Study of Radiation Therapy in Combination With Darolutamide + Degarelix in Intermediate Risk Prostate Cancer

NCT04176081 | Not Yet Recruiting Phase 2 DMC

• 1 other identifier: SChLAP/IDC Study
• Study Type: interventional
• Target: 208
• Locations: 1 country
• Sites: 1

Brief Summary

Prostate cancer (PCa) is the most frequently diagnosed cancer in men and second leading cause of cancer-related death. Men with PCa have a wide range of possible outcomes if the cancer has not spread and is classified as Intermediate-Risk PCa (IR-PCa). The standard treatment for IR-PCa is radiation therapy (RT) with or without hormone therapy which can result in cure in some men. In other men, the cancer can come back or spread to other areas of the body. Treatment response in men with IR-PCa is highly variable. This uncertainty has led to significant under- and over-treatment. This study aims to find out if the addition of intensive treatment (hormonal therapy: darolutamide + degarelix) to standard treatment for PCa will work better than standard treatment alone. To do this, some participants will receive hormone therapy and others will not. All participants will receive RT. Currently, it is difficult to identify men who may require more intensive therapy. Current methods, such as using prostate specific antigen (PSA) alone, may not give the doctor enough information about who requires more intensive treatment. The researchers conducting this study believe that a particular arrangement of cancer cells \[called intraductal carcinoma (IDC)\] and the presence of a genetic marker called SChLAP1 can be used to identify people who would benefit from more intensive therapy. Hormonal therapy such as with drugs called darolutamide (new drug for PCa) and Degarelix, reduce androgens (male hormones, such as testosterone) or block their effect on the cells. PCa cells require androgens to grow and divide, so removal of androgens may be effective in preventing the return of cancer following radiation therapy. Although darolutamide has been studied in about 1000 men with PCa and seems promising and well tolerated it is considered an experimental drug, therefore it can only be used in a research study such as this one. Degarelix has been approved by Health Canada to treat PCa. This is a phase 2, open label, randomized, controlled study and will be conducted across sites in Canada. To qualify, men must have IR-PCa and have both SChLAP1 and IDC present or both absent. Participants will be randomized to receive RT with hormone therapy or RT only. The study treatment period is 6 months for the RT + hormone therapy group. RT will take about 1-2 weeks. All participants will be followed for 5 years with multiple visits to assess safety and treatment effects.

Conditions

Prostate Cancer

Keywords

Intraductal carcinoma; SChLAP1; Radiation therapy

Outcome Measures

Primary Outcomes (1)

• Recurrence Free Survival

  Recurrence Free Survival (RFS), with recurrence event defined as (whichever occurs first): * Biochemical failure defined as per Phoenix criteria (i.e., a rise in PSA by 2 ng/mL or more above the nadir PSA, confirmed by a second PSA measurement) * Clinical, radiographic, or pathological evidence of local, regional, or distant recurrence/metastasis * Initiation of salvage hormonal therapy * Death from any cause.

  Recurrence Free Survival will be monitored for a duration of 5 years.

Secondary Outcomes (8)

• Difference in RFS rates (as defined in primary outcome measure) between IDC/SChLAP1 and treatment groups.

  5 years

• Incidence of early biochemical failure as defined by Pheonix criteria (i.e., within first 2 years of follow-up; surrogate of lethal disease).

  5 years

• Rates of positive prostate biopsies (local failure) performed at time of recurrence as per standard of care.

  5 years

• Testosterone levels

  5 years

• Changes in prostate cancer-specific HRQoL as measured by abbreviated EPIC (urinary, bowel, sexual, and hormonal domains) questionnaire, as a function of treatment assignment

  5 years

Other Outcomes (2)

• Incidence of treatment-emergent Adverse Events

  5 years

• Tolerability of Treatment

  5 years

Study Arms (2)

Group 1: Radiation Therapy Only

ACTIVE COMPARATOR

Participants randomized to Group 1 will receive radiation therapy only.

Radiation: Radiation Therapy

Group 2: Radiation Therapy + darolutamide + degarelix

EXPERIMENTAL

Participants randomized to Group 2 will receive radiation therapy only + darolutamide + degarelix.

Drug: Darolutamide; Drug: Degarelix; Radiation: Radiation Therapy

Interventions

Darolutamide DRUG

Darolutamide will be administered orally as a tablet. Total daily dose is 1200 mg (2 tablets of 300 mg taken twice daily) for 6 months.

Also known as: Nubeqa, ODM-201

Group 2: Radiation Therapy + darolutamide + degarelix

Degarelix DRUG

Degarelix is administered by subcutaneous injection. The first dose of degarelix is 240 mg followed by monthly doses of 80 mg for a total treatment duration of 6 months.

Also known as: Firmagon

Group 2: Radiation Therapy + darolutamide + degarelix

Radiation Therapy RADIATION

The total radiotherapy dose for all subjects will be: 36.25 Gy in 5Fx. The study will not include elective nodal irradiation. Every fraction will have 3D image guidance (i.e. cone-beam CT).

Group 1: Radiation Therapy Only; Group 2: Radiation Therapy + darolutamide + degarelix

Eligibility Criteria

• Age: 18 Years+
• Sex: male
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Male ≥ 18 years of age;
• Pathologic (histologic) proven diagnosis of prostate adenocarcinoma within 180 days prior to consent;
• PSA measurement performed within 60 days prior to consent;
• IR-PCa as per National Comprehensive Cancer Network (NCCN) criteria (PSA \>10 and \< 20 ng/mL and/or Gleason score 7 and/or T-category T2b-T2c clinical or ultrasound);
• UIR-PCa, at least one of the following:
• or 3 NCCN IR-PCa criteria;
• Gleason score 4+3;
• \>50% diagnostic cores involved by adenocarcinoma;
• Clinically negative (N0) stage, as defined by pelvic-CT or pelvic-MRI within 4 months prior to consent;
• No evidence of bone metastases (M0) assessed by a bone scan within 4 months prior to consent;
• Eastern Cooperative Oncology Group (ECOG) performance status 0-2;
• Able and willing to provide signed informed consent as per International Conference on Harmonization - Good Clinical Practices Guidelines (ICH-GCP) and applicable regulations.

You may not qualify if:

• Received any form of hormonal therapy such as bilateral orchiectomy, LHRH agonist/antagonist (e.g. goserelin, leuprolide, degarelix, etc.), anti-androgens (e.g. flutamide, bicalutamide, etc.), 5α-reductase inhibitors (e.g. finasteride, dutasteride, etc.) and/or estrogens within 1 year of consent;
• Received prior cytotoxic therapy for prostate cancer (e.g. taxanes, mitoxantrone);
• Currently taking medications that might cause toxicity if combined with darolutamide (see section 4.6);
• Hemoglobin \< 9.0 g/dL, independent of transfusion and/or growth factors, measured within 90 days prior to consent;
• Platelet count \< 100,000 × 109/μL, independent of transfusion and/or growth factors, within 90 days prior to consent;
• Serum albumin \< 3.0 g/dL within 90 days prior to consent;
• Abnormal renal function, assessed within 90 days prior to consent:
• Creatinine \> 2mg/dL;
• Glomerular filtration rate (GFR) ≤ 35 mL/min, estimated by Cockcroft-Gault formula or measured directly by 24 hour urine.
• Abnormal liver function assessed within 90 days prior to consent:
• Total bilirubin \> 1.5 times the upper limit of normal range;
• Aminotransferases (ALT or AST) \>1.5 times the upper limit of normal range;
• Currently on anticoagulant therapy for any indication (e.g. atrial fibrillation, valve replacement, pulmonary embolism, etc.);
• Any cardiac events (e.g. unstable angina, myocardial infarction and/or congestive heart failure;
• Does not agree to use highly effective method of birth control if he is having sex with a woman of childbearing potential or does not agree to use a condom if he is having sex with a woman who is pregnant while on study drug and for 4 weeks following the last dose of study drug;

Sponsors & Collaborators

• University Health Network, Toronto: lead
• Prostate Cancer Canada: collaborator
• Bayer: collaborator

Study Sites (1)

UHN Princess Margaret Hospital

Toronto, Ontario, M5G 2M9, Canada

Location

MeSH Terms

Conditions

Prostatic Neoplasms; Carcinoma, Intraductal, Noninfiltrating

Interventions

darolutamide; acetyl-2-naphthylalanyl-3-chlorophenylalanyl-1-oxohexadecyl-seryl-4-aminophenylalanyl(hydroorotyl)-4-aminophenylalanyl(carbamoyl)-leucyl-ILys-prolyl-alaninamide; Radiotherapy

Condition Hierarchy (Ancestors)

Genital Neoplasms, Male; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Genital Diseases, Male; Genital Diseases; Urogenital Diseases; Prostatic Diseases; Male Urogenital Diseases; Adenocarcinoma; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Breast Carcinoma In Situ; Carcinoma in Situ; Neoplasms, Ductal, Lobular, and Medullary

Intervention Hierarchy (Ancestors)

Therapeutics

Study Officials

• Neil Fleshner, MD

  UHN Princess Margaret Cancer Centre

  PRINCIPAL INVESTIGATOR

• Alejandro Berlin, MD

  UHN Princess Margaret Cancer Centre

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Sunakshi Chowdhary

CONTACT

416-946-4501; Sunakshi.Chowdhary@uhn.ca

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 6, 2019
• First Posted: November 25, 2019
• Study Start: July 2, 2024
• Primary Completion (Estimated): December 1, 2028
• Study Completion (Estimated): December 1, 2028
• Last Updated: January 24, 2024

Record last verified: 2024-01

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)