Androgen Ablation With or Without Docetaxel in Treating Patients With Advanced Prostate Cancer

Study Overview
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Brief Summary
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RATIONALE: Androgens can cause the growth of prostate cancer cells. Androgen ablation therapy may lessen the amount of androgens made by the body. Drugs used in chemotherapy, such as docetaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. It is not yet known whether giving androgen ablation therapy together with docetaxel is more effective than giving androgen ablation therapy alone in treating patients with advanced prostate cancer. PURPOSE: This randomized phase III trial is studying androgen ablation and docetaxel to see how well they work compared with androgen ablation alone in treating patients with advanced prostate cancer.

Detailed Description
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OBJECTIVES: Primary Compare the 2-year progression-free survival rate (biological progression and/or clinical progression) in patients with advanced prostate cancer treated with androgen ablation with vs without docetaxel. Secondary Compare the overall survival of patients treated with these regimens. Compare the time to treatment failure in patients treated with these regimens. Compare the toxicity profiles of these regimens in these patients. Compare the PSA response rate in patients treated with these regimens. Compare the response rate in patients with measurable disease treated with these regimens. Compare the percentage of patients who undergo PSA normalization. Compare the quality of life of patients treated with these regimens. Compare the efficacy of these regimens in controlling bone pain in these patients. Compare the changes in chromogranin A levels in patients treated with these regimens. Compare the total cost of care of patients treated with these regimens. OUTLINE: This is a multicenter study. Patients receive luteinizing hormone-releasing hormone analogue (LHRH-A) therapy for 6 months. Patients also receive antiandrogen therapy during the first 5 weeks of LHRH-A therapy. After 6 months of LHRH-A therapy, patients with PSA response are randomized to 1 of 2 treatment arms. Arm I: Patients continue to receive LHRH-A therapy until disease progression. Arm II:Patients receive LHRH-A therapy as in arm I. Patients also receive docetaxel IV on day 1. Treatment with docetaxel repeats every 21 days for up to 4 courses in the absence of disease progression or unacceptable toxicity. Patients complete questionnaires during treatment to assess bone pain. Quality of life is also assessed. After completion to study therapy, patients are followed for ≥ 2 years.

Official Title
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Phase III Study of Chemo-hormonal Therapy Versus Hormonal Therapy Alone in Advanced Hormone-naives Prostate Cancer Patients.

Conditions
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Pain, Prostate Cancer

Intervention / Treatment
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* Drug: docetaxel
* Drug: releasing hormone agonist therapy


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically confirmed adenocarcinoma of the prostate Meets one of the following criteria Metastatic disease Systemic progressive disease after locoregional therapy (surgery or radiotherapy) No metastatic disease AND meets one of the following criteria: Circulating PSA levels ≥ 50 ng/mL (confirmed by ≥ 2 subsequent evaluations) Biochemical progression with a PSA doubling time < 6 months (with ≥ 3 measurements taken 1 month apart) after primary locoregional treatment (radical prostatectomy or radiotherapy) with curative intent Prostate-confined tumor with high-risk features whose therapy of choice is androgen deprivation No symptomatic brain metastases or leptomeningeal disease PATIENT CHARACTERISTICS: ECOG or Zubrod performance status 0-2 Life expectancy ≥ 6 months ANC ≥ 1,500/mm^3 Platelet count ≥ 100,000/mm^3 Hemoglobin ≥ 10 g/dL Bilirubin ≤ 2.0 mg/dL AST/ALT ≤ 1.5 times upper limit of normal Creatinine ≤ 1.5 mg/dL No active infection requiring IV antibiotics No active ulcer, unstable diabetes mellitus, or other contraindication to corticotherapy None of the following cardiovascular conditions: Uncompensated heart failure (ejection fraction < 40%) Myocardial infarction or revascularization procedure within the past 6 months Unstable angina pectoris Uncontrolled cardiac arrhythmia No other severe clinical condition that, in the judgment of the local investigator, would place the patient at undue risk or interfere with the study Not a prisoner No prior malignancy, except for non-melanoma skin cancer, in situ cervical carcinoma, or other cancer that was curatively treated with no evidence of disease for ≥ 5 years No familial, social, or geographical condition or significant neurologic or psychiatric disorder that would preclude understanding or rendering informed consent or fully complying with study treatment and follow-up PRIOR CONCURRENT THERAPY: At least 5 years since prior radiotherapy outside the prostate Prior hormonal therapy allowed provided it was administered for ≤ 6 months At least 12 months since prior hormonal therapy More than 30 days since prior participation in another clinical trial involving investigational agents No prior surgical castration Concurrent androgen deprivation for prostate cancer allowed provided it was started ≤ 3 months prior to initiation of study treatment Concurrent anticoagulant treatment allowed No other concurrent investigational drugs

Ages Eligible for Study
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Minimum Age: 18 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
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Arm I<br>Patients continue to receive LHRH-A therapy until disease progression. | Drug: releasing hormone agonist therapy<br>* Patients receive luteinizing hormone-releasing hormone analogue therapy until disease progression.<br>|
| Experimental: Arm II<br>Patients receive LHRH-A therapy as in arm I. Patients also receive docetaxel IV on day 1. Treatment with docetaxel repeats every 21 days for up to 4 courses in the absence of disease progression or unacceptable toxicity. | Drug: docetaxel<br>* Given IV<br>Drug: releasing hormone agonist therapy<br>* Patients receive luteinizing hormone-releasing hormone analogue therapy until disease progression.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 2-year progression-free survival rate |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall survival |  |  | 
| Time to treatment failure |  |  | 
| Toxicity as assessed by NCI CTCAE criteria |  |  | 
| PSA response rate (> 50% reduction from baseline) |  |  | 
| Disease response rate as assessed by RECIST criteria (in patients with measurable disease) |  |  | 
| PSA normalization (normal range 0-4 ng/mL) |  |  | 
| Quality of life |  |  | 
| Efficacy of treatment in controlling bone pain |  |  | 
| Changes in chromogranin A levels |  |  | 
| Cost analysis |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pain, adenocarcinoma of the prostate, recurrent prostate cancer, stage IV prostate cancer, stage III prostate cancer