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Neoadjuvant Therapy of Abiraterone Plus ADT for High Risk Prostate Cancer

Primary Purpose

Prostate Cancer

Status
Active
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
Abiraterone Acetate
Prednisone
Goserelin 10.8 mg
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 Prostate Cancer

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients must be ≥ 18 and ≤75 years of age.
  • All patients must have a histologically or cytologically diagnosis of prostate cancer and must be eligible for radical prostatectomy.
  • All patients must undergo thorough tumor staging and meet one of the following criteria: 1. multi-parameter MRI or PSMA PET / CT shows clinical staging of primary tumor ≥ T3, 2. Gleason score of primary tumor ≥ 8, 3. prostate specific antigen (PSA) ≥20 ng/ml.
  • Eastern Cooperative Oncology Group (ECOG) physical condition score ≤ 1
  • Patients must have adequate hematologic function, within 28 days prior to registration as evidenced by: white blood cell (WBC) ≥ 4.0 × 109 / L, platelets≥ 100 × 109 / L, hemoglobin ≥ 9 g / dL, and international normalized ratio (INR) < 1.5.
  • Patients must have adequate hepatic function, within 28 days prior to registration, as evidenced by: total bilirubin (TBIL)≤1.5 x upper limit of normal (ULN),and SGOT (AST) and SGPT (ALT) ≤ 2.5 x ULN.
  • Patients must have adequate renal function, within 28 days prior to registration, as evidenced by serum creatinine ≤2×ULN
  • 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 be willing to obey the prohibitions and restrictions specified in the research protocol.

Exclusion Criteria:

  • Patients with prostate having neuroendocrine, small cell, or sarcoma-like features are not eligible.
  • Patients with low-risk and medium-risk, localized prostate cancer (the following conditions are met at the same time) are not eligible: multi-parameter MRI or PSMA PET / CT shows clinical staging of primary tumor < T3, Gleason score of primary tumor < 8, and prostate specific antigen (PSA) <20 ng/ml.
  • Patients with clinical or radiological evidence of regional or extra-regional lymph node metastases or bone metastases or visceral metastases are not eligible.
  • Patients with clinical or radiological evidence of regional or extra-regional lymph node metastases or bone metastases or visceral metastases are not eligible.
  • Patients who have previously received androgen deprivation therapy (medical or surgical) or focal treatment of prostate cancer or prostate cancer radiotherapy or prostate cancer chemotherapy 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.

Sites / Locations

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

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

ADT with Abiraterone and prednisone

ADT alone

Arm Description

All subjects in this arm will receive luteinizing hormone releasing hormone analogue (LHRHa) plus abiraterone acetate and prednisone, as per standard of care. Goserelin 10.8 mg will be used once per 12 weeks. Abiraterone acetate will be administered orally as 1000 mg once daily along with 5 mg of oral prednisone once per day. Subjects will continue to take abiraterone acetate and prednisone for 24 weeks before robotic assisted radical prostatectomy

All subjects in this arm will receive LHRHa alone for 24 weeks before receiving robotic assisted radical prostatectomy. Goserelin 10.8 mg will be administered once per 12 weeks.

Outcomes

Primary Outcome Measures

Pathologic Complete Response Rate
The proportion of subjects with no morphologically recognizable cancer cell in tumor specimens after radical prostatectomy
Proportion of Subjects With Minimal Residual Disease
The proportion of subjects that have residual tumors with maximum diameter of 5 mm or less after radical prostatectomy

Secondary Outcome Measures

Rate of Stage Degradation
Clinical or pathological stage degradation after neoadjuvant therapy
Rate of Positive Surgical Margins
The proportion of subjects with positive surgical margins after radical prostatectomy
Rate of Complete Serum Remission
The proportion of subjects whose PSA is less than or equal to 0.2 ng/ml after 6 months of treatment
Proportion of subjects without PSA progression
The proportion of subjects whose PSA has never gone below 1 ng/ml or who receive any radiotherapy or systemic treatment after radical prostatectomy
Imaging Response Rate
The proportion of subjects whose primary tumor is in complete remission on imaging or residual tumor's maximum diameter is less than 0.5cm
Recovery time of urinary continence (day)
The recovery time of urinary continence (day) after radical prostatectomy, defined as 0 pad/day.
biochemical recurrence-free survival (bRFS)
biochemical recurrence-free survival (bRFS) defined as time to PSA ≥ 0.2 ng/ml after radical prostatectomy.
metastasis-free survival (MFS)
time from date of randomization to date of evidence of systemic disease on bone scan or cross-sectional imaging.

Full Information

First Posted
April 12, 2020
Last Updated
December 14, 2022
Sponsor
The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School
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1. Study Identification

Unique Protocol Identification Number
NCT04356430
Brief Title
Neoadjuvant Therapy of Abiraterone Plus ADT for High Risk Prostate Cancer
Official Title
Medical Ethics Committee of Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University
Study Type
Interventional

2. Study Status

Record Verification Date
December 2021
Overall Recruitment Status
Active, not recruiting
Study Start Date
April 1, 2019 (Actual)
Primary Completion Date
March 1, 2021 (Actual)
Study Completion Date
December 1, 2023 (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
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
High risk prostate cancer (PCa) had worse outcomes on radical treatment results, short-time oncological results, even cancer-specific survival, than those low or mediate risk PCa. Neoadjuvant treatment before radical prostatectomy had been proven to get some benefits on peri-operation results, especially on reduction of tumor volume and minimization of biochemical recurrence. This study will evaluate the efficacy and safety of androgen deprivation therapy (ADT) with abiraterone in neoadjuvant therapy for surgically resectable high-risk or very high-risk PCa.

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
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
75 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
ADT with Abiraterone and prednisone
Arm Type
Experimental
Arm Description
All subjects in this arm will receive luteinizing hormone releasing hormone analogue (LHRHa) plus abiraterone acetate and prednisone, as per standard of care. Goserelin 10.8 mg will be used once per 12 weeks. Abiraterone acetate will be administered orally as 1000 mg once daily along with 5 mg of oral prednisone once per day. Subjects will continue to take abiraterone acetate and prednisone for 24 weeks before robotic assisted radical prostatectomy
Arm Title
ADT alone
Arm Type
Experimental
Arm Description
All subjects in this arm will receive LHRHa alone for 24 weeks before receiving robotic assisted radical prostatectomy. Goserelin 10.8 mg will be administered once per 12 weeks.
Intervention Type
Drug
Intervention Name(s)
Abiraterone Acetate
Intervention Description
1000 mg orally daily for 24 weeks before robotic assisted radical prostatectomy
Intervention Type
Drug
Intervention Name(s)
Prednisone
Intervention Description
5 mg oral low dose prednisone, once daily
Intervention Type
Drug
Intervention Name(s)
Goserelin 10.8 mg
Intervention Description
10.8 mg goserelin hypodermic once per 12 weeks
Primary Outcome Measure Information:
Title
Pathologic Complete Response Rate
Description
The proportion of subjects with no morphologically recognizable cancer cell in tumor specimens after radical prostatectomy
Time Frame
up to 8 months
Title
Proportion of Subjects With Minimal Residual Disease
Description
The proportion of subjects that have residual tumors with maximum diameter of 5 mm or less after radical prostatectomy
Time Frame
up to 8 months
Secondary Outcome Measure Information:
Title
Rate of Stage Degradation
Description
Clinical or pathological stage degradation after neoadjuvant therapy
Time Frame
up to 8 months
Title
Rate of Positive Surgical Margins
Description
The proportion of subjects with positive surgical margins after radical prostatectomy
Time Frame
up to 8 months
Title
Rate of Complete Serum Remission
Description
The proportion of subjects whose PSA is less than or equal to 0.2 ng/ml after 6 months of treatment
Time Frame
up to 6 months
Title
Proportion of subjects without PSA progression
Description
The proportion of subjects whose PSA has never gone below 1 ng/ml or who receive any radiotherapy or systemic treatment after radical prostatectomy
Time Frame
24 months
Title
Imaging Response Rate
Description
The proportion of subjects whose primary tumor is in complete remission on imaging or residual tumor's maximum diameter is less than 0.5cm
Time Frame
up to 8 months
Title
Recovery time of urinary continence (day)
Description
The recovery time of urinary continence (day) after radical prostatectomy, defined as 0 pad/day.
Time Frame
12 month
Title
biochemical recurrence-free survival (bRFS)
Description
biochemical recurrence-free survival (bRFS) defined as time to PSA ≥ 0.2 ng/ml after radical prostatectomy.
Time Frame
3 years
Title
metastasis-free survival (MFS)
Description
time from date of randomization to date of evidence of systemic disease on bone scan or cross-sectional imaging.
Time Frame
5 years

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must be ≥ 18 and ≤75 years of age. All patients must have a histologically or cytologically diagnosis of prostate cancer and must be eligible for radical prostatectomy. All patients must undergo thorough tumor staging and meet one of the following criteria: 1. multi-parameter MRI or PSMA PET / CT shows clinical staging of primary tumor ≥ T3, 2. Gleason score of primary tumor ≥ 8, 3. prostate specific antigen (PSA) ≥20 ng/ml. Eastern Cooperative Oncology Group (ECOG) physical condition score ≤ 1 Patients must have adequate hematologic function, within 28 days prior to registration as evidenced by: white blood cell (WBC) ≥ 4.0 × 109 / L, platelets≥ 100 × 109 / L, hemoglobin ≥ 9 g / dL, and international normalized ratio (INR) < 1.5. Patients must have adequate hepatic function, within 28 days prior to registration, as evidenced by: total bilirubin (TBIL)≤1.5 x upper limit of normal (ULN),and SGOT (AST) and SGPT (ALT) ≤ 2.5 x ULN. Patients must have adequate renal function, within 28 days prior to registration, as evidenced by serum creatinine ≤2×ULN 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 be willing to obey the prohibitions and restrictions specified in the research protocol. Exclusion Criteria: Patients with prostate having neuroendocrine, small cell, or sarcoma-like features are not eligible. Patients with low-risk and medium-risk, localized prostate cancer (the following conditions are met at the same time) are not eligible: multi-parameter MRI or PSMA PET / CT shows clinical staging of primary tumor < T3, Gleason score of primary tumor < 8, and prostate specific antigen (PSA) <20 ng/ml. Patients with clinical or radiological evidence of regional or extra-regional lymph node metastases or bone metastases or visceral metastases are not eligible. Patients with clinical or radiological evidence of regional or extra-regional lymph node metastases or bone metastases or visceral metastases are not eligible. Patients who have previously received androgen deprivation therapy (medical or surgical) or focal treatment of prostate cancer or prostate cancer radiotherapy or prostate cancer chemotherapy 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.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hongqian Guo, MD
Organizational Affiliation
Nanjing Drum Tower Hospital, affiliated to medical school of Nanjing University
Official's Role
Principal Investigator
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

12. IPD Sharing Statement

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Neoadjuvant Therapy of Abiraterone Plus ADT for High Risk Prostate Cancer

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