Radiation Therapy With or Without Apalutamide in Treating Patients With Stage III-IV Prostate Cancer

Official Title

A Phase II, Double-Blinded, Placebo Controlled Randomized Trial of Salvage Radiation Therapy With or Without Enhanced Anti-androgen Therapy With Apalutamide in Recurrent Prostate Cancer

Summary:

This phase II trial studies how well radiation therapy with or without apalutamide works in treating patients with stage III-IV prostate cancer. Radiation therapy uses high energy x-ray to kill tumour cells and shrink tumours. Androgen can cause the growth of prostate cancer cells. Drugs, such as apalutamide, may lessen the amount of androgen made by the body. Giving radiation therapy and apalutamide may work better at treating prostate cancer than radiation alone.

Trial Description

Primary Outcome:

  • Biochemical Progression-free survival (bPFS)
Secondary Outcome:
  • Acute Patient-Reported Morbidity (per the patient reported outcomes [PRO]- Common Terminology Criteria for Adverse Events [CTCAE])
  • Acute Physician-Reported Morbidity (per the Common Terminology Criteria for Adverse Events [CTCAE] version 5)
  • Late Patient-Reported Morbidity (per the patient reported outcomes [PRO]- Common Terminology Criteria for Adverse Events [CTCAE])
  • Late Physician-Reported Morbidity (per the Common Terminology Criteria for Adverse Events [CTCAE] version 4) defined as grade 3+ adverse events occurring more than 30 days after the completion of radiation therapy
  • Cancer-Specific Mortality (CSM)
  • Distant Metastasis
  • Initiation of Salvage Hormonal Therapy
  • Local-Regional Progression
  • Metastasis-Free Survival (MFS)
  • Overall survival (OS)
  • PSA Nadir During First Year of Treatment and Prior to Initiation of any Hormonal Salvage Therapy
  • Testosterone Levels
  • Undetectable PSA with a Non-Castrate Testosterone (PSA < 0.1 ng/ml and testosterone >= 50 ng/dl)
  • Undetectable PSA with a Non-Castrate testosterone (PSA < 0.1 ng/ml and testosterone >= 50 ng/dl))
PRIMARY OBJECTIVES:
I. To determine whether, in men with post-prostatectomy PSA recurrences, salvage radiation (SRT) with enhanced anti-androgen therapy with apalutamide will improve biochemical progression-free survival (bPFS) compared to SRT alone. SECONDARY OBJECTIVES:
I. To assess whether molecular stratification by the PAM50 gene expression clustering will identify subsets of prostate cancer (luminal A or basal, luminal B) which derive the greatest benefit from anti-androgen therapy. II. To assess overall survival. III. To assess cancer-specific mortality. IV. To assess metastasis-free survival. V. To assess distant metastasis. VI. To assess local-regional progression. VII. To assess PSA nadir during first year of treatment and prior to initiation of any hormonal salvage therapy. VIII. To assess initiation of salvage hormonal therapy. IX. To assess PSA with a non-castrate testosterone at 1 and 3 years post randomization: PSA < 0.1 ng/ml and testosterone >= 50 ng/dl. X. To assess acute and late physician-reported morbidity (per the Common Terminology Criteria for Adverse Events [CTCAE] version 5) after SRT +/- apalutamide. XI. To assess acute and late patient-reported morbidity (per the patient reported outcomes [PRO]-CTCAE) after SRT +/- apalutamide. XII. To assess testosterone levels at 3, 6, 9, 12, and 36 months post randomization. OUTLINE:

Patients are randomized to 1 of 2 arms. ARM 1: Patients undergo external beam radiation therapy on Day 1 for 7.5 weeks. Beginning on Day 1 of radiation therapy, patients receive placebo orally (PO) once daily (QD) on days 1-30. Treatment repeats every 30 days for up to 6 courses (6 months) in the absence of disease progression or unacceptable toxicity. ARM 2: Patients undergo external beam radiation therapy on Day 1 for 7.5 weeks. Beginning on Day 1 of radiation therapy, patients receive apalutamide PO QD on Days 1-30. Treatment repeats every 30 days for up to 6 courses (6 months) in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 2 years, then every 6 months for 3 years, and then yearly thereafter.

View this trial on ClinicalTrials.gov

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Resources

Canadian Cancer Society

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