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Androgen Receptor Antagonist ARN-509 With or Without Abiraterone Acetate, Gonadotropin-Releasing Hormone Analog, and Prednisone in Treating Patients With High-Risk Prostate Cancer Undergoing Surgery

Primary Purpose

Stage II Prostate Adenocarcinoma, Stage III Prostate Adenocarcinoma

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Abiraterone Acetate
Androgen Receptor Antagonist ARN-509
Gonadotropin-releasing Hormone Analog
Prednisone
Quality-of-Life Assessment
Questionnaire Administration
Radical Prostatectomy
Sponsored by
Rutgers, The State University of New Jersey
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Stage II Prostate Adenocarcinoma

Eligibility Criteria

undefined - undefined (Child, Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Histologically proven adenocarcinoma of the prostate and: Gleason > 8 OR prostatic specific antigen (PSA) > 20 and more than 1 positive core
  • Patients with Eastern Cooperative Oncology Group performance scale (ECOG PS) 0 or 1
  • Clinical stage T3 or less as demonstrated by abdominal/pelvic computed tomography (CT) or magnetic resonance imaging (MRI) will be selected as the prostate is resectable
  • Hemoglobin >= 9.0 g/dL, independent of transfusion and/or growth factors within 3 months prior to randomization
  • Platelet count >= 100,000 x 10^9/uL independent of transfusion and/or growth factors within 3 months prior to randomization
  • Serum albumin >= 3.0 g/dL
  • Glomerular filtration rate (GFR) >= 45 mL/min
  • Serum potassium >= 3.5 mmol/L
  • Serum total bilirubin =< 1.5 × upper limit of normal (ULN) (Note: In subjects with Gilbert's syndrome, if total bilirubin is > 1.5 × ULN, measure direct and indirect bilirubin and if direct bilirubin is =< 1.5 × ULN, subject may be eligible)
  • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 2.5 × ULN
  • Medications known to lower the seizure threshold must be discontinued or substituted at least 4 weeks prior to study entry
  • 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

Exclusion Criteria:

  • Clinical stage T4 (invasion into rectum or ureters) significantly increases the morbidity of the surgery

    • Patients with rectal or ureteral invasion will be considered to have unresectable disease
  • History of any of the following:

    • Seizure or known condition that may pre-dispose to seizure (e.g. prior stroke within 1year to randomization, brain arteriovenous malformation, Schwannoma, meningioma, or other benign central nervous system [CNS] or meningeal disease which may require treatment with surgery or radiation therapy)
    • Severe or unstable angina, myocardial infarction, symptomatic congestive heart failure, arterial within 6 months prior to randomization
    • Venous thromboembolic events (e.g., pulmonary embolism, cerebrovascular accident including transient ischemic attacks) within 6 months prior to randomization
    • Clinically significant ventricular arrhythmias within 6 months prior to randomization
  • Metastatic prostate cancer
  • Baseline moderate or severe hepatic impairment (Child-Pugh class B or C)

Sites / Locations

  • Yale Cancer CenterRecruiting
  • Rutgers Cancer Institute of New JerseyRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Active Comparator

Active Comparator

Arm Label

Arm I (androgen receptor ARN-509, radical prostatectomy)

Arm II (ARN-509, abiraterone acetate, GnRH, prednisone, RP)

Arm III (radical prostatectomy)

Arm Description

Patients receive androgen receptor antagonist ARN-509 PO daily for 3 months. Patients then undergo radical prostatectomy.

Patients receive GnRH agonist SC on day 1, androgen receptor antagonist ARN-509 PO daily PO for 4 times, abiraterone acetate PO daily for 4 times, and prednisone PO daily for 3 months. Patients then undergo radical prostatectomy.

Patients undergo radical prostatectomy.

Outcomes

Primary Outcome Measures

Post-surgical potency rate defined as proportion of patients with International Index of Erectile Function score >= 17
Each of the experimental arms will be compared to the surgery-only arm, so each test will be a 2.5% level one-sided test to control for the fact that there are two comparisons.

Secondary Outcome Measures

Change in tumor volume on pelvic MRI after neoadjuvant therapy
Will be correlated with clinical outcomes before and after androgen receptor antagonist ARN-509 or androgen receptor antagonist ARN-509, GnRH agonist, prednisone plus abiraterone acetate.
Number of patients with biochemical recurrence defined using the Prostate Cancer Clinical Trials Working Group 2 definition
Number of patients with pathological T0
Number of patients with positive surgical margins
Postoperative continence rate as determined by the American Urological Association Symptom Score (AUAss)
Postoperative continence rate as determined by the Sexual Health Inventory for Men
Postoperative continence rate as determined by the Expanded Prostate Cancer Index Composite (EPIC)
Quality of life as assessed by the AUAss questionnaires
Quality of life as assessed by the EPIC questionnaires

Full Information

First Posted
October 21, 2016
Last Updated
September 24, 2023
Sponsor
Rutgers, The State University of New Jersey
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT02949284
Brief Title
Androgen Receptor Antagonist ARN-509 With or Without Abiraterone Acetate, Gonadotropin-Releasing Hormone Analog, and Prednisone in Treating Patients With High-Risk Prostate Cancer Undergoing Surgery
Official Title
Randomized Three-Arm Trial to Evaluate the Effect of Neoadjuvant Apalutamide Alone or in Combination With Abiraterone Acetate and GnRH Agonist on Enhancing Surgical Outcome of Nerve-Sparing Radical Prostatectomy in Men With High-Risk Prostate Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 20, 2017 (Actual)
Primary Completion Date
January 20, 2024 (Anticipated)
Study Completion Date
January 20, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Rutgers, The State University of New Jersey
Collaborators
National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This randomized phase II trial studies how well androgen receptor antagonist ARN-509 works with or without abiraterone acetate, gonadotropin-releasing hormone agonist, and prednisone in treating patients with high-risk prostate cancer undergoing surgery. Androgen can cause the growth of prostate cancer cells. Hormone therapy using androgen receptor antagonist ARN-509, abiraterone acetate, and gonadotropin-releasing hormone analog (GnRH agonist) may fight prostate cancer by lowering the levels of androgen the body makes. Prednisone may either kill the tumor cells or stop them from dividing. Giving androgen receptor agonist ARN-509 with or without abiraterone acetate, GnRH agonist and prednisone may work better in treating patients with prostate cancer.
Detailed Description
PRIMARY OBJECTIVES: I. To evaluate the effect of neoadjuvant androgen receptor antagonist ARN-509 (apalutamide) with or without abiraterone acetate, GnRH agonist, and prednisone on the feasibility of performing nerve-sparing radical prostatectomy (RP) in men with high-risk prostate cancer (PCa). OUTLINE: Patients are randomized to 1 of 3 treatment arms. ARM I: Patients receive androgen receptor antagonist ARN-509 orally (PO) daily for 3 months. Patients then undergo radical prostatectomy. ARM II: Patients receive GnRH agonist subcutaneously (SC) on day 1, androgen receptor antagonist ARN-509 PO daily PO for 4 times, abiraterone acetate PO daily for 4 times, and prednisone PO daily for 3 months. Patients then undergo radical prostatectomy. ARM III: Patients undergo radical prostatectomy. After completion of study treatment, patients are followed up for 2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Stage II Prostate Adenocarcinoma, Stage III Prostate Adenocarcinoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
90 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Arm I (androgen receptor ARN-509, radical prostatectomy)
Arm Type
Experimental
Arm Description
Patients receive androgen receptor antagonist ARN-509 PO daily for 3 months. Patients then undergo radical prostatectomy.
Arm Title
Arm II (ARN-509, abiraterone acetate, GnRH, prednisone, RP)
Arm Type
Active Comparator
Arm Description
Patients receive GnRH agonist SC on day 1, androgen receptor antagonist ARN-509 PO daily PO for 4 times, abiraterone acetate PO daily for 4 times, and prednisone PO daily for 3 months. Patients then undergo radical prostatectomy.
Arm Title
Arm III (radical prostatectomy)
Arm Type
Active Comparator
Arm Description
Patients undergo radical prostatectomy.
Intervention Type
Drug
Intervention Name(s)
Abiraterone Acetate
Other Intervention Name(s)
CB7630, Zytiga
Intervention Description
Given PO
Intervention Type
Drug
Intervention Name(s)
Androgen Receptor Antagonist ARN-509
Other Intervention Name(s)
ARN-509
Intervention Description
Given PO
Intervention Type
Biological
Intervention Name(s)
Gonadotropin-releasing Hormone Analog
Other Intervention Name(s)
GnRH Agonist, GnRH Analog, Gonadotropin-Releasing Hormone Agonist, Gonadotropin-Releasing Hormone Analogue, LH-RH agonist, LH-RH Analogs, LHRH Agonist, luteinizing hormone-releasing hormone agonist, Luteinizing Hormone-Releasing Hormone Analog
Intervention Description
Given SC
Intervention Type
Drug
Intervention Name(s)
Prednisone
Other Intervention Name(s)
.delta.1-Cortisone, 1, 2-Dehydrocortisone, Adasone, Cortancyl, Dacortin, DeCortin, Decortisyl, Decorton, Delta 1-Cortisone, Delta-Dome, Deltacortene, Deltacortisone, Deltadehydrocortisone, Deltasone, Deltison, Deltra, Econosone, Lisacort, Meprosona-F, Metacortandracin, Meticorten, Ofisolona, Orasone, Panafcort, Panasol-S, Paracort, PRED, Predicor, Predicorten, Prednicen-M, Prednicort, Prednidib, Prednilonga, Predniment, Prednisonum, Prednitone, Promifen, Servisone, SK-Prednisone
Intervention Description
Given PO
Intervention Type
Other
Intervention Name(s)
Quality-of-Life Assessment
Other Intervention Name(s)
Quality of Life Assessment
Intervention Description
Ancillary studies
Intervention Type
Other
Intervention Name(s)
Questionnaire Administration
Intervention Description
Ancillary studies
Intervention Type
Procedure
Intervention Name(s)
Radical Prostatectomy
Other Intervention Name(s)
Prostatovesiculectomy
Intervention Description
Undergo radical prostatectomy
Primary Outcome Measure Information:
Title
Post-surgical potency rate defined as proportion of patients with International Index of Erectile Function score >= 17
Description
Each of the experimental arms will be compared to the surgery-only arm, so each test will be a 2.5% level one-sided test to control for the fact that there are two comparisons.
Time Frame
At 12 months
Secondary Outcome Measure Information:
Title
Change in tumor volume on pelvic MRI after neoadjuvant therapy
Description
Will be correlated with clinical outcomes before and after androgen receptor antagonist ARN-509 or androgen receptor antagonist ARN-509, GnRH agonist, prednisone plus abiraterone acetate.
Time Frame
Baseline to week 13
Title
Number of patients with biochemical recurrence defined using the Prostate Cancer Clinical Trials Working Group 2 definition
Time Frame
Up to 5 years
Title
Number of patients with pathological T0
Time Frame
Up to 5 years
Title
Number of patients with positive surgical margins
Time Frame
Up to 5 years
Title
Postoperative continence rate as determined by the American Urological Association Symptom Score (AUAss)
Time Frame
Up to 24 months after surgery
Title
Postoperative continence rate as determined by the Sexual Health Inventory for Men
Time Frame
Up to 24 months after surgery
Title
Postoperative continence rate as determined by the Expanded Prostate Cancer Index Composite (EPIC)
Time Frame
Up to 24 months after surgery
Title
Quality of life as assessed by the AUAss questionnaires
Time Frame
Up to 24 months after surgery
Title
Quality of life as assessed by the EPIC questionnaires
Time Frame
Up to 24 months after surgery

10. Eligibility

Sex
Male
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically proven adenocarcinoma of the prostate and: Gleason > 8 OR prostatic specific antigen (PSA) > 20 and more than 1 positive core Patients with Eastern Cooperative Oncology Group performance scale (ECOG PS) 0 or 1 Clinical stage T3 or less as demonstrated by abdominal/pelvic computed tomography (CT) or magnetic resonance imaging (MRI) will be selected as the prostate is resectable Hemoglobin >= 9.0 g/dL, independent of transfusion and/or growth factors within 3 months prior to randomization Platelet count >= 100,000 x 10^9/uL independent of transfusion and/or growth factors within 3 months prior to randomization Serum albumin >= 3.0 g/dL Glomerular filtration rate (GFR) >= 45 mL/min Serum potassium >= 3.5 mmol/L Serum total bilirubin =< 1.5 × upper limit of normal (ULN) (Note: In subjects with Gilbert's syndrome, if total bilirubin is > 1.5 × ULN, measure direct and indirect bilirubin and if direct bilirubin is =< 1.5 × ULN, subject may be eligible) Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 2.5 × ULN Medications known to lower the seizure threshold must be discontinued or substituted at least 4 weeks prior to study entry 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 Exclusion Criteria: Clinical stage T4 (invasion into rectum or ureters) significantly increases the morbidity of the surgery Patients with rectal or ureteral invasion will be considered to have unresectable disease History of any of the following: Seizure or known condition that may pre-dispose to seizure (e.g. prior stroke within 1year to randomization, brain arteriovenous malformation, Schwannoma, meningioma, or other benign central nervous system [CNS] or meningeal disease which may require treatment with surgery or radiation therapy) Severe or unstable angina, myocardial infarction, symptomatic congestive heart failure, arterial within 6 months prior to randomization Venous thromboembolic events (e.g., pulmonary embolism, cerebrovascular accident including transient ischemic attacks) within 6 months prior to randomization Clinically significant ventricular arrhythmias within 6 months prior to randomization Metastatic prostate cancer Baseline moderate or severe hepatic impairment (Child-Pugh class B or C)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Saum Ghodoussipour, MD
Organizational Affiliation
Rutgers Cancer Institute of New Jersey
Official's Role
Principal Investigator
Facility Information:
Facility Name
Yale Cancer Center
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06519
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Isaac Kim, MD
Phone
203-785-6540
Email
isaac.kim@yale.edu
Facility Name
Rutgers Cancer Institute of New Jersey
City
New Brunswick
State/Province
New Jersey
ZIP/Postal Code
08903
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Saum Ghodoussipour, MD
Phone
732-235-2043
Email
sg1621@cinj.rutgers.edu
First Name & Middle Initial & Last Name & Degree
Saum Ghodoussipour

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Androgen Receptor Antagonist ARN-509 With or Without Abiraterone Acetate, Gonadotropin-Releasing Hormone Analog, and Prednisone in Treating Patients With High-Risk Prostate Cancer Undergoing Surgery

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