External Beam Radiation With or Without Chemotherapy to Treat High Risk Prostate Cancer

Study Overview
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Brief Summary
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The purpose of this study is to compare the effects on prostate cancer using radiation therapy with or without chemotherapy.

Detailed Description
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The recommended treatment for a high risk prostate cancer consists of a combination of radiation therapy and androgen suppression for 2-3 years. Recent studies have shown a survival advantage for chemotherapy for prostate cancer. Chemotherapy has already been successfully integrated in the treatment of other cancer types and is our belief that chemotherapy will prove to be beneficial for patients with high risk prostate cancer. However, a clinical study is necessary to compare the results good or bad of chemotherapy with radiation therapy.

Official Title
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Phase 2/3 Study of Dose-escalated External Beam Radiation Therapy With or Without Chemotherapy for High Risk Adenocarcinoma of the Prostate

Conditions
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Prostate Cancer

Intervention / Treatment
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* Drug: Luteinizing hormone-releasing hormone (LHRH)
* Drug: Docetaxel
* Other: Conformal Radiation Therapy (RT)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Histologically confirmed prostate adenocarcinoma (within 365 days of randomization. High-risk for recurrence as determined by evidence of at least one of the following: Gleason score 8-10, PSA > 20, T state T3. Histological evaluation of prostate biopsy with assignment of a Gleason score to the biopsy material: Gleason score must be in the range 2-10. > 6 cores are strongly recommended. Clinical stages T1a- T3 N0 M0 as staged by the treating investigator. (AJCC Criteria 7th Ed.-appendix III). PSA values < = 50 ng/ml within 90 days prior to randomization. Must be completed prior to biopsy or at least 21 days after prostate biopsy. Absolute Neutrophil Count (ANC) > = 1,800 cells/mm³ within 90 days prior to randomization. Platelets > = 100,000 cells/mm³ within 90 days prior to randomization. Hemoglobin > 10 g/dl within 90 days prior to randomization. ALT, AST, and total bilirubin within 1.5 X institutional upper normal limits within 90 days prior to randomization. ECOG status 0-1 (appendix II) documented within 90 days of randomization. Patient must sign study specific informed consent prior to randomization. Note: consent for legally authorized representative is not permitted. Completed all requirements listed in section 4.0 within the specified time frames. Able to start treatment within 56 days of randomization. At least 18 years old and less than or equal to 75 years of age. Men of child-producing potential must be willing to consent to use effective contraception while on treatment and for at least 3 months afterwards. Medical oncology consultation prior to randomization and medically approved for chemotherapy treatment per protocol. Exclusion Criteria: Evidence of distant metastasis. Pelvic lymph nodes > 1.5 cm in greatest dimension unless the enlarged lymph node is biopsied and negative. Prior prostate cancer surgery including but not limited to prostatectomy, hyperthermia and cryosurgery. Prior pelvic radiation for their prostate cancer. Prior androgen deprivation. Severe, active co-morbidity, defined as follows: Active rectal diverticulitis, Crohn's disease affecting the rectum or ulcerative colitis. (Non-active diverticulitis and Crohn's disease not affecting the rectum are allowed). Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months. Myocardial infarction within the last 6 months. Acute bacterial or fungal infection requiring intravenous antibiotics at the time of randomization. Acquired Immune Deficiency Syndrome (AIDS) based upon current CDC definition; note, however, that HIV testing is not required for entry into this protocol. The need to exclude patients with AIDS from this protocol is necessary because the treatments involved in this protocol may be significantly immunosuppressive. Prior allergic reaction to the drugs involved in this protocol. Existing peripheral neuropathy > = grade 2. Prior systemic chemotherapy for prostate cancer. History of proximal urethral stricture requiring dilatation. Major medical, addictive or psychiatric illness which in the investigator's opinion, will prevent the consent process, completion of the treatment and/or interfere with follow-up. Evidence of any other cancer within the past 5 years and < 50% probability of a 5 year survival. (Prior or concurrent diagnosis of basal cell or non-invasive squamous cell cancer of the skin is allowed.)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Radiation + 24mo luteinizing hormone-releasing hormone (LHRH)<br>Conformal RT 79.2 Gy(RBE) total dose + 24 months LHRH agonist (androgen suppression). | Drug: Luteinizing hormone-releasing hormone (LHRH)<br>* Androgen suppression therapy using luteinizing hormone-releasing hormone (LHRH) agonists such as leuprolide, goserelin, buserelin, triptorelin.<br>* Other names: -Viadur;Other: Conformal Radiation Therapy (RT)<br>* 1.8 Gy(RBE) (or Gy for IMRT) per fraction,five fractions per week for a total dose of 79.2 Gy (RBE) (or Gy).<br>* Other names: Particle Therapy;|
| Experimental: Radiation + Chemo + 6mo luteinizing hormone-releasing hormone<br>Conformal RT 79.2 Gy(RBE) total dose + Chemotherapy: Docetaxel 20mg/m2 x every 7 days x 8 weeks followed by 6 months LHRH (androgen suppression). | Drug: Luteinizing hormone-releasing hormone (LHRH)<br>* Androgen suppression therapy using luteinizing hormone-releasing hormone (LHRH) agonists such as leuprolide, goserelin, buserelin, triptorelin.<br>* Other names: -Viadur;Drug: Docetaxel<br>* Docetaxel 20mg/m2 IV every 7 days x 8 weeks.<br>* Other names: -docetaxel;Other: Conformal Radiation Therapy (RT)<br>* 1.8 Gy(RBE) (or Gy for IMRT) per fraction,five fractions per week for a total dose of 79.2 Gy (RBE) (or Gy).<br>* Other names: Particle Therapy;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Phase 2 - Assessment of Number of Freedom From Failure Events in the Chemotherapy Arm | Measurement of Freedom from Failure i.e. the first occurence of clinical failure (local recurrence, regional recurrence, or distant metastasis), biochemical failure by the Phoenix definition (Prostate Specific Antigen [PSA] > = 2 ng/ml over the nadir PSA discounting bounces per the investigators discretion), or the start of salvage therapy including androgen deprivation. This study was terminated prior to the time frame of 2 years being reached. Therefore, this outcome was assessed at time of study closure (22 months). | No failures were reported at the time of study termination (22 months). This outcome was originally written to assess failure at 2 years. However, that end point was not reached. | 
| Phase 2 - Assessment of Number of Freedom From Failure Event Comparing Chemotherapy Arm to Standard Treatment Arm | This endpoint will be examined if decision is made to not move forward with phase 3 study. This study was terminated prior to a decision being made about moving on to a phase 3 study. Therefore, this outcome was not assessed. | at 5 years | 
| Phase 2 - Cumulative Number of Incidences of Grade 3 or Higher Adverse Events. | Assessment will be performed using CTCAE v4 criteria. This study was terminated prior to the time frame of 2 years being reached. Therefore, this outcome was assessed at time of study closure (22 months). | 2 years | 
| Phase 3 - Assessment of the Number of Freedom From Failure (FFF) Events Comparing the Chemotherapy Arm to the Standard Treatment Arm. | The events for FFF will be the first occurence of clinical failure (local recurrence, regional recurrence, or distant metastasis), biochemical failure by the Phoenix definition (PSA > = ng/ml over the nadir PSA discounting bounces per the investigators discretion), or the start of salvage androgen deprivation. This study was terminated prior to a decision being made about moving on to a phase 3 study. Therefore, this outcome was not assessed. | at 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of Number of Grade 2 or Higher Genitourinary (GU) and Gastrointestinal (GI) Adverse Events | Assessment will be performed using CTCAE v 4 criteria. | at 6 months | 
| Assessment of Number of GI and GU Adverse Events | Descriptive measurements of frequency will be compiled. This study was terminated prior to the time frame of 3 years being reached. Therefore, this outcome was not assessed. Data were collected on toxicities up until study closure at 22 months. However, this timepoint was not indicated as a secondary objective in the protocol. Therefore, data was not analyzed at time of study closure. | at 3 years | 
| Assessment of Total Number of Local/Distant Failures | The total number of local/distant failures will be assessed. | at time of study closure (22 months) | 
| Assessment of Impotence by Summation of Relative Scores for Sexual Function From the EPIC Quality of Life Instrument. | unable to assess due to lack of data | Up to 10 years | 
| Assessment of Total Number of Salvage Androgen Deprivation Use With Comparison of Arms. | The total number of subjects with salvage androgen deprivation use will be assessed. | At study closure (22 months) | 
| Assessment of Total Number of Survival Events With Comparison of Group Arms | The number of deaths in both arms will be assessed. | at study closure (22 months) | 
| Assessment of Total Number of Biochemical Failure Events | The number of biochemical failure events will be assessed on both arms. | at study closure (22 months) | 
| Assessment of Quality of Life - Summation of Relative Scores From the EPIC Instrument. | unable to assess due to lack of data | Up to 10 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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prostate, cancer, radiation, proton, chemotherapy, high risk