A Study of Adding Apalutamide to Radiotherapy and LHRH Agonist in High-Risk Patients With Hormone-Sensitive Prostate Cancer (PRIMORDIUM)
Prostatic Neoplasms
About this trial
This is an interventional treatment trial for Prostatic Neoplasms
Eligibility Criteria
Inclusion Criteria:
- Histologically confirmed adenocarcinoma of the prostate
- Previously treated with radical prostatectomy with or without lymph node dissection and any post-operative prostate-specific antigen (PSA) measurement of less than (<) 0.1 nanogram/milliliter (ng/mL) between Week 6 and Week 20
- Be able to swallow whole the study drug tablets or follow the instructions for admixing with apple sauce
- Prostate specific membrane antigen-positron emission tomography (PSMA-PET) must be performed at screening: Patients who are PSMA-PET-positive for at least one loco-regional (pelvic) lesion with or without distant (extra-pelvic) lesions at screening, as determined by Blinded Independent Central Review (BICR), will be eligible to be randomized to either arm of the Interventional Cohort.The investigators will be blinded to the location of the PSMA-PET lesions after randomization and patients who are PSMA-PET-negative for any prostate cancer lesions (that is no loco-regional lesion and no distant lesion) at screening, as determined by BICR, will be eligible for inclusion in the Observational Cohort
- Biochemically recurrent prostate cancer after RP with a high risk of developing metastasis defined as pathological Gleason score greater than or equal to (>=) 8 evaluated from prostate tissue specimen at radical prostatectomy, OR PSADT less than or equal to (<=) 12 months at the time of screening
- No evidence of prostate cancer metastases on screening CT/MRI of the chest/abdomen/pelvis, Technetium 99m [99mTc] whole-body bone scan. Participants with a single bone lesion on 99mTc whole-body bone scan should have confirmatory imaging by CT or MRI; if the confirmatory scan confirms the bone lesion, the patient should be excluded from the study. Conventional images (99mTc-bone scan and CT/MRI) from the screening will be sent to BICR for confirmation of non-metastatic prostate cancer before randomization
- Eastern Cooperative Oncology Group Performance Status Grade 0 or 1
Exclusion Criteria:
- History of pelvic radiation for malignancy
- Previous treatment with androgen deprivation therapy (ADT) for prostate cancer
- Previously treated for biochemical recurrence (BCR) prostate cancer (previous surgical treatment of one or more loco-regional lesions is allowed)
- Prior treatment with a CYP17 inhibitor (example, oral ketoconazole, orteronel, abiraterone acetate, galeterone) or any androgen receptor (AR) antagonist including bicalutamide, flutamide, nilutamide, apalutamide, enzalutamide or darolutamide and any other medications that may lower androgen levels (estrogens, progestins, aminoglutethimide, etc.), including bilateral orchiectomy
- Known or suspected contraindications or hypersensitivity to apalutamide, Luteinizing Hormone-Releasing Hormone (LHRH) agonist or any of the components of the formulations
- Prior chemotherapy for prostate cancer
- Any evidence of prostate cancer metastasis on computed tomography/magnetic resonance imaging (CT/MRI) of the chest/abdomen/pelvis or 99mTc whole-body bone scan, at any time prior to screening
Sites / Locations
- Arizona Urology SpecialistsRecruiting
- Arkansas UrologyRecruiting
- Colorado Clinical ResearchRecruiting
- Urological Research NetworkRecruiting
- First Urology, PSCRecruiting
- Michigan Institute of UrologyRecruiting
- Associated Medical Professionals of NyRecruiting
- The Urology GroupRecruiting
- MidLantic UrologyRecruiting
- Houston Metro UrologyRecruiting
- Spokane UrologyRecruiting
- Bundaberg HospitalRecruiting
- Hervey Bay HospitalRecruiting
- Epworth HealthcareRecruiting
- St Vincent's Hospital - MelbourneRecruiting
- Genesis Care HurstvilleRecruiting
- Macquarie University Hospital
- Calvary Mater NewcastleRecruiting
- GenesisCare WembleyRecruiting
- Ordensklinikum Linz GmbH ElisabethinenRecruiting
- Universitätsklinikum Salzburg - LandeskrankenhausRecruiting
- Medizinische Universität Wien
- A.Z. Sint JanRecruiting
- UZ GentRecruiting
- Az GroeningeRecruiting
- GZA ZiekenhuisRecruiting
- Liga Paranaense de Combate ao CancerRecruiting
- Liga Norte Riograndense Contra O CancerRecruiting
- Associacao Hospitalar Moinhos de VentoRecruiting
- Irmandade Santa Casa de Misericordia de Porto AlegreRecruiting
- Hospital Sao RafaelRecruiting
- Hospital Alemao Oswaldo CruzRecruiting
- Hospital Sao Camilo Unidade Vila MarianaRecruiting
- Sociedade Beneficente de Senhoras - Hospital Sírio LibanêsRecruiting
- Fakultni nemocnice Plzen, Urologicka klinikaRecruiting
- Urocentrum PrahaRecruiting
- Urologicka klinika 1.LF UK a VFNRecruiting
- Fakultni nemocnice v MotoleRecruiting
- Aalborg University HospitalRecruiting
- Aarhus University HospitalRecruiting
- RigshospitaletRecruiting
- Gentofte Herlev HospitalRecruiting
- Oulu University HospitalRecruiting
- Tampere University HospitalRecruiting
- Turku University HospitalRecruiting
- Vaasa Central HospitalRecruiting
- Péterfy Sándor utcai KórházRecruiting
- Bajcsy-Zsilinszky Kórház és RendelőintézetRecruiting
- Orszagos Onkologiai IntezetRecruiting
- Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő Budai CsaládközpontúRecruiting
- Uzsoki Utcai KorhazRecruiting
- Jahn Ferenc Del-pesti Korhaz es RendelointezetRecruiting
- Debreceni Egyetem Klinikai KozpontRecruiting
- Radioterapia Oncologica, A.O.U. San'T OrsolaRecruiting
- Azienda Ospedaliero Universitaria CareggiRecruiting
- Ospedale San RaffaeleRecruiting
- Fondazione Policlinico Tor VergataRecruiting
- Istituto Nazionale Tumori Regina ElenaRecruiting
- Azienda Ospedaliera Sant AndreaRecruiting
- King Hussein Cancer CenterRecruiting
- St Georges Hospital university medical centreRecruiting
- American Universitty of Beirut Medical CenterRecruiting
- Notre Dame De SecoursRecruiting
- Centre Hospitalier du NordRecruiting
- Consultorio de Especialidad en Urologia PrivadoRecruiting
- Hospital Aranda de la Parra S.A. de C.V.Recruiting
- Avix Investigacion Clinica, S.C.Recruiting
- Oncologia Integral SateliteRecruiting
- Centro de Investigacion Clinica de OaxacaRecruiting
- OncocenterRecruiting
- Centro de Estudio Clínicos de Querétaro S.C.Recruiting
- Centrum Onkologii im. Prof. F. Lukaszczyka w BydgoszczyRecruiting
- NU-MED Grupa S.A Centrum Radioterapii i UsprawnianiaRecruiting
- Uniwersyteckie Centrum KliniczneRecruiting
- Szpitale Pomorskie Sp. z o.o.Recruiting
- Swietokrzyskie Centrum Onkologii SPZOZ w KielcachRecruiting
- Wojewodzkie Wielospecjalistyczne Centrum Onkologii i Traumatologii im. M. Kopernika w LodziRecruiting
- Radomskie Centrum OnkologiiRecruiting
- Narodowy Instytut Onkologii im. Marii Sklodowskiej-Curie - Panstwowy Instytut BadawczyRecruiting
- IPO LisboaRecruiting
- Hospital CUF TejoRecruiting
- Fundação ChampalimaudRecruiting
- Centro Hospitalar Lisboa Ocidental - Hospital São Fracisco XavierRecruiting
- Hospital da LuzRecruiting
- Chln - Hosp. Santa MariaRecruiting
- Centro Hospitalar Universitario do Porto, EPERecruiting
- Centro Hospitalar de Entre o Douro e Vouga, E.P.ERecruiting
- SHI Sverdlovsk Regional Clinical Hospital #1
- Ivanovo Regional Oncology Dispensary
- City Clinical Hospital #57
- I.M. Sechenov First Moscow State Medical University
- Hertzen Oncology Research Institute
- SPb SBIH 'City Clinical Oncological Dispensary'
- Multifunctional clinical medical center 'Medical city'
- CUIMED - urologická ambulanciaRecruiting
- Východoslovenský Onkologický ÚstavRecruiting
- Univerzitná nemocnica MartinRecruiting
- Uroexam s.r.o.Recruiting
- Urologicka ambulancia e.cho Poprad, s.r.oRecruiting
- MILAB s.r.o.Recruiting
- Privátna urologická ambulanciaRecruiting
- Hospital Universitario Puerto Del MarRecruiting
- Hosp. Arquitecto MarcideRecruiting
- Hosp. de Jerez de La FronteraRecruiting
- Hosp. Univ. 12 de OctubreRecruiting
- Hosp. Univ. de La PazRecruiting
- Hosp. Virgen de La VictoriaRecruiting
- Complejo Hosp. de NavarraRecruiting
- Clinica Univ. de NavarraRecruiting
- Hosp. Virgen Del RocioRecruiting
- Hosp. Clinico Univ. Lozano BlesaRecruiting
- Urologiska MottagningenRecruiting
- ProstatacancercentrumRecruiting
- SödersjukhusetRecruiting
- Adana Baskent Yuregir HospitalRecruiting
- Hacettepe University Medical FacultyRecruiting
- Memorial Ankara HastanesiRecruiting
- Ankara University Medical FacultyRecruiting
- Dr.Abdurrahman Yurtaslan Oncology Training and Research HospitalRecruiting
- Istanbul University Cerrahpasa Medical Faculty
- Bakirkoy Training and Research HospitalRecruiting
- Goztepe Prof. Dr. Suleyman Yalcin Sehir HastanesiRecruiting
- Kartal Dr. Lutfi Kirdar Egitim ve Arastirma Hastanesi
- Dokuz Eylul Universitesi Tip FakultesiRecruiting
- Sakarya Üniversitesi Tıp Fakültesi HastanesiRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Active Comparator
Experimental
No Intervention
Interventional Cohort (Group 1): RT+ LHRHa
Interventional Cohort (Group 2): RT+LHRHa + Apalutamide
Observational Cohort(Group3) PSMA-PET Negative Participants
Participants will receive radiotherapy (RT) which is defined as prostate-bed plus pelvic lymph node salvage external-beam radiotherapy with or without optional stereotactic body radiation therapy (SBRT), along with a luteinizing hormone-releasing hormone agonist (LHRHa) as a 3-monthly depot preparation within 3 days after randomization and the end of Week 12, or as a 6-monthly depot preparation within 3 days after randomization.
Participants will receive prostate-bed plus pelvic lymph node salvage external-beam radiotherapy (RT) with or without optional stereotactic body radiation therapy (SBRT), along with a LHRHa as a 3-monthly depot preparation within 3 days after randomization and the end of Week 12, or as a 6-monthly depot preparation within 3 days after randomization. Participants will also receive 240 milligram (mg) of apalutamide starting within 3 days after randomization as film-coated tablets, to be swallowed whole and together once daily with or without food, for a period of 180 Days.
Enrollment into this cohort will be stopped further. Participants who were PSMA-PET-negative at screening and were already enrolled in the Observational Cohort will continue in this cohort. Data collected in the course of routine clinical practice during this period will include clinical evaluations, disease progression, therapies administered as per standard-of-care at the study-sites and survival status. For Observational Cohort, information will be entered into the electronic case report form (eCRF) from the medical records at least twice a year. The use of any medicinal product(s) for the treatment and management of participants will be at discretion of the treating physician.