Hormone Therapy Compared With Combination Chemotherapy in Treating Patients With Prostate Cancer

Last updated: June 13, 2023
Sponsor: Eastern Cooperative Oncology Group
Overall Status: Completed

Phase

3

Condition

Prostate Cancer

Prostate Cancer, Early, Recurrent

Prostate Disorders

Treatment

docetaxel

ketoconazole

therapeutic hydrocortisone

Clinical Study ID

NCT00027859
CDR0000069088
SWOG-E1899
CALGB-E1899
E1899
  • Ages 18-120
  • Male

Study Summary

RATIONALE: Androgens can stimulate the growth of prostate cancer cells. Drugs such as ketoconazole may stop the production of androgens. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known whether hormone therapy is more effective than combination chemotherapy in treating prostate cancer.

PURPOSE: Randomized phase III trial to compare the effectiveness of hormone therapy with that of combination chemotherapy in treating patients who have prostate cancer that has been previously treated with androgen suppression.

Eligibility Criteria

Inclusion

DISEASE CHARACTERISTICS:

  • Histologically confirmed adenocarcinoma of the prostate that was continuously treated with androgen suppression

  • Rising prostate-specific antigen (PSA), defined as PSA > 5 ng/mL, rising on 2 consecutive measurements at least 4 weeks apart

  • Gleason score 7 or higher and/or seminal vesicle involvement at diagnosis

  • Patients previously treated with antiandrogen or glucocorticoid therapy must meet the following criteria:

  • Must show a continued rise in PSA after stopping antiandrogen (flutamide, bicalutamide, or nilutamide) or glucocorticoid (dexamethasone or prednisone)

  • At least 4 weeks continued rise in PSA after flutamide or nilutamide (6 weeks for bicalutamide)

  • Testosterone less than 50 ng/dL

  • Patients who have not undergone surgical castration must continue primary androgen suppression to maintain castrate levels of testosterone

  • No progressive or measurable local or metastatic disease (including bone metastases)

PATIENT CHARACTERISTICS:

Age:

  • 18 and over

Performance status:

  • ECOG 0-1

Life expectancy:

  • Not specified

Hematopoietic:

  • Granulocyte count at least 2,000/mm^3

  • Platelet count at least 100,000/mm^3

Hepatic:

  • SGOT no greater than 2 times upper limit of normal

  • Bilirubin no greater than 1.5 mg/dL

Renal:

  • Creatinine no greater than 1.7 mg/dL

Cardiovascular:

  • No American Heart Association class III or IV heart disease

  • No uncontrolled congestive heart failure

  • No life-threatening cardiac arrhythmias

Other:

  • Fertile patients must use effective contraception

  • No other prior malignancy unless curatively treated and disease-free for appropriate time period for specific cancer

  • No preexisting peripheral neuropathy greater than grade 1

  • No known hypersensitivity to polysorbate 80

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • Not specified

Chemotherapy:

  • At least 5 years since prior systemic chemotherapy

Endocrine therapy:

  • See Disease Characteristics

  • At least 4 weeks since prior hydrocortisone

  • No prior ketoconazole

Radiotherapy:

  • At least 28 days since prior radiotherapy to primary site

  • No prior palliative radiotherapy

  • No concurrent radiotherapy

Surgery:

  • See Disease Characteristics

Other:

  • Recovered form prior therapy

  • At least 7 days since prior parenteral antibiotics for active infection

  • No concurrent digitalis

  • No concurrent H_2 blockers or proton pump inhibitors (arm I only)

  • Concurrent bisphosphonates allowed provided they were initiated prior to study therapy

Study Design

Treatment Group(s): 4
Primary Treatment: docetaxel
Phase: 3
Study Start date:
October 08, 2003
Estimated Completion Date:

Study Description

OBJECTIVES:

  • Compare time to objective progression in patients with prostate cancer and a rising prostate-specific antigen (PSA) after androgen suppression when treated with second-line hormonal therapy (ketoconazole and hydrocortisone) vs combination chemotherapy (docetaxel and estramustine).

  • Compare time to PSA progression and correlate this with time to objective progression in patients treated with these regimens.

  • Compare the quality of life in patients treated with these regimens.

  • Compare overall survival of patients treated with these regimens.

  • Compare the natural history of progression in patients treated with these regimens.

  • Identify prognostic indicators of clinical outcome by immunohistochemical evaluation of apoptopic biomarkers in patients treated with these regimens.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to prior treatment with bisphosphonates (yes vs no). Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive oral ketoconazole three times daily and oral hydrocortisone twice daily. Treatment continues in the absence of disease progression or unacceptable toxicity.

  • Arm II: Patients receive oral estramustine three times daily on days 1-5 and docetaxel IV over 1 hour on day 2. Treatment repeats every 3 weeks for up to 6 courses in the absence of disease progression or unacceptable toxicity.

Quality of life is assessed at baseline, on day 1 of week 9, at 6 months and 1 year, and then annually for up to 10 years or until beginning of first non-protocol therapy.

Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually for 5 years.

PROJECTED ACCRUAL: A total of 590 patients (295 per treatment arm) will be accrued for this study within 4 years.

Connect with a study center

  • Comprehensive Cancer Institute

    Huntsville, Alabama 35801
    United States

    Site Not Available

  • CCOP - Mayo Clinic Scottsdale Oncology Program

    Scottsdale, Arizona 85259-5404
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Tucson

    Tucson, Arizona 85723
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Little Rock

    Little Rock, Arkansas 72205
    United States

    Site Not Available

  • City of Hope Comprehensive Cancer Center

    Duarte, California 91010-3000
    United States

    Site Not Available

  • Rebecca and John Moores UCSD Cancer Center

    La Jolla, California 92093-0658
    United States

    Site Not Available

  • Cedars-Sinai Comprehensive Cancer Center at Cedars-Sinai Medical Center

    Los Angeles, California 90048
    United States

    Site Not Available

  • Veterans Affairs Outpatient Clinic - Martinez

    Martinez, California 94553
    United States

    Site Not Available

  • Naval Medical Center - San Diego

    San Diego, California 92134-3202
    United States

    Site Not Available

  • UCSF Comprehensive Cancer Center

    San Francisco, California 94115
    United States

    Site Not Available

  • Medical Center of Aurora - South Campus

    Aurora, Colorado 80012-0000
    United States

    Site Not Available

  • Boulder Community Hospital

    Boulder, Colorado 80301-9019
    United States

    Site Not Available

  • Penrose Cancer Center at Penrose Hospital

    Colorado Springs, Colorado 80933
    United States

    Site Not Available

  • CCOP - Colorado Cancer Research Program, Incorporated

    Denver, Colorado 80224
    United States

    Site Not Available

  • Porter Adventist Hospital

    Denver, Colorado 80210
    United States

    Site Not Available

  • Presbyterian - St. Luke's Medical Center

    Denver, Colorado 80218
    United States

    Site Not Available

  • Rocky Mountain Cancer Centers - Denver Rose

    Denver, Colorado 80220
    United States

    Site Not Available

  • St. Joseph Hospital

    Denver, Colorado 80218-1191
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Denver

    Denver, Colorado 80220
    United States

    Site Not Available

  • Swedish Medical Center

    Englewood, Colorado 80112
    United States

    Site Not Available

  • Sky Ridge Medical Center

    Lone Tree, Colorado 80124
    United States

    Site Not Available

  • Hope Cancer Care Center at Longmont United Hospital

    Longmont, Colorado 80501
    United States

    Site Not Available

  • St. Mary-Corwin Regional Medical Center

    Pueblo, Colorado 81004
    United States

    Site Not Available

  • Rocky Mountain Cancer Centers - Thornton

    Thornton, Colorado 80221
    United States

    Site Not Available

  • Walter Reed Army Medical Center

    Washington, District of Columbia 20307-5001
    United States

    Site Not Available

  • Memorial Regional Cancer Center at Memorial Regional Hospital

    Hollywood, Florida 33021
    United States

    Site Not Available

  • H. Lee Moffitt Cancer Center and Research Institute at University of South Florida

    Tampa, Florida 33612-9497
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Tampa (Haley)

    Tampa, Florida 33612
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Atlanta (Decatur)

    Decatur, Georgia 30033
    United States

    Site Not Available

  • MBCCOP - Hawaii

    Honolulu, Hawaii 96813
    United States

    Site Not Available

  • University of Chicago Cancer Research Center

    Chicago, Illinois 60637-1470
    United States

    Site Not Available

  • CCOP - Central Illinois

    Decatur, Illinois 62526
    United States

    Site Not Available

  • Decatur Memorial Hospital Cancer Care Institute

    Decatur, Illinois 62526
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Hines

    Hines, Illinois 60141
    United States

    Site Not Available

  • CCOP - Illinois Oncology Research Association

    Peoria, Illinois 61615-7828
    United States

    Site Not Available

  • West Suburban Center for Cancer Care

    River Forest, Illinois 60305
    United States

    Site Not Available

  • CCOP - Carle Cancer Center

    Urbana, Illinois 61801
    United States

    Site Not Available

  • Indiana University Cancer Center

    Indianapolis, Indiana 46202-5289
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Indianapolis (Roudebush)

    Indianapolis, Indiana 46202
    United States

    Site Not Available

  • CCOP - Cedar Rapids Oncology Project

    Cedar Rapids, Iowa 52403-1206
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Wichita

    Wichita, Kansas 67218
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Lexington

    Lexington, Kentucky 40502-2236
    United States

    Site Not Available

  • CCOP - Ochsner

    New Orleans, Louisiana 70121
    United States

    Site Not Available

  • MBCCOP - LSU Health Sciences Center

    New Orleans, Louisiana 70112
    United States

    Site Not Available

  • Veterans Affairs Medical Center - New Orleans

    New Orleans, Louisiana 70112
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Shreveport

    Shreveport, Louisiana 71101-4295
    United States

    Site Not Available

  • Greenebaum Cancer Center at University of Maryland Medical Center

    Baltimore, Maryland 21201
    United States

    Site Not Available

  • Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

    Baltimore, Maryland 21231
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Detroit

    Detroit, Michigan 48201-1932
    United States

    Site Not Available

  • CCOP - Kalamazoo

    Kalamazoo, Michigan 49007-3731
    United States

    Site Not Available

  • West Michigan Cancer Center

    Kalamazoo, Michigan 49007
    United States

    Site Not Available

  • Lakeland Cancer Care Center at Lakeland Hospital - St. Joseph

    Saint Joseph, Michigan 49085
    United States

    Site Not Available

  • Mayo Clinic Cancer Center

    Rochester, Minnesota 55905
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Jackson

    Jackson, Mississippi 39216
    United States

    Site Not Available

  • Ellis Fischel Cancer Center at University of Missouri - Columbia

    Columbia, Missouri 65203
    United States

    Site Not Available

  • CCOP - Kansas City

    Kansas City, Missouri 64131
    United States

    Site Not Available

  • Missouri Baptist Cancer Center

    Saint Louis, Missouri 63131
    United States

    Site Not Available

  • CCOP - Southern Nevada Cancer Research Foundation

    Las Vegas, Nevada 89106
    United States

    Site Not Available

  • New Hampshire Oncology-Hematology, PA - Hooksett

    Hooksett, New Hampshire 03106
    United States

    Site Not Available

  • Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center

    Lebanon, New Hampshire 03756-0002
    United States

    Site Not Available

  • Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School

    New Brunswick, New Jersey 08903
    United States

    Site Not Available

  • MBCCOP - University of New Mexico HSC

    Albuquerque, New Mexico 87131
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Albuquerque

    Albuquerque, New Mexico 87108-5138
    United States

    Site Not Available

  • Roswell Park Cancer Institute

    Buffalo, New York 14263-0001
    United States

    Site Not Available

  • Memorial Sloan-Kettering Cancer Center

    New York, New York 10021
    United States

    Site Not Available

  • Mount Sinai Medical Center

    New York, New York 10029
    United States

    Site Not Available

  • NYU School of Medicine's Kaplan Comprehensive Cancer Center

    New York, New York 10016
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Syracuse

    Syracuse, New York 13210
    United States

    Site Not Available

  • Cape Fear Valley Health System

    Fayetteville, North Carolina 28302-2000
    United States

    Site Not Available

  • CCOP - Southeast Cancer Control Consortium

    Goldsboro, North Carolina 27534-9479
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Cincinnati

    Cincinnati, Ohio 45220-2288
    United States

    Site Not Available

  • Cleveland Clinic Taussig Cancer Center

    Cleveland, Ohio 44195
    United States

    Site Not Available

  • Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University

    Columbus, Ohio 43210-1240
    United States

    Site Not Available

  • CCOP - Columbus

    Columbus, Ohio 43206
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Dayton

    Dayton, Ohio 45428-1002
    United States

    Site Not Available

  • CCOP - Toledo Community Hospital

    Toledo, Ohio 43623-3456
    United States

    Site Not Available

  • Oklahoma University Medical Center

    Oklahoma City, Oklahoma 73104
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Portland

    Portland, Oregon 97207
    United States

    Site Not Available

  • CCOP - Geisinger Clinic and Medical Center

    Danville, Pennsylvania 17822-2001
    United States

    Site Not Available

  • Abramson Cancer Center at the University of Pennsylvania

    Philadelphia, Pennsylvania 19104
    United States

    Site Not Available

  • Fox Chase Cancer Center

    Philadelphia, Pennsylvania 19111-2497
    United States

    Site Not Available

  • Western Pennsylvania Hospital

    Pittsburgh, Pennsylvania 15224
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Charleston

    Charleston, South Carolina 29401-5799
    United States

    Site Not Available

  • CCOP - Sioux Community Cancer Consortium

    Sioux Falls, South Dakota 57104
    United States

    Site Not Available

  • Vanderbilt-Ingram Cancer Center at Vanderbilt Medical Center

    Nashville, Tennessee 37232-6307
    United States

    Site Not Available

  • Harrington Cancer Center

    Amarillo, Texas 79106
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Amarillo

    Amarillo, Texas 79106
    United States

    Site Not Available

  • Veterans Affairs Medical Center - San Antonio (Murphy)

    San Antonio, Texas 78229
    United States

    Site Not Available

  • CCOP - Scott and White Hospital

    Temple, Texas 76508
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Temple

    Temple, Texas 76504
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Salt Lake City

    Salt Lake City, Utah 84148
    United States

    Site Not Available

  • Martha Jefferson Hospital

    Charlottesville, Virginia 22902
    United States

    Site Not Available

  • Oncology and Hematology Associates of Southwest Virginia, Incorporated - Roanoke

    Roanoke, Virginia 24014
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Seattle

    Seattle, Washington 98108
    United States

    Site Not Available

  • St. Mary's Medical Center

    Huntington, West Virginia 25701
    United States

    Site Not Available

  • CCOP - St. Vincent Hospital Cancer Center, Green Bay

    Green Bay, Wisconsin 54307-3453
    United States

    Site Not Available

  • University of Wisconsin Comprehensive Cancer Center

    Madison, Wisconsin 53792-0001
    United States

    Site Not Available

  • Medical College of Wisconsin Cancer Center

    Milwaukee, Wisconsin 53226-3596
    United States

    Site Not Available

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