Radium-223 in Biochemically Recurrent Prostate Cancer

STATUS

Recruiting
End date

Nov 15, 2025
participants needed

26
sponsor

National Cancer Institute (NCI)

Updated on 10 September 2023

See if I qualify

Summary

Background

Some men who have been treated for localized prostate cancer with surgery or radiation still show signs of the disease in their blood. This is called biochemically recurrent prostate cancer. Radium-223 is a small molecule. It uses radiation to kill cancer cells and improves survival in advanced prostate cancer. Researchers want to see if it can treat prostate cancer and induced immune changes earlier in the disease when the cancer is only detectable by prostate specific antigen (PSA) in the blood.

Objective

To learn how Radium-223 affects men with rising PSA but no evidence of cancer on conventional CT or bone scan, but positive findings on PET or molecular imaging in the bones. The primary focus is impact on the immune system with secondary focus on impact on PSA and imaging.

Eligibility

Men ages 18 and older with prostate cancer who have had surgery and/or radiation, but their PSA is rising even though no disease is visible on routine imaging scans (CT or bone scans). Patients are required to have PET or molecular imaging findings in bones, but not organs (lymph nodes are allowed).

Design

Participants will be screened with a medical history and physical exam. Their ability to do normal tasks will be reviewed. They will give tissue samples or a report from their doctor about their cancer. They will have blood and urine tests. They will have an electrocardiogram to measure heart function. They will have a scan of their chest and abdomen using radiation or magnetic resonance imaging. They will have a bone scan with injection of Tc99. They will have a positron emission tomography scan with intravenous (IV) injection of 18F-NaF.

Participants will get Radium-223 by IV. For this, a small plastic tube is put into an arm vein. Radium-223 will be given on Day 1 of each cycle (1 cycle = 4 weeks) for up to 6 cycles. Participants will repeat the screening tests during the study. They will also complete Quality of Life Surveys and give stool samples.

After treatment, participants will have long-term follow-up every 6 weeks for the rest of their lives.

Description

Background

Androgen deprivation therapy (ADT) and surveillance are treatment options for prostate cancer patients with biochemical progression after localized therapy with either definitive radiation or surgery (biochemically recurrent prostate cancer). A primary goal in these patients is to prevent morbidity from their cancer that results from disease progression and metastatic disease on conventional imaging.

Radium-223 has demonstrated the ability to improve survival in men with symptomatic metastatic castration resistant prostate cancer (mCRPC) with a manageable toxicity profile, particularly in patients who have not yet received docetaxel.

Radiation, even at low doses can impact immune recognition and immune cell killing of cancer cells. Recent findings by the LTIB suggest that radium-223 potentiated T-cell killing of prostate cancer cells.

Radium-223 may present an alternative option for patients with BRPC that is not associated with substantial toxicity (as seen with ADT) and may have a lasting effect due to its potential effect on the immune system and/or the bone microenvironment.

Emerging PET imaging studies will likely find evidence of micrometastatic disease, often in the bones, in biochemically recurrent prostate cancer patients, although these patients will have no standard of care that can be supported by prospective data.

Radium-223 has demonstrated the ability to improve survival in men with symptomatic prostate cancer, but it remains unknown what the impact is in patients with micrometastatic or PET positive prostate cancer in their bones

Preclinical data has suggested that radium-223 can impact the immune system.

In addition, changes in PSA kinetics, changes on PET scan findings, and safety and tolerability of radium-223 in this population will also be evaluated.

Objective

To determine statistically significant changes in immune cell populations compared to baseline in participants with biochemically recurrent or 18F NaF PET scan positive prostate cancer treated with radium-223

Eligibility

Histologically confirmed adenocarcinoma of the prostate

Imaging showing positive findings on NaF PET, negative CT Scan and Tc-99m Bone Scan

Detectable PSA

ECOG 0-1

Design

Single arm study

Participants will receive 6 injections of radium-223 with monthly assessments of PSA and periodic immune response. NaF PET scans will be completed at screening then at 4 and 7 months after the start of radium-223.

After completion of treatment participant will be followed every 6 (+/- 2 weeks).

Details

Condition	Biochemical Recurrent Prostate Cancer
Treatment	radium-223, 18F Sodium Fluoride
Clinical Study Identifier	NCT04206319
Sponsor	National Cancer Institute (NCI)
Last Modified on	10 September 2023

How understandable was the trial content above?

Hard to understand

Easy to understand

Eligibility		Yes	No	Not Sure
Inclusion Criteria
	Histopathological confirmation of prostate adenocarcinoma confirmed in either the Laboratory of Pathology at the National Institutes of Health (NIH) Clinical Center, or Walter Reed National Military Medical Center prior to enrollment. If no pathologic specimen is available, participants may enroll with a pathologist s report showing a histologic diagnosis of prostate cancer and a clinical course consistent with the disease
	Biochemical progression after definitive surgery or radiation define as follows
	Participants must have a detectable PSA
	Negative CT scan/MRI and Tc99 bone scan for metastatic prostate cancer. (Only Tc99 will be used to detect bone lesions, CT/MRI would be used to detect soft tissue lesions)
	Presence of findings on PET scan (i.e., NaF PET scan) suspicious for metastatic prostate cancer in bone. Note: while lymph node findings would be allowed and provide the opportunity for the assessment of any abscopal effects, PET scan findings suggesting visceral disease will be excluded
	Testosterone >= 100 ng/dL
	ECOG performance status of 0 1
	Recovery from acute toxicity related to prior therapy, including surgery and radiation, (defined as no toxicity >= grade 2)
	Hematological eligibility parameters (within 16 days before treatment initiation)
	Granulocyte count >= 3,000/mm^3
	Absolute neutrophil count (ANC) >= 1,500/mm^3
	\-- Bilirubin <=1.5 mg/dL (OR in participants with Gilbert s syndrome, a total
	Platelet count >= 100,000/mm^3
	bilirubin <= 3.0), AST and ALT <= 2.5 times upper limit of normal
	Hgb >= 10 g/dL
	Hepatic function eligibility parameters (within 16 days before treatment initiation)
	Participants must be >=18 years old. Currently, no dosing or adverse event data is available on the use of radium in participants < 18 years of age; therefore, only adults are included in this study
	Adequate renal function defined by eGFR within normal as predicted by the CKD-EPI equation (>= 50 mL/min/1.73m^2) or by measure o f creatinine clearance from 24-hour urine collection
	No other active malignancies within 36 months of treatment initiation (with the exception of nonmelanoma skin cancers or carcinoma in situ of the bladder)
	after the last treatment administration. Female partners of reproductive potential must use
	Ability of subject to understand and the willingness to sign a written informed consent document
	a highly effective method of birth control during treatment and for 6 months after their
	The effects radium-223 on the developing human fetus are unknown but based on the mechanism of action, radium-223 has the potential to cause fetal harm. For this reason, men must agree to use condoms for the duration of study therapy and at least 6 months
	partner s last treatment administration. 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
Exclusion Criteria
	Participants with immunocompromised status due to Human Immunodeficiency Virus (HIV)
	infection or other immunodeficiency diseases because this is a trial with a primary
	endpoint looking at immune response, requiring functional immune systems
	Participants who test positive for HBV or HCV
	Chronic administration (defined as daily or every other day for continued use > 14
	days) of systemic corticosteroids within 28 days of treatment initiation. Use of
	corticosteroids with minimal systemic absorption (e.g., inhaled steroids, nasal
	sprays, intraarticular, and topical agents) is allowed
	Receipt of any organ transplantation, including allogeneic stem-cell transplantation
	but with the exception of transplants that do not require immunosuppression (e.g
	corneal transplant, hair transplant)
	History of prior chemotherapy
	Serious intercurrent medical illness that, in the judgement of the investigator, would
	interfere with participant's ability to carry out the treatment program
	Major surgery within 28 days prior to treatment initiation
	Subjects required other medications known to alter PSA including 5-alpha reductase
	PET scan findings suggesting visceral disease
	inhibitors (finasteride and dutasteride) and alternative therapies (e.g
	phytoestrogens and saw palmetto)
	History of prior systemic therapy with radionuclides (e.g., strontium-89
	samarium-153, rhenium-186, rhenium-188, or radium 223 dichloride)
	Receipt of an investigational agent within 28 days (or 56 days for an antibody-based
	therapy) of treatment initiation

How to participate?

Step 1 Connect with a study center

Select a site
Send a message

You have contacted , on

Your message has been sent to the study team at ,

A copy of the message has been sent to your email

What happens next?

You can expect the study team to contact you via email or phone in the next few days.
Sign up as volunteer to help accelerate the development of new treatments and to get notified about similar trials.

You are contacting

Primary Contact

By sending a message, I agree that my data will be sent to a representative for the selected site and processed in accordance with this website's Privacy Policy (see link in footer).

Step 2 Get screened

Additional screening procedures may be conducted by the study team before you can be confirmed eligible to participate.

Learn more

Step 3 Enroll in the clinical study

If you are confirmed eligible after full screening, you will be required to understand and sign the informed consent if you decide to enroll in the study. Once enrolled you may be asked to make scheduled visits over a period of time.

Learn more

Step 4 Get your study results

Complete your scheduled study participation activities and then you are done. You may receive summary of study results if provided by the sponsor.

Learn more

Similar trials to consider

Not finding what you're looking for?

Every year hundreds of thousands of volunteers step forward to participate in research. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.

Edit Delete

Added by •

•

Private

Edit Delete

Reply by • • Private

Edit Delete

Lorem ipsum dolor sit amet consectetur, adipisicing elit. Ipsa vel nobis alias. Quae eveniet velit voluptate quo doloribus maxime et dicta in sequi, corporis quod. Ea, dolor eius? Dolore, vel!

Enter the passcode

The passcode will expire in None.

Radium-223 in Biochemically Recurrent Prostate Cancer