Trial of Rad-223 Activity in Asymptomatic Patients With mCRPC While on Abiraterone or Enzalutamide Besides AR-V7 Status
Primary Purpose
Prostate Cancer
Status
Completed
Phase
Phase 2
Locations
Spain
Study Type
Interventional
Intervention
radium-223
Sponsored by

About this trial
This is an interventional treatment trial for Prostate Cancer
Eligibility Criteria
Inclusion Criteria:
- Subject is an adult ≥ 18 years at the time of informed consent and has signed informed consent before any trial related activities and according to local guidelines.
- Subject has histologically confirmed adenocarcinoma of the prostate without neuroendocrine differentiation or small cell features.
- Subject has bone metastases due to the prostate cancer and absence of visceral metastases.
- Subject has a serum testosterone of ≤ 1.7 nmol/L (or ≤ 50 ng/dL) at screening.
- Subject must have received a minimum of 24 weeks of treatment with abiraterone acetate or enzalutamide within its approved label indication and has discontinued use at least four weeks prior to start of study drug at day 1.
- Prior use of docetaxel is allowed in castration-naïve patients (maximum of six cycles).
- Subject receives and will continue to receive ongoing androgen deprivation with LHRH analogue therapy throughout the course of the study or has had a bilateral orchiectomy.
- Subject is asymptomatic from prostate cancer, defined as patients with the score on brief pain inventory (short form) (BPI-SF) Question #3 must zero and no use of opiate analgesics for prostate cancer-related pain currently or anytime within two weeks prior to screening.
- Subject has an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1 at screening.
- Subject receiving bisphosphonate or other approved bone-targeting therapy must have been on stable doses for at least four weeks prior to start of study drug at day 1.
- Subject has a life expectancy of more than or equal to 12 months.
- Subject agrees not to participate in another interventional study while on study drug.
- Subject and his female partner who is of childbearing potential must use two acceptable methods of birth control (one of which must include a condom as a barrier method of contraception) starting at screening and continuing throughout the study period and for six months after final study drug administration.
Exclusion Criteria:
- Subject has received any anti-neoplastic therapy (including ketokonazol and chemotherapy) following abiraterone acetate or enzalutamide discontinuation and prior to start of study drug at day 1.
- Subject has known or suspected brain metastases or active leptomeningeal disease.
- Subject has concurrent disease or any clinically significant abnormality following the investigator's review of the physical examination and safety laboratory tests at screening, which in the judgment of the investigator would interfere with the subject's participation in this study or evaluation of study results.
- Subject has a history of another invasive cancer within three years prior to screening, with the exceptions of non-melanoma skin cancers or a non-infiltrating muscle bladder cancer that have a remote probability of recurrence in the opinion of the investigator in consultation with the medical monitor.
- Subject had major surgery within one month prior to screening.
- Subject has received investigational therapy within 28 days or 5 half lives, whichever is longer, prior to start of study drug at day 1.
- Subject has absolute neutrophil count < 1,500/μL, platelet count < 100,000/μL, and hemoglobin < 6.25 mmol/L (or < 10 g/dL) at screening (Note: Subjects must not have received any growth factors or blood transfusions within seven days of the hematologic laboratory values obtained at screening).
- Subject has total bilirubin > 1.5 times the upper limit of normal (ULN) at screening, except for subjects with documented Gilbert's syndrome.
- Subject has creatinine > 2.5 mg/dL at screening.
- Subject has albumin ≤ 30 g/L (or ≤ 3.0 g/dL) at screening.
Sites / Locations
- MedSIR Investigative site
- MedSIR Investigative site
- MedSIR Investigative site
- MedSIR Investigative site
- MedSIR Investigative site
- MedSIR investigative site
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
open-label
Arm Description
Patient will be treated with radium-223 at a dose of 55 kBq (after 2015 NIST implementation) per kilogram body weight, given at four-week intervals for six intravenous injections.
Outcomes
Primary Outcome Measures
Assess the efficacy of radium-223 in terms of radiological rPFS
The primary efficacy endpoint is the median PFS achieved with radium-223 treatment
Secondary Outcome Measures
AEs and serious adverse events (SAEs) will be assessed to determine the safety and tolerability
Radiographic progression-free survival (rPFS) depending on AR-V7 status.
Overall survival (OS).
Time to first symptomatic skeletal event (SSE).
Time to first SSE defined as the time from treatment initiation until SSE (pathological fractures, vertebral or non-vertebral, spinal cord compression, radiation or surgery to bone). For all other events, the start date of the event/medication/therapy was used as the time of the event. If an event has not occurred at the time of the analysis or the patient has been lost to follow-up, the time-to-event variables will be censored at the last disease assessment date.
Time to PSA progression according to the ALSYMPCA study criteria.
Determination percentage of PSA progression
PSA progression (defined as PSA elevation ≥ 25% and ≥ 2 ng/mL after 12 weeks).
Alkaline phosphatase level response (AF), normalization of alkaline phosphatase level
Progression defined as FA elevation ≥ 25% after 12 weeks
Assessment of AR-V7 mutation evolution
Determination changes in CTCs number
Full Information
NCT ID
NCT03002220
First Posted
October 20, 2016
Last Updated
November 25, 2020
Sponsor
MedSIR
Collaborators
Bayer
1. Study Identification
Unique Protocol Identification Number
NCT03002220
Brief Title
Trial of Rad-223 Activity in Asymptomatic Patients With mCRPC While on Abiraterone or Enzalutamide Besides AR-V7 Status
Official Title
A Phase II Clinical Trial of Radium-223 Activity in Patients With Metastatic Castration-resistant Prostate Cancer (mCRPC) With Asymptomatic Progression While on Abiraterone Acetate or Enzalutamide Besides AR-V7 Mutational Status
Study Type
Interventional
2. Study Status
Record Verification Date
November 2020
Overall Recruitment Status
Completed
Study Start Date
November 2016 (undefined)
Primary Completion Date
May 6, 2020 (Actual)
Study Completion Date
undefined (undefined)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
MedSIR
Collaborators
Bayer
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Radium-223 is indicated for the treatment of patients with mCRPC with symptomatic bone metastases and no known visceral metastatic disease. However, very few data have been reported in patients with mCRPC who are asymptomatic or mildly symptomatic. Recently, results from an International Expanded Access Program have also suggested a benefit of radium-223 in asymptomatic patients with mCRPC. In addition, the mechanism of action of radium-223 should not be correlated with the presence/absence of the AR-V7 mutation, although this issue has not yet been evaluated.
The aim of this study is to assess the efficacy of radium-223 in asymptomatic patients with mCRPC, and to establish the association between AR-V7 status and radium-223 activity.
Detailed Description
Primary objective:
To assess the efficacy of radium-223 in asymptomatic patients with mCRPC who have progressed while on abiraterone acetate or enzalutamide treatment.
Primary endpoint:
To determine the efficacy of radium-223 in terms of radiological rPFS.
Secondary objectives:
Safety profile.
To determine the association between AR-V7 status (positive vs. negative) and PFS.
To establish the relationship between CTCs number with radium-223 efficacy.
Secondary endpoints:
Safety AEs will be evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) of the US National Cancer Institute (NCI) version 4.0 [20]. Grade 3 or 4 AEs and serious adverse events (SAEs) will be assessed to determine the safety and tolerability of the various combinations of drugs.
Efficacy
Radiographic progression-free survival (rPFS) depending on AR-V7 status.
Overall survival (OS).
Time to first symptomatic skeletal event (SSE).
Time to PSA progression according to the ALSYMPCA study criteria.
Determination percentage of PSA progression.
Alkaline phosphatase level response (AF), normalization of alkaline phosphatase level, according to the ALSYMPCA study criteria.
Molecular aspects
Assessment of AR-V7 mutation evolution during the study treatment.
Determination changes in CTCs number during the study treatment.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prostate Cancer
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
52 (Actual)
8. Arms, Groups, and Interventions
Arm Title
open-label
Arm Type
Experimental
Arm Description
Patient will be treated with radium-223 at a dose of 55 kBq (after 2015 NIST implementation) per kilogram body weight, given at four-week intervals for six intravenous injections.
Intervention Type
Drug
Intervention Name(s)
radium-223
Other Intervention Name(s)
Xofigo
Intervention Description
Radium-223 at a dose of 55 kBq
Primary Outcome Measure Information:
Title
Assess the efficacy of radium-223 in terms of radiological rPFS
Description
The primary efficacy endpoint is the median PFS achieved with radium-223 treatment
Time Frame
From date of first drug administration until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 20 months
Secondary Outcome Measure Information:
Title
AEs and serious adverse events (SAEs) will be assessed to determine the safety and tolerability
Time Frame
Starting from the first procedure required by the study up to three months after study discontinuation.
Title
Radiographic progression-free survival (rPFS) depending on AR-V7 status.
Time Frame
From date of inclusion until Radiographic progression, assessed up to 20 months
Title
Overall survival (OS).
Time Frame
From date of inclusion until death from any cause or the last date the patient was known to be alive, assessed up to 20 months.
Title
Time to first symptomatic skeletal event (SSE).
Description
Time to first SSE defined as the time from treatment initiation until SSE (pathological fractures, vertebral or non-vertebral, spinal cord compression, radiation or surgery to bone). For all other events, the start date of the event/medication/therapy was used as the time of the event. If an event has not occurred at the time of the analysis or the patient has been lost to follow-up, the time-to-event variables will be censored at the last disease assessment date.
Time Frame
From date of first drug administration until SSE, assessed up to 20 months
Title
Time to PSA progression according to the ALSYMPCA study criteria.
Time Frame
From date of first study drug administration to when PSA progression is observed, assessed up to 20 months
Title
Determination percentage of PSA progression
Description
PSA progression (defined as PSA elevation ≥ 25% and ≥ 2 ng/mL after 12 weeks).
Time Frame
From date of first study drug administration to when PSA progression is observed, assessed up to 20 months
Title
Alkaline phosphatase level response (AF), normalization of alkaline phosphatase level
Description
Progression defined as FA elevation ≥ 25% after 12 weeks
Time Frame
From date of first study drug administration until End of Treatment, assessed up to 6 months
Title
Assessment of AR-V7 mutation evolution
Time Frame
From date of first study drug administration until End of Treatment, assessed up to 6 months
Title
Determination changes in CTCs number
Time Frame
From date of first study drug administration until End of Treatment, assessed up to 6 months
10. Eligibility
Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Subject is an adult ≥ 18 years at the time of informed consent and has signed informed consent before any trial related activities and according to local guidelines.
Subject has histologically confirmed adenocarcinoma of the prostate without neuroendocrine differentiation or small cell features.
Subject has bone metastases due to the prostate cancer and absence of visceral metastases.
Subject has a serum testosterone of ≤ 1.7 nmol/L (or ≤ 50 ng/dL) at screening.
Subject must have received a minimum of 24 weeks of treatment with abiraterone acetate or enzalutamide within its approved label indication and has discontinued use at least four weeks prior to start of study drug at day 1.
Prior use of docetaxel is allowed in castration-naïve patients (maximum of six cycles).
Subject receives and will continue to receive ongoing androgen deprivation with LHRH analogue therapy throughout the course of the study or has had a bilateral orchiectomy.
Subject is asymptomatic from prostate cancer, defined as patients with the score on brief pain inventory (short form) (BPI-SF) Question #3 must zero and no use of opiate analgesics for prostate cancer-related pain currently or anytime within two weeks prior to screening.
Subject has an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1 at screening.
Subject receiving bisphosphonate or other approved bone-targeting therapy must have been on stable doses for at least four weeks prior to start of study drug at day 1.
Subject has a life expectancy of more than or equal to 12 months.
Subject agrees not to participate in another interventional study while on study drug.
Subject and his female partner who is of childbearing potential must use two acceptable methods of birth control (one of which must include a condom as a barrier method of contraception) starting at screening and continuing throughout the study period and for six months after final study drug administration.
Exclusion Criteria:
Subject has received any anti-neoplastic therapy (including ketokonazol and chemotherapy) following abiraterone acetate or enzalutamide discontinuation and prior to start of study drug at day 1.
Subject has known or suspected brain metastases or active leptomeningeal disease.
Subject has concurrent disease or any clinically significant abnormality following the investigator's review of the physical examination and safety laboratory tests at screening, which in the judgment of the investigator would interfere with the subject's participation in this study or evaluation of study results.
Subject has a history of another invasive cancer within three years prior to screening, with the exceptions of non-melanoma skin cancers or a non-infiltrating muscle bladder cancer that have a remote probability of recurrence in the opinion of the investigator in consultation with the medical monitor.
Subject had major surgery within one month prior to screening.
Subject has received investigational therapy within 28 days or 5 half lives, whichever is longer, prior to start of study drug at day 1.
Subject has absolute neutrophil count < 1,500/μL, platelet count < 100,000/μL, and hemoglobin < 6.25 mmol/L (or < 10 g/dL) at screening (Note: Subjects must not have received any growth factors or blood transfusions within seven days of the hematologic laboratory values obtained at screening).
Subject has total bilirubin > 1.5 times the upper limit of normal (ULN) at screening, except for subjects with documented Gilbert's syndrome.
Subject has creatinine > 2.5 mg/dL at screening.
Subject has albumin ≤ 30 g/L (or ≤ 3.0 g/dL) at screening.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joan Carles Galcerán
Organizational Affiliation
H. Vall Hebrón
Official's Role
Study Director
Facility Information:
Facility Name
MedSIR Investigative site
City
Barcelona
Country
Spain
Facility Name
MedSIR Investigative site
City
Cáceres
Country
Spain
Facility Name
MedSIR Investigative site
City
Córdoba
Country
Spain
Facility Name
MedSIR Investigative site
City
Lugo
Country
Spain
Facility Name
MedSIR Investigative site
City
Madrid
Country
Spain
Facility Name
MedSIR investigative site
City
Palma De Mallorca
ZIP/Postal Code
07120
Country
Spain
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
35981452
Citation
Carles J, Alonso-Gordoa T, Mellado B, Mendez-Vidal MJ, Vazquez S, Gonzalez-Del-Alba A, Piulats JM, Borrega P, Gallardo E, Morales-Barrera R, Paredes P, Reig O, Garcias de Espana C, Collado R, Bonfill T, Suarez C, Sampayo-Cordero M, Malfettone A, Garde J. Radium-223 for patients with metastatic castration-resistant prostate cancer with asymptomatic bone metastases progressing on first-line abiraterone acetate or enzalutamide: A single-arm phase II trial. Eur J Cancer. 2022 Sep;173:317-326. doi: 10.1016/j.ejca.2022.06.057. Epub 2022 Aug 16.
Results Reference
derived
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Trial of Rad-223 Activity in Asymptomatic Patients With mCRPC While on Abiraterone or Enzalutamide Besides AR-V7 Status
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