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Neoadjuvant Intense Endocrine Therapy for High Risk and Locally Advanced Prostate Cancer

Primary Purpose

Neoadjuvant Therapy, High Risk Prostate Cancer, Locally Advanced Prostate Cancer

Status
Recruiting
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
ADT
Abiraterone Acetate
Prednisolone tablets
Enzalutamide
Apalutamide
Darotamide
Rezvilutamide
PARP inhibitor
Robot-assisted radical prostatectomy
Sponsored by
The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Neoadjuvant Therapy

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. All patients must have been histologically diagnosed of prostate cancer and must be eligible for radical prostatectomy.
  2. All patients must undergo thorough tumor staging and meet one of the following criteria: a) multi-parameter MRI or PSMA PET/CT shows clinical staging of primary tumor ≥ T3; b) Gleason score of primary tumor ≥ 8; c)prostate specific antigen(PSA) ≥20 ng/ml; d) Imaging evaluation shows regional lymph node metastases (N1).
  3. Eastern Cooperative Oncology Group (ECOG) physical condition score ≤ 1.
  4. Patients must have adequate hematologic function, hepatic function, renal function and cardiac function.
  5. Patients must participate voluntarily and sign an informed consent form(ICF), indicating that they understand the purpose and required procedures of the study, and are willing to participate in. Patients must bewilling to obey the prohibitions and restrictions specified in the research protocol.
  6. Fertile patients must be willing to use highly effective contraception during the study period and within 120 days of the last dose of treatment.

Exclusion Criteria:

  1. Patients with neuroendocrine, small cell, or sarcoma-like pathologic features are not eligible.
  2. Patients with low-risk or medium-risk, localized prostate cancer (the following conditions are met at the same time) are not eligible: a) multiparameter MRI or PSMA PET / CT shows clinical staging of primary tumor < T3; b) Gleason score of primary tumor < 8; c) prostate specific antigen (PSA) <20 ng/ml.
  3. Patients with clinical or radiological evidence of extra-regional lymph node metastases or bone metastases or visceral metastases (any M1) are not eligible.
  4. Patients who have previously received androgen deprivation therapy (medical or surgical) or focal treatment, radiotherapy, chemotherapy for prostate cancer are not eligible.
  5. Patients with severe or uncontrolled concurrent infections are not eligible.
  6. Patients must not have New York Heart Association Class III or IV congestive heart failure at the time of screening. Patients must not have any thromboembolic event, unstable angina pectoris, myocardial infarction within 6 months prior to registration.
  7. Patients must not have uncontrolled severe hypertension, persistent uncontrolled diabetes, oxygen-dependent lung disease, chronic liver disease, or HIV infection.
  8. Patients must not have had other malignancies other than prostate cancer in the past 5 years, but cured basal cell or squamous cell skin cancers can be enrolled.
  9. Patients with mental illness, mental disability or inability to give informed consent are not eligible.

Sites / Locations

  • Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm 8

Arm Type

Active Comparator

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

ADT alone + prostatectomy

ADT plus Abiraterone

ADT plus Enzalutamide

ADT plus Apalutamide

ADT plus Darotamide

ADT plus Rizvilutamide

PARP inhibitor + abiraterone + ADT

PARP inhibitor + ADT

Arm Description

A total of 100 subjects receive ADT for 6 cycles (28 days per cycle) before prostatectomy. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.

A total of 150 subjects in this group received abiraterone acetate + prednisolone acetate daily for 6 cycles along with ADT. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.

A total of 50 subjects in this group received enzalutamide daily for 6 cycles along with ADT. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.

A total of 150 subjects in this group received apalutamide daily for 6 cycles along with ADT. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.

A total of 150 subjects in this group received darotamide daily for 6 cycles along with ADT. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.

A total of 150 subjects in this group received rizvilutamide daily for 6 cycles along with ADT. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.

A total of 100 subjects in this group received Poly ADP-ribose Polymerase (PARP) Inhibitor plus abiraterone along with ADT. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.

A total of 50 subjects in this group in this group received Poly ADP-ribose Polymerase (PARP) Inhibitor along with ADT mentioned above. Enrolled patients carry homologous recombination repair (HRR) gene mutation verified by molecular testing. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.

Outcomes

Primary Outcome Measures

Pathologic response rate
Pathologic response rate= Pathologic Complete Response (pCR) Rate + Minimal Residual Disease (MRD) rate
3 year biochemical progression free survival (bPFS)
Biochemical progression free survival (bPFS) within 3 years

Secondary Outcome Measures

Metastasis-Free Survival (MFS)
Metastasis-Free Survival (MFS) after intense neoadjuvant therapy
Time to castration-resistant prostate cancer(CRPC)
Time to castration-resistant prostate cancer(CRPC) after intense neoadjuvant therapy
PSA response rate
Prostate specific antigen (PSA) drops ≥ 98% after intense neoadjuvant therapy
Positive margin rate
The positive margin rate of whole-mount pathology for prostatectomy after intense neoadjuvant therapy
Pathologic downgrade rate
The pathologic downgrade rate of whole-mount pathology for prostatectomy after intense neoadjuvant therapy compared with initial T stage.
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0. All grades of adverse events will be documented.

Full Information

First Posted
May 29, 2022
Last Updated
August 12, 2022
Sponsor
The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School
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1. Study Identification

Unique Protocol Identification Number
NCT05406999
Brief Title
Neoadjuvant Intense Endocrine Therapy for High Risk and Locally Advanced Prostate Cancer
Official Title
A Prospective, Multi-arm, Multi-center Clinical Trial on Neoadjuvant Intense Endocrine Therapy for High Risk and Locally Advanced Prostate Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Recruiting
Study Start Date
February 1, 2020 (Actual)
Primary Completion Date
December 31, 2026 (Anticipated)
Study Completion Date
June 30, 2030 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School

4. Oversight

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

5. Study Description

Brief Summary
This is a prospective, multicenter, multi-arm, non-randomized, open-label clinical trial to evaluate the efficacy and safety of neoadjuvant intense endocrine therapy for high-risk or locally advanced prostate cancer.
Detailed Description
The study was designed to evaluate the efficacy and safety of different forms of neoadjuvant intense androgen deprivation therapy (ADT) compared with ADT alone, followed by prostatectomy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Neoadjuvant Therapy, High Risk Prostate Cancer, Locally Advanced Prostate Cancer, Intense Endocrine Therapy

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
ADT alone + prostatectomy
Arm Type
Active Comparator
Arm Description
A total of 100 subjects receive ADT for 6 cycles (28 days per cycle) before prostatectomy. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.
Arm Title
ADT plus Abiraterone
Arm Type
Experimental
Arm Description
A total of 150 subjects in this group received abiraterone acetate + prednisolone acetate daily for 6 cycles along with ADT. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.
Arm Title
ADT plus Enzalutamide
Arm Type
Experimental
Arm Description
A total of 50 subjects in this group received enzalutamide daily for 6 cycles along with ADT. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.
Arm Title
ADT plus Apalutamide
Arm Type
Experimental
Arm Description
A total of 150 subjects in this group received apalutamide daily for 6 cycles along with ADT. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.
Arm Title
ADT plus Darotamide
Arm Type
Experimental
Arm Description
A total of 150 subjects in this group received darotamide daily for 6 cycles along with ADT. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.
Arm Title
ADT plus Rizvilutamide
Arm Type
Experimental
Arm Description
A total of 150 subjects in this group received rizvilutamide daily for 6 cycles along with ADT. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.
Arm Title
PARP inhibitor + abiraterone + ADT
Arm Type
Experimental
Arm Description
A total of 100 subjects in this group received Poly ADP-ribose Polymerase (PARP) Inhibitor plus abiraterone along with ADT. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.
Arm Title
PARP inhibitor + ADT
Arm Type
Experimental
Arm Description
A total of 50 subjects in this group in this group received Poly ADP-ribose Polymerase (PARP) Inhibitor along with ADT mentioned above. Enrolled patients carry homologous recombination repair (HRR) gene mutation verified by molecular testing. Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.
Intervention Type
Drug
Intervention Name(s)
ADT
Intervention Description
The ADT regimen will be determined by the investigators at separate centers. The dose and frequency of administration will be consistent with the prescribing information. Available drugs include triptorelin, goserelin, leuprolide, digareke ect.
Intervention Type
Drug
Intervention Name(s)
Abiraterone Acetate
Intervention Description
1000 mg (250 mg×4 tablets) once daily, orally
Intervention Type
Drug
Intervention Name(s)
Prednisolone tablets
Intervention Description
5 mg once daily, orally.
Intervention Type
Drug
Intervention Name(s)
Enzalutamide
Intervention Description
160 mg (40 mg× 4 tablets) once daily, orally.
Intervention Type
Drug
Intervention Name(s)
Apalutamide
Intervention Description
240 mg (60 mg×4 tablets) once daily, orally.
Intervention Type
Drug
Intervention Name(s)
Darotamide
Intervention Description
600 mg (300 mg × 2 tablets) twice daily, orally.
Intervention Type
Drug
Intervention Name(s)
Rezvilutamide
Intervention Description
240 mg (80 mg × 3 tablets) once daily orally
Intervention Type
Drug
Intervention Name(s)
PARP inhibitor
Intervention Description
The PARP inhibitors will be determined by the investigators at separate centers. The dosage and frequency of administration will be consistent with the prescribing information. Available drugs include olaparib, fluzoparib, pamiparib, talazoparib ect.
Intervention Type
Procedure
Intervention Name(s)
Robot-assisted radical prostatectomy
Intervention Description
Robot-assisted radical prostatectomy was performed within 2 weeks after the end of the therapy.
Primary Outcome Measure Information:
Title
Pathologic response rate
Description
Pathologic response rate= Pathologic Complete Response (pCR) Rate + Minimal Residual Disease (MRD) rate
Time Frame
up to 3 years
Title
3 year biochemical progression free survival (bPFS)
Description
Biochemical progression free survival (bPFS) within 3 years
Time Frame
up to 3 years
Secondary Outcome Measure Information:
Title
Metastasis-Free Survival (MFS)
Description
Metastasis-Free Survival (MFS) after intense neoadjuvant therapy
Time Frame
up to 5 years
Title
Time to castration-resistant prostate cancer(CRPC)
Description
Time to castration-resistant prostate cancer(CRPC) after intense neoadjuvant therapy
Time Frame
up to 5 years
Title
PSA response rate
Description
Prostate specific antigen (PSA) drops ≥ 98% after intense neoadjuvant therapy
Time Frame
up to 3 years
Title
Positive margin rate
Description
The positive margin rate of whole-mount pathology for prostatectomy after intense neoadjuvant therapy
Time Frame
up to 6 months
Title
Pathologic downgrade rate
Description
The pathologic downgrade rate of whole-mount pathology for prostatectomy after intense neoadjuvant therapy compared with initial T stage.
Time Frame
up to 6 months
Title
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Description
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0. All grades of adverse events will be documented.
Time Frame
up to 5 years

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: All patients must have been histologically diagnosed of prostate cancer and must be eligible for radical prostatectomy. All patients must undergo thorough tumor staging and meet one of the following criteria: a) multi-parameter MRI or PSMA PET/CT shows clinical staging of primary tumor ≥ T3; b) Gleason score of primary tumor ≥ 8; c)prostate specific antigen(PSA) ≥20 ng/ml; d) Imaging evaluation shows regional lymph node metastases (N1). Eastern Cooperative Oncology Group (ECOG) physical condition score ≤ 1. Patients must have adequate hematologic function, hepatic function, renal function and cardiac function. Patients must participate voluntarily and sign an informed consent form(ICF), indicating that they understand the purpose and required procedures of the study, and are willing to participate in. Patients must bewilling to obey the prohibitions and restrictions specified in the research protocol. Fertile patients must be willing to use highly effective contraception during the study period and within 120 days of the last dose of treatment. Exclusion Criteria: Patients with neuroendocrine, small cell, or sarcoma-like pathologic features are not eligible. Patients with low-risk or medium-risk, localized prostate cancer (the following conditions are met at the same time) are not eligible: a) multiparameter MRI or PSMA PET / CT shows clinical staging of primary tumor < T3; b) Gleason score of primary tumor < 8; c) prostate specific antigen (PSA) <20 ng/ml. Patients with clinical or radiological evidence of extra-regional lymph node metastases or bone metastases or visceral metastases (any M1) are not eligible. Patients who have previously received androgen deprivation therapy (medical or surgical) or focal treatment, radiotherapy, chemotherapy for prostate cancer are not eligible. Patients with severe or uncontrolled concurrent infections are not eligible. Patients must not have New York Heart Association Class III or IV congestive heart failure at the time of screening. Patients must not have any thromboembolic event, unstable angina pectoris, myocardial infarction within 6 months prior to registration. Patients must not have uncontrolled severe hypertension, persistent uncontrolled diabetes, oxygen-dependent lung disease, chronic liver disease, or HIV infection. Patients must not have had other malignancies other than prostate cancer in the past 5 years, but cured basal cell or squamous cell skin cancers can be enrolled. Patients with mental illness, mental disability or inability to give informed consent are not eligible.
Facility Information:
Facility Name
Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University
City
Nanjing
State/Province
Jiangsu
ZIP/Postal Code
210000
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Junlong Zhuang, MD
Phone
8615950451917
Email
zhuangjl-2008@163.com

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Neoadjuvant Intense Endocrine Therapy for High Risk and Locally Advanced Prostate Cancer

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