Testing the Addition of the Drug Relugolix to the Usual Radiation Therapy for Advanced-Stage Prostate Cancer (NRG PROMETHEAN)
Oligometastatic Prostate Carcinoma, Prostate Adenocarcinoma, Stage IVB Prostate Cancer AJCC v8
About this trial
This is an interventional treatment trial for Oligometastatic Prostate Carcinoma
Eligibility Criteria
Inclusion Criteria:
- Pathologically (histologically or cytologically) proven diagnosis of prostate adenocarcinoma at any anatomical location (for example, prostate, metastatic site), including intraductal or ductal carcinoma, at any time before registration
- Age ≥ 18 years
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2 within 120 days prior to registration
Prior curative-intent treatment to the prostate, by either:
- External beam and/or brachytherapy to: Prostate alone, prostate and seminal vesicles, prostate and pelvic nodes, or radiation to all three sites
- Radical prostatectomy alone, radical prostatectomy plus postoperative radiotherapy to the prostate bed, or radical prostatectomy plus postoperative radiotherapy to the pelvic nodes
Must meet study entry criteria based on the following diagnostic workup within 120 days prior to registration:
- History and physical examination;
- Technetium TC-99m (99mTc) bone scan (Must be negative);
- Either computed tomography (CT) or magnetic resonance imaging (MRI) of pelvis +/- abdomen (Must be negative);
- Fluciclovine or prostate-specific membrane antigen (PSMA) PET scan (Must be positive with exception of local disease);
- Note: All 3 scans are mandatory (bone scan; CT/magnetic resonance [MR]; PET)
1 - 5 oligometastatic lesions in bone and/or nodal/soft tissue sites on fluciclovine or PSMA PET within 120 days prior to registration and includes at least ONE of the following:
- Bone - each metastasis is counted (for example, 2 distinct lesions in the right ilium count as 2 oligometastatic lesions)
- Extrapelvic Nodal/ soft tissue - requires at least one extrapelvic inguinal or a nodal/soft tissue lesion superior to the iliac bifurcation (that is, American Joint Committee on Cancer [AJCC] M1a version 8)
- Note: Although a patient must have bone and/or extrapelvic disease to be eligible, when counting the number of oligometastatic lesions, each lymph node lesion, whether pelvic or extrapelvic, is counted (for example, 2 distinct lymph nodes in the right external iliac basin count as 2 oligometastatic lesions; one extrapelvic and one pelvic node count as 2 oligometastic lesions, etc)
Serum total prostate-specific antigen (PSA) ≤10.0 ng/mL obtained within 120 days prior to registration that also meets ONE of the following PSA recurrence definitions:
- PSA ≥ post-radiation therapy (RT) nadir PSA + 2 ng/mL, if patient received-radiation therapy to intact prostate, or
- Current PSA ≥ 0.2 ng/mL, with a second confirmatory PSA ≥ 0.2 ng/mL if patient received a radical prostatectomy with or without post-op RT
Must have ≥3 PSA values within the last two years since end of primary treatment or within the last 2 years prior to registration, whichever is less
- Note: PSA doubling time must be calculated by entering all PSA values since end of primary treatment or within the last 2 years prior to registration (whichever is less) into the PSA Doubling Time Calculator found at MDCalc.com
Serum total testosterone ≥ 100 ng/dL within 120 days prior to registration
- Note: Prior androgen deprivation therapy (other than bilateral orchiectomy) is allowed if discontinued prior to registration and serum total testosterone is ≥ 100 ng/dL
- Total bilirubin: ≤ 1.5 x institutional upper limit of normal (ULN) (Note: In subjects with Gilbert's syndrome, if total bilirubin is > 1.5 x ULN, subject is eligible if direct bilirubin is ≤ 1.5 x ULN) (within 120 days prior to registration)
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]): ≤ 2.5 x institutional ULN (within 120 days prior to registration)
For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
- Note: Known positive test for hepatitis B virus surface antigen (HBV sAg) indicating acute or chronic infection would make the patient ineligible unless the viral load becomes undetectable on suppressive therapy. Patients who are immune to hepatitis B (anti-hepatitis B surface antibody positive) are eligible (e.g. patients immunized against hepatitis B)
Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
- Note: Known positive test for hepatitis C virus ribonucleic acid (HCV RNA) indicating acute or chronic infection would make the patient ineligible unless the viral load becomes undetectable on suppressive therapy
- Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial
- The patient must agree to use a highly effective contraception (even men with vasectomies) if he is having sex with a woman of childbearing potential or with a woman who is pregnant while on study drug and for 2 weeks following the last dose of study drug
- The patient or a legally authorized representative must provide study-specific informed consent prior to study entry and, for patients treated in the United States (U.S.), authorization permitting release of personal health information.
Exclusion Criteria:
Clinical, biopsy-proven, or radiologic (conventional or PET imaging) evidence of local tumor recurrence in the prostate and/or periprostatic/seminal vesicle region after radiotherapy, or in the prostate bed after prostatectomy
- Note: if a patient had a prior local recurrence and received local salvage therapy, the patient is eligible if there is no current evidence of disease in the prostate/prostate bed. Patients with positive findings on examination or imaging remain eligible if biopsy of the site is negative for cancer.
- Currently on androgen deprivation or anti-androgen therapy
Definitive radiologic evidence of metastatic disease on conventional imaging, defined by one of the following:
- Osseous metastasis on 99mTc radionuclide bone scan, or
- Extra pelvic nodal/soft tissue disease (> 1.5 cm in short axis) on CT or MRI pelvis +/- abdomen
Spinal cord compression, or spinal intramedullary, brain, and/or visceral (for example liver, lung, etc.) metastasis
- Note: Spinal metastases (PET-detected) with epidural extension are eligible if there is > 0.3 cm spatial separation between the gross tumor volume and spinal cord.
- Biopsy-proven prostatic carcinoma with signet-ring, sarcomatoid, or neuroendocrine features (for example, small cell)
- Prior metastatic or non-metastatic, invasive malignancy (except non metastatic, non-melanomatous skin cancer) unless continuously disease free for ≥ 3 years
Prior chemotherapy for prostate cancer or bilateral orchiectomy
- Note: Prior chemotherapy for a different cancer is allowed if continuously disease-free for ≥ 3 years
Prior radiotherapy to a lesion (i.e. oligometastatic recurrence by PET)
- Note: Lesions outside of a previously irradiated planning treatment volume (PTV) are eligible as long as the prescription isovolume dose of any prior radiotherapy course is > 2.0 cm distant from new lesion
- Inability to treat all oligometastatic sites with radiotherapy in the judgement of the investigator
- Intrapelvic lymph nodes as only site of prostate cancer recurrence
- Inability to swallow whole, undivided, unchewed, and uncrushed pills
- Known gastrointestinal disorder affecting oral medication absorption
Co-morbidity defined as follows:
- Patients with any comorbidities that would prohibit completion of protocol specified therapy
- Inflammatory bowel disease in patients in whom abdominopelvic radiotherapy is planned
- History of congenital long QT syndrome
- Current severe or unstable angina
- New York Heart Association functional classification III/IV heart failure (Note: Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification)
Sites / Locations
- Cancer Center at Saint Joseph'sRecruiting
- Alta Bates Summit Medical Center-Herrick CampusRecruiting
- Tower Cancer Research FoundationRecruiting
- Los Angeles County-USC Medical CenterRecruiting
- USC / Norris Comprehensive Cancer CenterRecruiting
- Cedars Sinai Medical CenterRecruiting
- Memorial Medical CenterRecruiting
- UC Irvine Health/Chao Family Comprehensive Cancer CenterRecruiting
- UCHealth University of Colorado HospitalRecruiting
- Rocky Mountain Cancer Centers-BoulderRecruiting
- UCHealth Memorial Hospital CentralRecruiting
- Memorial Hospital NorthRecruiting
- Poudre Valley HospitalRecruiting
- Cancer Care and Hematology-Fort CollinsRecruiting
- UCHealth Greeley HospitalRecruiting
- UCHealth Highlands Ranch HospitalRecruiting
- Medical Center of the RockiesRecruiting
- Beebe South Coastal Health CampusRecruiting
- Helen F Graham Cancer CenterRecruiting
- Medical Oncology Hematology Consultants PARecruiting
- Beebe Health CampusRecruiting
- Jupiter Medical CenterRecruiting
- GenesisCare USA - Lakewood Ranch
- GenesisCare USA - Plantation
- Emory University Hospital MidtownRecruiting
- Piedmont Hospital
- Emory University Hospital/Winship Cancer InstituteRecruiting
- Emory Saint Joseph's HospitalRecruiting
- Piedmont Fayette Hospital
- Advocate Good Shepherd HospitalRecruiting
- AMG Crystal Lake - OncologyRecruiting
- Decatur Memorial HospitalRecruiting
- Crossroads Cancer CenterRecruiting
- Advocate Sherman HospitalRecruiting
- AMG Libertyville - OncologyRecruiting
- Advocate Lutheran General HospitalRecruiting
- Methodist Medical Center of IllinoisRecruiting
- OSF Saint Francis Medical CenterRecruiting
- Memorial Medical CenterRecruiting
- Parkview Regional Medical CenterRecruiting
- Mary Greeley Medical CenterRecruiting
- McFarland Clinic - AmesRecruiting
- Iowa Methodist Medical CenterRecruiting
- East Jefferson General HospitalRecruiting
- LSU Healthcare Network / Metairie Multi-Specialty ClinicRecruiting
- Saint Joseph Mercy HospitalRecruiting
- Saint Joseph Mercy BrightonRecruiting
- Trinity Health IHA Medical Group Hematology Oncology - BrightonRecruiting
- Saint Joseph Mercy CantonRecruiting
- Trinity Health IHA Medical Group Hematology Oncology - CantonRecruiting
- Saint Joseph Mercy ChelseaRecruiting
- Trinity Health IHA Medical Group Hematology Oncology - Chelsea HospitalRecruiting
- GenesisCare USA - Clarkston
- GenesisCare USA - Farmington Hills
- Trinity Health Saint Mary Mercy Livonia HospitalRecruiting
- GenesisCare USA - Macomb
- GenesisCare USA - Madison Heights
- Saint Joseph Mercy OaklandRecruiting
- William Beaumont Hospital-Royal OakRecruiting
- William Beaumont Hospital - TroyRecruiting
- GenesisCare USA - Troy
- Trinity Health IHA Medical Group Hematology Oncology Ann Arbor CampusRecruiting
- Regions HospitalRecruiting
- Saint Francis Medical CenterRecruiting
- Delbert Day Cancer Institute at PCRMCRecruiting
- Dartmouth Hitchcock Medical Center/Dartmouth Cancer CenterRecruiting
- University of New Mexico Cancer CenterRecruiting
- Roswell Park Cancer InstituteRecruiting
- Highland HospitalRecruiting
- University of RochesterRecruiting
- East Carolina University
- Sanford Broadway Medical CenterRecruiting
- Sanford Roger Maris Cancer CenterRecruiting
- UH Seidman Cancer Center at UH Avon Health CenterRecruiting
- UHHS-Chagrin Highlands Medical CenterRecruiting
- Case Western Reserve UniversityRecruiting
- UH Seidman Cancer Center at Lake Health Mentor CampusRecruiting
- University Hospitals Parma Medical CenterRecruiting
- University Hospitals Portage Medical CenterRecruiting
- ProMedica Flower HospitalRecruiting
- University of Oklahoma Health Sciences CenterRecruiting
- Oregon Health and Science UniversityRecruiting
- UPMC AltoonaRecruiting
- UPMC-Heritage Valley Health System BeaverRecruiting
- Bryn Mawr HospitalRecruiting
- Carlisle Regional Cancer CenterRecruiting
- Christiana Care Health System-Concord Health CenterRecruiting
- Chambersburg HospitalRecruiting
- Geisinger Medical CenterRecruiting
- Fox Chase Cancer Center - East Norriton Hospital Outpatient Center
- UPMC Hillman Cancer Center ErieRecruiting
- UPMC Cancer Center at UPMC HorizonRecruiting
- Fox Chase Cancer Center Buckingham
- UPMC Pinnacle Cancer Center/Community Osteopathic CampusRecruiting
- IRMC Cancer CenterRecruiting
- Geisinger Medical Oncology-LewisburgRecruiting
- UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer PavilionRecruiting
- Riddle Memorial HospitalRecruiting
- UPMC Hillman Cancer Center in CoraopolisRecruiting
- Paoli Memorial HospitalRecruiting
- Fox Chase Cancer Center
- UPMC-Magee Womens HospitalRecruiting
- University of Pittsburgh Cancer Institute (UPCI)Recruiting
- UPMC-Shadyside HospitalRecruiting
- UPMC-Passavant HospitalRecruiting
- Geisinger Cancer Services-PottsvilleRecruiting
- UPMC Cancer Center at UPMC NorthwestRecruiting
- UPMC Washington Hospital Radiation OncologyRecruiting
- Geisinger Wyoming Valley/Henry Cancer CenterRecruiting
- Divine Providence HospitalRecruiting
- Lankenau Medical CenterRecruiting
- UPMC MemorialRecruiting
- Carolina Regional Cancer Center
- Sanford Cancer Center Oncology ClinicRecruiting
- Sanford USD Medical Center - Sioux FallsRecruiting
- Covenant Medical Center-LakesideRecruiting
- Norris Cotton Cancer Center-NorthRecruiting
- Edwards Comprehensive Cancer CenterRecruiting
- Langlade Hospital and Cancer CenterRecruiting
- Aurora Cancer Care-GraftonRecruiting
- Aurora BayCare Medical CenterRecruiting
- Aurora Bay Area Medical Group-MarinetteRecruiting
- Marshfield Medical Center-MarshfieldRecruiting
- Froedtert Menomonee Falls HospitalRecruiting
- Aurora Saint Luke's Medical CenterRecruiting
- Medical College of WisconsinRecruiting
- Aurora Sinai Medical CenterRecruiting
- Marshfield Clinic-Minocqua CenterRecruiting
- ProHealth D N Greenwald CenterRecruiting
- Cancer Center of Western WisconsinRecruiting
- Drexel Town Square Health CenterRecruiting
- ProHealth Oconomowoc Memorial HospitalRecruiting
- Vince Lombardi Cancer Clinic - OshkoshRecruiting
- Vince Lombardi Cancer Clinic-SheboyganRecruiting
- Ascension Saint Michael's HospitalRecruiting
- Marshfield Medical Center-River Region at Stevens PointRecruiting
- Aurora Medical Center in SummitRecruiting
- UW Cancer Center at ProHealth CareRecruiting
- Aspirus Regional Cancer CenterRecruiting
- Aurora Cancer Care-Milwaukee WestRecruiting
- Aurora West Allis Medical CenterRecruiting
- Froedtert West Bend Hospital/Kraemer Cancer CenterRecruiting
- Marshfield Medical Center - WestonRecruiting
- Aspirus Cancer Care - Wisconsin RapidsRecruiting
Arms of the Study
Arm 1
Arm 2
Placebo Comparator
Experimental
Arm I (placebo, SABR)
Arm II (relugolix, SABR)
Patients receive placebo PO QD on days 1-180 and undergo SABR for 1-3 weeks in the absence of disease progression or unacceptable toxicity.
Patients receive relugolix PO QD on days 1-180 and undergo SABR for 1-3 weeks in the absence of disease progression or unacceptable toxicity.