A Phase II Study of Neoadjuvant Androgen Deprivation Therapy Combined With Enzalutamide and Abiraterone Using Multiparametric MRI and 18F-DCFPyL-PET/CT in Newly Diagnosed Prostate Cancer

  • STATUS
    Recruiting
  • End date
    Aug 1, 2028
  • participants needed
    30
  • sponsor
    National Cancer Institute (NCI)
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Updated on 28 October 2022
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Summary

Background

Prostate cancer is a common cancer among men. There are several ways to treat it, including hormone blocking drugs, radiation therapy, and surgery. Researchers want to combine abiraterone and enzalutamide to see if there is a better way to treat prostate cancer. They also want to study a new radiotracer called 18F-DCFPyL, with the help of a scan called positron emission tomography/computed tomography (PET/CT) to see if there is a better way to detect prostate cancer.

Objective

To develop improved techniques to localize and detect prostate cancer; and to develop new ways to treat prostate cancer

Eligibility

Men ages 18 and older with prostate cancer that has not spread to other parts of the body

Design
  • Participants will have a medical evaluation to determine eligibility for the study.
  • Participants will take three different medications daily by mouth and receive two injections during the course of the study.
  • Participants will have a medical evaluation monthly (for 6 months) while taking the medications.
  • Participants will have prostate MRI and PET/CT scans before treatment, 2 months after starting treatment and again before surgery. The radiotracer will be given by injection about 2 hours before the whole-body scan. The PET/CT scan itself is about an hour.
  • Participants may be asked to do a biopsy before treatment and 2 months after starting treatment.
  • Participants will have a full medical evaluation before surgery to remove their prostate.
  • Participants will have a follow-up visit 3 months after surgery and then as needed.
  • Participants will be contacted once a year for their PSA and testosterone levels for 5 years...

Description

Background
  • Most men diagnosed with prostate cancer will present with intermediate or high-risk disease, and many develop castrate resistant prostate cancer (CRPC) as curative strategies are often unsuccessful
  • Treatment options typically involve radical prostatectomy (RP) or radiation therapy (RT) in combination with androgen deprivation therapy (ADT)
  • PET imaging based on prostate specific membrane antigen (PSMA), including use of the radiotracer DCFPyL, which binds PSMA, has emerged as a sensitive modality to detect localized and metastatic prostate cancer
  • It is unknown how androgen-targeted therapy affects expression of the androgenregulated PSMA gene, FOLH1, and 18F -DCFPyL-PET/CT sensitivity; and, the correlation between response on 18F -DCFPyL-PET/CT imaging and clinical response needs further evaluation
  • The use of highly effective androgen pathway inhibitors enzalutamide and abiraterone offers an opportunity to understand the characteristics of 18F -DCFPyL-PET imaging during treatment while potentially improving the cure rate of men with potentially lethal localized prostate cancer
  • There remains a great need for improved techniques to determine mechanisms of treatment response and resistance
    Objectives
  • To test the feasibility of 18F -DCFPyL-PET/CT for the localization of prostate cancer before, during, and after pre-operative treatment with ADT, enzalutamide, and abiraterone/prednisone in patients negative for metastatic disease
    Eligibility
  • Pathologic diagnosis of castration-sensitive prostate cancer with intermediate- or highrisk features and no evidence of metastases beyond N1 on conventional imaging
  • Candidates for radical prostatectomy
  • Testosterone levels greater than or equal to 100 ng/dL
  • ECOG PS 0-1
  • Men age greater than or equal to 18 years
    Design
  • Patients will be treated with ADT, enzalutamide, and abiraterone/prednisone for 6 months, followed by standard of care radical prostatectomy (RP)
  • 18F-DCFPyL-PET/CT and mpMRI scans prior to treatment, during months 3-5 and after 6 months of treatment
  • Prostate tumor biopsy (MR/US-guided) samples for research analyses at baseline and after mid-treatment imaging (post-month 2)
  • It is anticipated that approximately 1.5 to 2 years may be required for accrual of up to 25 evaluable subjects.

Details
Condition Castrate Sensitive Prostate Cancer
Treatment prednisone, Abiraterone, Enzalutamide, Goserelin, Radical Prostatectomy, 18F-DCFPyL
Clinical Study IdentifierNCT03860987
SponsorNational Cancer Institute (NCI)
Last Modified on28 October 2022

Eligibility

 Yes No Not Sure

Inclusion Criteria

Patients must have histologically or cytologically confirmed prostate cancer confirmed by the Laboratory of Pathology, NCI, OR documented histopathological confirmation of prostate cancer from a CLIA-certified laboratory
Must have previously untreated (with definitive therapy ie: surgery, systemic treatment or radiation therapy) prostate cancer with intermediate or high risk features defined as
Intermediate risk (patient must have at least one of the features listed below)
PSA level is between 10 and 20 ng/ml
Gleason score is 7, OR
Stage T2b or T2c
High risk (patient must have at least one of the features listed below)
PSA > 20 at the time of diagnosis
Gleason 8 or higher
Seminal vesicle involvement
Possible (on MRI) extra-capsular extension (T3 disease), OR
Clinical stage T4
Patients must be eligible for and must be planning to undergo radical prostatectomy
Patients must have testosterone levels greater than or equal to 100 ng/dL
Men age greater than or equal to18 years
Children are excluded because prostate cancer is not common in pediatric
populations
Women are not eligible because this disease occurs only in men
ECOG performance status 0-1
Patients must have adequate organ and marrow function, and other laboratory parameters as defined below
hemoglobin greater than or equal to 9 g/dL
total bilirubin within normal institutional limits
AST(SGOT)/ALT(SGPT) less than or equal to 3 X institutional upper limit of normal
creatinine within normal institutional limits; OR
creatinine clearance greater than or equal to 30 mL/min/1.73 m2 for patients with creatinine levels above institutional normal (calculated via EGFR)
Lesions within prostate must be detectable on MRI for biopsy
The effects of enzalutamide and abiraterone on the developing human fetus are unknown. For this reason and because androgen receptor antagonists as well as other therapeutic agents used in this trial are known to be teratogenic, male participants and their female partners of child bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence). Male participants should use a condom if having intercourse with a pregnant woman. Additionally, a condom plus another effective method of birth control is recommended during therapy and for 3 months after treatment for male participants having intercourse with a woman of reproductive potential. Should a woman become pregnant or suspect she is pregnant while her partner is participating in this study, she should inform her treating physician immediately and her partner should inform the study team
Ability of subject to understand and the willingness to sign a written informed consent document
Willingness to adhere to protocol requirements (e.g., required biopsies)
Willingness to travel to NIH for follow-up visits

Exclusion Criteria

Patients who are receiving any other investigational agents (in the past 28 days) or herbal medications (within 1 day prior to registration)
Patients with evidence of distant metastatic disease beyond N1 (regional) lymph nodes on conventional imaging studies (e.g., CT, MRI or Bone Scan)
Patients who have received any prior definitive therapy (ie: surgery, systemic treatment or radiation therapy) for prostate cancer
History of allergic reactions attributed to compounds of similar chemical or biologic composition to enzalutamide, abiraterone or other agents used in study
Clinically significant cardiac disease, e.g., New York Heart Association (NYHA) classes III-IV; uncontrolled angina, uncontrolled arrhythmia or uncontrolled hypertension (greater than or equal to 160/100 mmHg on two consecutive readings), myocardial infarction in the previous 6 months as confirmed by an electrocardiogram (ECG)
Contraindication to biopsy
Bleeding disorders for which a prostate biopsy would pose a bleeding risk
PT/PTT greater than or equal to 1.5 times the upper limit of normal
Artificial heart valve
Contraindication to MRI
Patients weighing more than the weight limit or unable to fit the scanner
Allergy to MR contrast agent
Patients with pacemakers, cerebral aneurysm clips, shrapnel injury or implantable electronic device
HIV-positive patients on antiretroviral therapy are ineligible because of potential pharmacokinetic interactions with study drugs. However, patients with long-standing (>5 years) HIV on antiretroviral therapy > 1 month (undetectable HIV viral load and CD4 count > 150 cells/microliter) may be eligible if the PI determines no anticipated clinically significant drug-drug interactions
Patients undergoing active treatment for Hepatitis B or C infections
Patients who have taken medications that are strong inhibitors or inducers of CYP3A4 or PgP within 14 days prior to enrollment and need to remain on these medications
Other medications used for urinary symptoms including 5-alpha reductase inhibitors (finasteride and dutasteride) and alternative medications known to alter PSA (e.g., phytoestrogens and saw palmetto) cannot be taken while patients are receiving enzalutamide and abiraterone
Uncontrolled intercurrent illness including, but not limited to, ongoing or active
Contraindication to steroid use
infection, or psychiatric illness/social situations that would limit
Patients with malignancy within the past 3 years for which study drugs or a prostatectomy is a contraindication
compliance with study requirements
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