18F-fluciclovine PET in Metastatic Castration Resistant Prostate Cancer Treated With Life Prolonging Therapies

  • End date
    Jun 21, 2023
  • participants needed
  • sponsor
    Tulane University
Updated on 21 October 2021
platelet count
renal function
neutrophil count
bone scan
luteinizing hormone
gonadotropin releasing hormone
soft tissue disease
prostate adenocarcinoma


This is a pilot phase 2 single-arm study, of men with metastatic castration-resistant prostate cancer (mCRPC). Patients will be treated with any of the approved life-prolonging therapies: abiraterone 1000 mg daily plus prednisone 5 mg (or dexamethasone 0.5 mg) daily, enzalutamide 160 mg daily, or docetaxel 50 mg/m2 every two weeks or 75 mg/m2 every three weeks.


Prostate cancer is a hormonally-driven disease and androgens are key in the growth of both normal prostate and prostate cancer cells. Once mCRPC is evident, most patients receive a second-generation hormonal therapy to further suppress the synthesis or androgens (abiraterone) and to block androgen receptor (AR) activation, nuclear translocation and DNA binding (enzalutamide).

Conventional imaging of prostate cancer has limitations in staging, restaging after biochemical relapse, and response assessment. Functional imaging with positron emission tomography (PET) can target various aspects of tumor biology and is clearly superior in the detection of extra-prostatic disease. 18F-fluciclovine is a synthetic amino acid transported across mammalian cell membranes by amino acid transporters that are upregulated in prostate cancer cells.

18F-fluciclovine is approved for PET imaging to identify sites of prostate cancer recurrence in men with rising prostate specific antigen (PSA) following prior definitive treatment. This study describes the changes in 18F-fluciclovine PET scan and compare these results with PSA and conventional computerized tomography (CT) and bone scans, in mCRPC patients treated with abiraterone acetate-prednisone, enzalutamide or docetaxel.

Condition Metastatic Castration Resistant Prostate Cancer
Treatment 18F-fluciclovine PET Scan
Clinical Study IdentifierNCT04158245
SponsorTulane University
Last Modified on21 October 2021


Yes No Not Sure

Inclusion Criteria

Eastern Cooperative Oncology Group (ECOG) Performance status 0-2
Age 18 years
Histologically confirmed adenocarcinoma of the prostate
Ongoing use of luteinizing hormone-releasing hormone (LHRH) required in the absence of surgical castration and castrate concentration of testosterone (< 50 ng/dL)
Detectable PSA of at least 2 ng/dL
Metastatic disease documented by CT or bone scan within 42 days of cycle 1 day 1
Life expectancy of 6 months
Must have disease progression despite a castrate concentration of testosterone of < 50 ng/dL based on
PSA progression defined as increase in PSA of at least 2 ng/dL and 25% from nadir values of prior therapy, determined by 2 separate measurement taken at least 1 week apart
B. Radiographic disease progression based on response evaluation criteria in
solid tumors (RECIST) 1.1 for soft tissue disease and/or prostate cancer
working group 3 (PCWG3) for bone only disease
\. No prior life-prolonging therapies for mCRPC are allowed, except
\. The use of docetaxel in the metastatic hormone-sensitive prostate cancer
(mHSPC) setting is allowed
\. Low dose prednisone (10 mg or less) or equivalent is allowed
\. Acceptable liver function (within 28 days from enrollment) defined as
Bilirubin < 2.5 times upper limit of normal (ULN), except for patients with known Gilbert disease (in such cases bilirubin < 5 times ULN)
AST (SGOT) and ALT (SGPT) < 3 times ULN
Acceptable renal function (within 28 days from enrollment)
Serum creatinine 2.0 x ULN or creatinine clearance 30 mL/min
Acceptable hematologic status (within 28 days from enrollment)
Absolute neutrophil count (ANC) 1000 cell/mm3 (100 x 109/L)
Platelet count 100,000 platelet/mm3 (100 x 109/L)
Hemoglobin 9 g/dL
At least 2 weeks since prior radiation before starting study treatment (cycle 1 day 1)
Able to understand and willing to sign a written informed consent document
Patients who have partners of childbearing potential must be willing to use a method of birth control with adequate barrier protection as determined to be acceptable by the principal investigator and sponsor during the study and for 1 week after last dose of abiraterone acetate

Exclusion Criteria

Pathological findings consistent with small cell carcinoma of the prostate
Prior treatment with docetaxel for metastatic castration-resistant prostate cancer (CRPC)
Patient with normal 18F-flucicolovine PET/CT scans at baseline
Know allergies, hypersensitivity, or intolerance to abiraterone, prednisone, 18F-fluciclovine or their excipients
Any chronic medical condition requiring 10 mg daily of systemic prednisone (or equivalent)
Major surgery (e.g., required general anesthesia) within 2 weeks before screening
Uncontrolled active infection (including hepatitis B or C or AIDS). Patients with hepatitis B/C who have disease under control and no significant liver function impairment, and undetectable viral load will be allowed to participate. Similarly, patients with known HIV and 400 CD4 + T cells are allowed to participate
Evidence of other metastatic malignancies within the last year
Evidence of serious and/or unstable pre-existing medical, psychiatric or other condition (including laboratory abnormalities) that could interfere with patient safety or provision of informed consent to participate in this study
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