRT [Intensity-modulated radiation therapy]) 66.6-70.2 Gy as 1.8 Gy M-F for 37-39 fx PLUS Enzalutamide (MDV3100) 160 mg PO once daily for 6 months (2 months prior to SRT, 2 months during SRT and 2 months following SRT)
Arm Title
SRT plus placebo
Arm Type
Placebo Comparator
Arm Description
Arm 1 (control): Salvage radiation therapy (3D-CRT (Three dimensional conformal radiation therapy)/IMRT (Intensity-modulated radiation therapy)) 66.6-70.2 Gy given 1.8 Gy M-F for 37 -39 fx PLUS Placebo PO daily for 6 months (2 months prior to SRT, 2 months during SRT and 2 months following SRT)
Intervention Type
Drug
Intervention Name(s)
Enzalutamide
Other Intervention Name(s)
XTANDI
Intervention Description
Enzalutamide (MDV3100) 160 mg PO once daily for 6 months (2 months prior to SRT, 2 months during SRT and 2 months following SRT)
Intervention Type
Radiation
Intervention Name(s)
SRT
Other Intervention Name(s)
Salvage Radiation Therapy
Intervention Description
Salvage radiation therapy (3D-CRT (Three dimensional conformal radiation therapy)/IMRT) 66.6-70.2 Gy given 1.8 Gy M-F for 37 -39 fx
Primary Outcome Measure Information:
Title
Freedom of PSA (Prostate Specific Antigen) progression
Description
The primary efficacy endpoint is the rate of Freedom-from-PSA-progression (FFPP) at 2-years. FFPP is defined as the time from randomization to the date of PSA progression. A subject who does not have PSA progression at the time of the analysis will be censored at the last date of PSA measurement.
Time Frame
2 years from end of therapy
Secondary Outcome Measure Information:
Title
Local recurrence
Description
Local recurrence within the radiation field (confirmed pathologically) at 2-years
Time Frame
2 years from end of therapy
Title
Metastatic free survival rate
Description
Metastasis-free survival (MFS) rates at 2 years. Metastasis-free survival will be defined as the time from the date of registration to date of evidence of systemic disease on bone scan or cross sectional imaging or death, which occurs first.
Time Frame
2 years from the time of registration
Title
Adverse Events Encountered
Description
Safety as assessed by NCI Common Toxicity Scales (v4.0)
Time Frame
At the end of therapy at months 2, 3, 4, 5, 6 and then every 3 months for 24 months
Title
How well participants tolerate treatment
Description
Quality of life (QoL) tools to be used to determine participant tolerability of treatment will include FACT-P, European Organization for the Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) -C30/QLQ-PR25, and SHIM.
Time Frame
During active treatment phase of study, at the end of therapy at months 2, 3, 4, 5, 6 and then every 3 months for 24 months
Title
Feasibility of achieving stated accrual
Description
Compare anticipated accrual versus actual.
Time Frame
During active treatment phase of study, at the end of therapy at months 2, 3, 4, 5, 6 and then every 3 months for 24 months

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
100 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Willing and able to provide written informed consent and Health Insurance Portability and Accountability Act (HIPPA) authorization for the release of personal health information. Males aged 18 years of age and above Patients must have adenocarcinoma of the prostate gland Patients must have received primary treatment with radical prostatectomy. Patients must have evidence of biochemical (PSA) relapse after prostatectomy Patients must have PSA within study range Patients must have non-metastatic (M0) disease, as defined by a lack of metastases seen on CT scan of the chest/abdomen/pelvis and whole-body radionuclide 99Technetium (Tc) bone scan, (or sodium fluoride PET scan) taken within 3 months of study entry. Patients must have had node negative (pN0) disease found at the time of surgery. Patients must have non-castrate levels of serum testosterone levels within study range. Patients must not have previously received hormonal therapy (LHRH agonist, antiandrogen, or both), with the exception of neoadjuvant or adjuvant hormones given in conjunction with prostatectomy. Patients must have Eastern Cooperative Oncology Group (ECOG)performance status of 0-1, and life expectancy greater 3 years. Patients must have laboratory test results within the certain ranges Patients must be disease-free from prior malignancies for greater than 3 years, with the exception of non-melanoma skin cancers and superficial urothelial cancers. Patients must have the ability to swallow the study drug whole as a tablet or capsule. Throughout study, male patient and his female partner who is of childbearing potential must use 2 acceptable methods of birth control (1 of which must include a condom as a barrier method of contraception) starting at screening and continuing throughout the study period and for 3 months after final study drug administration or per local guidelines where these require additional description of contraceptive methods. Throughout the study, patients must use a condom if having sex with a pregnant woman. Exclusion Criteria: Currently active second malignancy Primary treatment with radiation therapy. Radiographic or clinical evidence of local-regional tumor recurrence, Concurrent use of other antiandrogens, estrogen-like agents, or 5a-reductase inhibitors. Use of systemic corticosteroids equivalent to prednisone (inhaled corticosteroids are permitted). Concurrent use of other anti-cancer agents or treatments. Serious concurrent medical illnesses (including uncontrolled major cardiac, pulmonary, Child-Pugh C liver or psychiatric diseases) or active major infections (including HIV, Hepatitis A-C). Clinically significant cardiovascular disease including: Myocardial infarction within 6 months of Screening visit. Uncontrolled angina within 3 months of Screening visit. Congestive heart failure (within certain ranges) History of clinically significant ventricular arrhythmias Prolonged corrected QT interval History of Mobitz II second degree or third degree heart block without a permanent pacemaker in place. Hypotension within certain ranges Uncontrolled hypertension within certain ranges Medications which lowers seizure threshold. History of seizure or any condition that may predispose to seizure including, but not limited to underlying brain injury, stroke, primary brain tumors, brain metastases, or alcoholism. Also, history of loss of consciousness or transient ischemic attack within 12months of enrollment (Day 1 visit). Patients taking medications that may have adverse interactions with enzalutamide
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Phuoc Tran, M.D.
Organizational Affiliation
The SKCCC at Johns Hopkins
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sibley Memorial Hospital
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20016
Country
United States
Facility Name
University of Chicago Medical Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States
Facility Name
Indiana University
City
Lafayette
State/Province
Indiana
ZIP/Postal Code
47904
Country
United States
Facility Name
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Facility Name
Suburban Hospital
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20814
Country
United States
Facility Name
University of Michigan Health System
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48109
Country
United States
Facility Name
Karmanos Cancer Center
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
Facility Name
Oregon Health Sciences University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States
Facility Name
University of Utah - Huntsman Cancer Center
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84112
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
36367998
Citation
Tran PT, Lowe K, Tsai HL, Song DY, Hung AY, Hearn JWD, Miller S, Proudfoot JA, Deek MP, Phillips R, Lotan T, Paller CJ, Marshall CH, Markowski M, Dipasquale S, Denmeade S, Carducci M, Eisenberger M, DeWeese TL, Orton M, Deville C, Davicioni E, Liauw SL, Heath EI, Greco S, Desai NB, Spratt DE, Feng F, Wang H, Beer TM, Antonarakis ES. Phase II Randomized Study of Salvage Radiation Therapy Plus Enzalutamide or Placebo for High-Risk Prostate-Specific Antigen Recurrent Prostate Cancer After Radical Prostatectomy: The SALV-ENZA Trial. J Clin Oncol. 2023 Feb 20;41(6):1307-1317. doi: 10.1200/JCO.22.01662. Epub 2022 Nov 11.
Results Reference
derived
PubMed Identifier
31196032
Citation
Kapoor R, Deek MP, McIntyre R, Raman N, Kummerlowe M, Chen I, Gaver M, Wang H, Denmeade S, Lotan T, Paller C, Markowski M, Carducci M, Eisenberger M, Beer TM, Song DY, DeWeese TL, Hearn JW, Greco S, DeVille C, Desai NB, Heath EI, Liauw S, Spratt DE, Hung AY, Antonarakis ES, Tran PT. A phase II randomized placebo-controlled double-blind study of salvage radiation therapy plus placebo versus SRT plus enzalutamide with high-risk PSA-recurrent prostate cancer after radical prostatectomy (SALV-ENZA). BMC Cancer. 2019 Jun 13;19(1):572. doi: 10.1186/s12885-019-5805-z.
Results Reference
derived

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Randomized Salvage Radiation Therapy Plus Enzalutamide Post Prostatectomy

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