S9916, Combination Therapy in Treating Patients With Advanced Prostate Cancer That Has Not Responded to Hormone Therapy

Last updated: February 21, 2014
Sponsor: Southwest Oncology Group
Overall Status: Completed

Phase

3

Condition

Prostate Cancer

Prostate Cancer, Early, Recurrent

Prostate Disorders

Treatment

N/A

Clinical Study ID

NCT00004001
CDR0000067211
U10CA032102
S9916
  • Ages > 18
  • Male

Study Summary

RATIONALE: Drugs used in chemotherapy and hormone therapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug and giving drugs in different ways may kill more tumor cells. It is not yet known whether estramustine plus docetaxel is more effective than mitoxantrone plus prednisone for prostate cancer.

PURPOSE: Randomized phase III trial to compare the effectiveness of estramustine plus docetaxel with that of mitoxantrone plus prednisone in treating patients who have stage IV prostate cancer that has not responded to hormone therapy.

Eligibility Criteria

Inclusion

DISEASE CHARACTERISTICS:

  • Histologically confirmed metastatic adenocarcinoma of the prostate

  • Unresponsive or refractory to hormonal therapy, as defined by at least 1 of the following criteria:

  • Progression of bidimensionally measurable disease

  • Progression of evaluable but not measurable disease (bone scan)

  • At least 2 consecutive rises in PSA and a PSA level of at least 5 ng/mL

  • No minimum PSA required for measurable disease or non-PSA evaluable disease

  • Soft tissue disease that has been irradiated within the past 2 months is not considered measurable disease

  • Prior orchiectomy OR

  • Medical castration using leuprolide or goserelin

  • Luteinizing hormone-releasing hormone (LHRH) agonist therapy must continue during study

  • Prior nonsteroidal antiandrogens (flutamide, ketoconazole, bicalutamide, or nilutamide) allowed if disease progression occurred

  • No third-space fluid accumulation such as ascites or symptomatic pleural effusion

  • No brain metastases

PATIENT CHARACTERISTICS:

Age:

  • 18 and over

Performance status:

  • SWOG 0-3

  • Performance status 3 must be due to pain secondary to bone metastases

Life expectancy:

  • Not specified

Hematopoietic:

  • No hypercoagulability

Hepatic:

  • Not specified

Renal:

  • Creatinine no greater than 2.0 mg/dL

Cardiovascular:

  • No history of myocardial infarction

  • No history of congestive heart failure unless well controlled

  • No history of cerebrovascular accident or atrial fibrillation

  • No active thrombophlebitis

  • Left ventricular ejection fraction (LVEF) at least 50% by Multi Gated Acquisition Scan (MUGA) scan or 2-D echocardiogram

Pulmonary:

  • No history of pulmonary embolus

Other:

  • Recovered from major infections

  • No other significant active medical illness

  • No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer or stage I or II cancer currently in complete remission

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • At least 4 weeks since prior biologic therapy and recovered

  • No more than 1 prior biologic therapy regimen

  • No concurrent biological response modifiers

Chemotherapy:

  • At least 4 weeks since prior chemotherapy and recovered

  • No more than 1 prior chemotherapy regimen

  • No prior estramustine, taxanes, anthracyclines, or mitoxantrone

  • No other concurrent chemotherapy

Endocrine therapy:

  • See Disease Characteristics

  • At least 4 weeks since prior flutamide or ketoconazole (6 weeks for bicalutamide or nilutamide)

  • No concurrent corticosteroids or hormonal therapy (except megestrol for hot flashes or continuing LHRH treatment)

Radiotherapy:

  • See Disease Characteristics

  • Prior samarium Sm 153 lexidronam pentasodium allowed

  • At least 4 weeks since prior radiotherapy and recovered

  • No prior radiotherapy to 30% or more of bone marrow

  • No prior strontium chloride Sr 89

  • No concurrent radiotherapy

Surgery:

  • See Disease Characteristics

  • At least 3 weeks since prior surgery and recovered

Other:

  • At least 4 weeks since prior bisphosphonates

  • No prior anticoagulation therapy (i.e., warfarin), except aspirin

  • No concurrent bisphosphonates

Study Design

Total Participants: 770
Study Start date:
October 01, 1999
Estimated Completion Date:
January 31, 2007

Study Description

OBJECTIVES:

  • Compare the overall survival and progression-free survival in patients with hormone-refractory, metastatic adenocarcinoma of the prostate treated with docetaxel and estramustine vs mitoxantrone and prednisone.

  • Compare the qualitative and quantitative toxic effects of these regimens in this patient population.

  • Compare the quality of life, including palliation of metastatic bone pain and global quality of life, of patients treated with these regimens.

  • Record prostate-specific antigen values for future correlations with response and survival in patients treated with these regimens.

  • Compare the responses in patients with bidimensionally measurable disease treated with these regimens.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to disease status (measurable or evaluable disease progression vs rising PSA only), NCI Common Toxicity Criteria version 2.X pain scale (grade 2 or greater vs less than 2), and SWOG performance status (0-1 vs 2-3). Patients are randomized to one of two treatment arms.

  • Arm I: Patients receive oral estramustine 3 times daily on days 1-5 and docetaxel IV over 1 hour on day 2.

  • Arm II: Patients receive mitoxantrone IV over 30 minutes on day 1 and oral prednisone twice daily on days 1-21.

Treatment in both arms repeats every 3 weeks for a maximum of 12 courses in the absence of unacceptable toxicity or disease progression.

Quality of life is assessed at baseline, after courses 4 and 8, and then at 1 year after randomization.

Patients are followed every 6 months for 2 years and then annually for 1 year.

PROJECTED ACCRUAL: A total of 620 patients (310 per arm) will be accrued for this study within 3.5 years.

Connect with a study center

  • CCOP - Scottsdale Oncology Program

    Scottsdale, Arizona 85259-5404
    United States

    Site Not Available

  • Mayo Clinic

    Jacksonville, Florida 32224
    United States

    Site Not Available

  • CCOP - Illinois Oncology Research Association

    Peoria, Illinois 61602
    United States

    Site Not Available

  • CCOP - Carle Cancer Center

    Urbana, Illinois 61801
    United States

    Site Not Available

  • CCOP - Cedar Rapids Oncology Project

    Cedar Rapids, Iowa 52403-1206
    United States

    Site Not Available

  • CCOP - Iowa Oncology Research Association

    Des Moines, Iowa 50309-1016
    United States

    Site Not Available

  • Siouxland Hematology-Oncology

    Sioux City, Iowa 51101-1733
    United States

    Site Not Available

  • Mayo Clinic Cancer Center

    Rochester, Minnesota 55905
    United States

    Site Not Available

  • CentraCare Health Plaza

    Saint Cloud, Minnesota 56303
    United States

    Site Not Available

  • CCOP - Missouri Valley Cancer Consortium

    Omaha, Nebraska 68106
    United States

    Site Not Available

  • Medcenter One Health System

    Bismarck, North Dakota 58501
    United States

    Site Not Available

  • CCOP - Merit Care Hospital

    Fargo, North Dakota 58122
    United States

    Site Not Available

  • Altru Health System

    Grand Forks, North Dakota 58201
    United States

    Site Not Available

  • CCOP - Geisinger Clinic and Medical Center

    Danville, Pennsylvania 17822-2001
    United States

    Site Not Available

  • Rapid City Regional Hospital

    Rapid City, South Dakota 57709
    United States

    Site Not Available

  • CCOP - Sioux Community Cancer Consortium

    Sioux Falls, South Dakota 57104
    United States

    Site Not Available

Not the study for you?

Let us help you find the best match. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.