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Phase II Study of the Use of Neoadjuvant Cabazitaxel With Hormonal Treatment in Patients Operable Prostate Cancer, Assess the Efficacy and Toxicity of Cabazitaxel, and Explore Potential Predictive and Prognostic Markers of Clinical Outcome (CHROME)

Primary Purpose

Prostate Cancer

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Cabazitaxel
Sponsored by
The Clatterbridge Cancer Centre NHS Foundation Trust
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prostate Cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Aged ≥18 years
  2. ECOG performance status 0-1 (Appendix 2)
  3. Diagnosis of high risk prostate cancer as defined by one or more of the following: clinically T2c/T3, Gleason 8-10 and or PSA >10ng/ml
  4. Appropriate candidate for radical prostatectomy
  5. Life expectancy greater than 10 years
  6. Adequate organ function as evidenced by peripheral blood counts and serum chemistries at enrolment
  7. Ability and capacity to consent and comply with study and follow-up procedures
  8. Fit to receive chemotherapy

Exclusion Criteria:

  1. Locally advanced or metastatic disease
  2. Patients with a history of other previous malignancy except treated CIN or non melanomatous skin cancer
  3. Grade ≥2 peripheral neuropathy
  4. Grade ≥2 stomatitis
  5. History of severe hypersensitivity reaction (≥ grade 3) to taxane
  6. History of severe hypersensitivity reaction (≥ grade 3) to polysorbate 80 containing drugs
  7. Other concurrent serious illness or medical conditions
  8. Inadequate organ and bone marrow function as evidenced by:

    1. Haemoglobin <10.0 g/dL
    2. Absolute neutrophil count <1.5 x 109/L
    3. Platelet count <100 x 109/L
    4. AST/SGOT and/or ALT/SGPT >1.5 xULN
    5. Total bilirubin >1.5 x ULN
    6. Serum creatinine >1.5 x ULN (if creatinine is 1.0 - 1.5 xULN, creatinine clearance will be calculated according to CKD-EPI formula and patients with creatinine clearance <60mL/min should be excluded - see Appendix 3)
  9. Uncontrolled diabetes mellitus
  10. Active uncontrolled gastro oesophageal reflux disease (GORD)
  11. Active infection requiring systemic antibiotic or antifungal medication
  12. Participation in another clinical trial with any investigational drug within 30 days prior to study enrolment
  13. Concurrent or planned treatment with strong inhibitors of cytochrome P450 3A4/5 (a 1-week washout period is necessary for patients who are already on these treatments - see Appendix 5 for a list of CYP3A inhibitors)
  14. Concurrent or planned treatment with strong inducers of cytochrome P450 3A4/5 (a 1-week washout period is necessary for patients who are already on these treatments) - see Appendix 4 for a list of CYP3A inducers)
  15. Contraindications or sensitivity to GCSF treatments
  16. History of myocardial infarction, unstable symptomatic ischemic heart disease, ongoing arrhythmias of Grade > 2 (NCI CTCAE, version 4.03), thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism, or symptomatic cerebrovascular events), or any other cardiac condition (e.g., pericardial effusion restrictive cardiomyopathy) within 6 months prior to first dose of study drug. Chronic stable atrial fibrillation on stable anticoagulant therapy is allowed.

    -

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    No Intervention

    Experimental

    Arm Label

    control

    treatment

    Arm Description

    Immediate surgery (radical prostatectomy) (standard care)

    14 days prior to starting Cabazitaxel patients will take 50mg Bicalutamide once daily for 21 days. 7 days prior to starting Cabazitaxel patients will be given 3 months LHRH treatment via injection. The entire dose will be administered via one injection 7 days prior to starting Cabazitaxel. This may be either leuprorelin or goserelin acetate and should be given as per local practice. At least 30 minutes prior to each administration of Cabazitaxel, patients will be administered IV premedication consisting of: 50mg Ranitidine 10mg Chlorphenamine 8mg Dexamethasone Daily from Day 1 until end of Cabazitaxel treatment patients will take 10mg Prednisolone once daily from Day 1 until end of Cabazitaxel treatment Day 1 of each cycle - Patients will receive Cabazitaxel 25 mg/m2 intravenously over one hour every 21 days (on Day 1 of each cycle). Treatment will be continued for 4 cycles.

    Outcomes

    Primary Outcome Measures

    To assess the efficacy activity of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy in patients with high risk operable prostate cancer, measuring the reduction in treatment failure and comparing this to that obtained in the control arm
    Treatment failure is defined as: PSA level ≥ 0.12ng/ml measured on at least two occasions (1 confirmatory sample) post-surgery within three years of follow-up or death related to prostate cancer or use of a salvage therapy or not undergoing surgery at all.)

    Secondary Outcome Measures

    • To assess the efficacy of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy, measuring the pathological and radiological response rates and comparing this to that obtained in a control arm of immediate surgery.
    Pathological response rate assessed as per pTNM staging system Radiological response rates as defined in RECIST V1.1 Combined to give overall response rate
    To assess the efficacy of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy, assessing surgical margin involvement and comparing this to that obtained in a control arm of immediate surgery.
    The proportion of patients with positive resection margin will be reported and compared across the treatment groups using Chi-square tests. Multivariable models using logistic regression techniques shall be used to adjust for key prognostic variables of interest.
    To assess the efficacy of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy, assessing lymph node involvement and comparing this to that obtained in a control arm of immediate surgery.
    The proportion of patients with positive lymph nodes will be reported and compared across the treatment groups using Chi-square tests.
    To assess the efficacy of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy, measuring progression free survival and comparing this to that obtained in a control arm of immediate surgery.
    • To assess the efficacy of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy, measuring overall survival from time of randomisation to death and comparing this to that obtained in a control arm of immediate surgery.
    To assess the efficacy of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy, measuring surgical feasibility and comparing this to that obtained in a control arm of immediate surgery.
    The proportion of patients with delays to surgery, perioperative morbidities, mortalities and surgical complications will be reported and compared across the treatment groups.
    To assess the quality of life of patients receiving neoadjuvant Cabazitaxel chemotherapy and hormonal therapy and comparing this to quality of life patients in a control arm of immediate surgery using the EORTC QLQ-C30 version 3 questionnaire.
    Responses to EORTC QLQ-C30 will be reported (median, IQR) according to global health status, the functional scales and symptom scales, by intervention group, and over time. Joint modelling or quality-adjusted survival analysis will be undertaken to allow a simultaneous assessment of quality of life and survival.

    Full Information

    First Posted
    September 29, 2020
    Last Updated
    January 4, 2021
    Sponsor
    The Clatterbridge Cancer Centre NHS Foundation Trust
    Collaborators
    University of Liverpool
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04622761
    Brief Title
    Phase II Study of the Use of Neoadjuvant Cabazitaxel With Hormonal Treatment in Patients Operable Prostate Cancer, Assess the Efficacy and Toxicity of Cabazitaxel, and Explore Potential Predictive and Prognostic Markers of Clinical Outcome
    Acronym
    CHROME
    Official Title
    Phase II Study of the Use of Neoadjuvant Cabazitaxel With Hormonal Treatment in Patients With High Risk Operable Prostate Cancer, to Assess the Efficacy and Toxicity of Cabazitaxel, and, to Explore Potential Predictive and Prognostic Markers of Clinical Outcome
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    November 2020
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    January 15, 2021 (Anticipated)
    Primary Completion Date
    November 2, 2025 (Anticipated)
    Study Completion Date
    May 2, 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    The Clatterbridge Cancer Centre NHS Foundation Trust
    Collaborators
    University of Liverpool

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Product Manufactured in and Exported from the U.S.
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This study is evaluating the efficacy of cabazitaxel and hormonal treatment as neoadjuvant treatment for patients with clinically operable disease suitable for surgery, and a high risk of relapse after surgery
    Detailed Description
    This study is evaluating the efficacy of cabazitaxel and hormonal treatment (LHRH analogues) as neoadjuvant treatment for patients with clinically operable disease suitable for surgery (no lymph node, visceral or bony metastases), and a high risk of relapse after surgery (5 year risk of relapse). Patients will receive four cycles of neoadjuvant treatment (cabazitaxel treatment and 3 months LHRH treatment) unless there is evidence of disease progression, unacceptable toxicity or patient request to withdraw consent.

    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
    Model Description
    A two arm, phase II randomised multi-centre trial. 120 patients will be recruited to the trial. Patients will be randomised to a control arm of immediate surgery or a treatment arm in a ratio of 1:2 (control 40pts: treatment 80pts). Patients in the treatment arm will receive hormonal treatment and Cabazitaxel 25 mg/m2 day 1 intravenously over one hour every 21 days. Treatment will be continued for 4 cycles (3 months) unless disease progression, unacceptable toxicity or patient request.
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    120 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    control
    Arm Type
    No Intervention
    Arm Description
    Immediate surgery (radical prostatectomy) (standard care)
    Arm Title
    treatment
    Arm Type
    Experimental
    Arm Description
    14 days prior to starting Cabazitaxel patients will take 50mg Bicalutamide once daily for 21 days. 7 days prior to starting Cabazitaxel patients will be given 3 months LHRH treatment via injection. The entire dose will be administered via one injection 7 days prior to starting Cabazitaxel. This may be either leuprorelin or goserelin acetate and should be given as per local practice. At least 30 minutes prior to each administration of Cabazitaxel, patients will be administered IV premedication consisting of: 50mg Ranitidine 10mg Chlorphenamine 8mg Dexamethasone Daily from Day 1 until end of Cabazitaxel treatment patients will take 10mg Prednisolone once daily from Day 1 until end of Cabazitaxel treatment Day 1 of each cycle - Patients will receive Cabazitaxel 25 mg/m2 intravenously over one hour every 21 days (on Day 1 of each cycle). Treatment will be continued for 4 cycles.
    Intervention Type
    Drug
    Intervention Name(s)
    Cabazitaxel
    Other Intervention Name(s)
    jevtana, XRP6258, RPR116258A
    Intervention Description
    Patients will receive Cabazitaxel 25 mg/m2 * intravenously over one hour every 21 days (on Day 1 of each cycle). Treatment will be continued for 4 cycles unless disease progression, unacceptable toxicity or patient request. These patients will have surgery (radical prostatectomy) 4-86 weeks following treatment. *Cabazitaxel dose should be capped at 50mg (BSA=2)
    Primary Outcome Measure Information:
    Title
    To assess the efficacy activity of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy in patients with high risk operable prostate cancer, measuring the reduction in treatment failure and comparing this to that obtained in the control arm
    Description
    Treatment failure is defined as: PSA level ≥ 0.12ng/ml measured on at least two occasions (1 confirmatory sample) post-surgery within three years of follow-up or death related to prostate cancer or use of a salvage therapy or not undergoing surgery at all.)
    Time Frame
    through study completion, average 3 years
    Secondary Outcome Measure Information:
    Title
    • To assess the efficacy of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy, measuring the pathological and radiological response rates and comparing this to that obtained in a control arm of immediate surgery.
    Description
    Pathological response rate assessed as per pTNM staging system Radiological response rates as defined in RECIST V1.1 Combined to give overall response rate
    Time Frame
    3 year follow up
    Title
    To assess the efficacy of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy, assessing surgical margin involvement and comparing this to that obtained in a control arm of immediate surgery.
    Description
    The proportion of patients with positive resection margin will be reported and compared across the treatment groups using Chi-square tests. Multivariable models using logistic regression techniques shall be used to adjust for key prognostic variables of interest.
    Time Frame
    3 year follow up
    Title
    To assess the efficacy of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy, assessing lymph node involvement and comparing this to that obtained in a control arm of immediate surgery.
    Description
    The proportion of patients with positive lymph nodes will be reported and compared across the treatment groups using Chi-square tests.
    Time Frame
    3 year follow up
    Title
    To assess the efficacy of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy, measuring progression free survival and comparing this to that obtained in a control arm of immediate surgery.
    Time Frame
    3 year follow up
    Title
    • To assess the efficacy of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy, measuring overall survival from time of randomisation to death and comparing this to that obtained in a control arm of immediate surgery.
    Time Frame
    3 year follow up
    Title
    To assess the efficacy of neoadjuvant Cabazitaxel chemotherapy and hormonal therapy, measuring surgical feasibility and comparing this to that obtained in a control arm of immediate surgery.
    Description
    The proportion of patients with delays to surgery, perioperative morbidities, mortalities and surgical complications will be reported and compared across the treatment groups.
    Time Frame
    3 year follow up
    Title
    To assess the quality of life of patients receiving neoadjuvant Cabazitaxel chemotherapy and hormonal therapy and comparing this to quality of life patients in a control arm of immediate surgery using the EORTC QLQ-C30 version 3 questionnaire.
    Description
    Responses to EORTC QLQ-C30 will be reported (median, IQR) according to global health status, the functional scales and symptom scales, by intervention group, and over time. Joint modelling or quality-adjusted survival analysis will be undertaken to allow a simultaneous assessment of quality of life and survival.
    Time Frame
    3 year follow up

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Aged ≥18 years ECOG performance status 0-1 (Appendix 2) Diagnosis of high risk prostate cancer as defined by one or more of the following: clinically T2c/T3, Gleason 8-10 and or PSA >10ng/ml Appropriate candidate for radical prostatectomy Life expectancy greater than 10 years Adequate organ function as evidenced by peripheral blood counts and serum chemistries at enrolment Ability and capacity to consent and comply with study and follow-up procedures Fit to receive chemotherapy Exclusion Criteria: Locally advanced or metastatic disease Patients with a history of other previous malignancy except treated CIN or non melanomatous skin cancer Grade ≥2 peripheral neuropathy Grade ≥2 stomatitis History of severe hypersensitivity reaction (≥ grade 3) to taxane History of severe hypersensitivity reaction (≥ grade 3) to polysorbate 80 containing drugs Other concurrent serious illness or medical conditions Inadequate organ and bone marrow function as evidenced by: Haemoglobin <10.0 g/dL Absolute neutrophil count <1.5 x 109/L Platelet count <100 x 109/L AST/SGOT and/or ALT/SGPT >1.5 xULN Total bilirubin >1.5 x ULN Serum creatinine >1.5 x ULN (if creatinine is 1.0 - 1.5 xULN, creatinine clearance will be calculated according to CKD-EPI formula and patients with creatinine clearance <60mL/min should be excluded - see Appendix 3) Uncontrolled diabetes mellitus Active uncontrolled gastro oesophageal reflux disease (GORD) Active infection requiring systemic antibiotic or antifungal medication Participation in another clinical trial with any investigational drug within 30 days prior to study enrolment Concurrent or planned treatment with strong inhibitors of cytochrome P450 3A4/5 (a 1-week washout period is necessary for patients who are already on these treatments - see Appendix 5 for a list of CYP3A inhibitors) Concurrent or planned treatment with strong inducers of cytochrome P450 3A4/5 (a 1-week washout period is necessary for patients who are already on these treatments) - see Appendix 4 for a list of CYP3A inducers) Contraindications or sensitivity to GCSF treatments History of myocardial infarction, unstable symptomatic ischemic heart disease, ongoing arrhythmias of Grade > 2 (NCI CTCAE, version 4.03), thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism, or symptomatic cerebrovascular events), or any other cardiac condition (e.g., pericardial effusion restrictive cardiomyopathy) within 6 months prior to first dose of study drug. Chronic stable atrial fibrillation on stable anticoagulant therapy is allowed. -
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Marie Maguire
    Phone
    0151 556 5321
    Email
    maria.maguire2@nhs.net
    First Name & Middle Initial & Last Name or Official Title & Degree
    Claire Taylor
    Phone
    0151 795 14010
    Email
    chrome@liverpool.ac.uk

    12. IPD Sharing Statement

    Plan to Share IPD
    Undecided

    Learn more about this trial

    Phase II Study of the Use of Neoadjuvant Cabazitaxel With Hormonal Treatment in Patients Operable Prostate Cancer, Assess the Efficacy and Toxicity of Cabazitaxel, and Explore Potential Predictive and Prognostic Markers of Clinical Outcome

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