Clinical trial NCT02814968: PET/CT and WB MRI for Staging and Response in CRPC Patients Receiving Enzalutamide
Official title: A Phase 2, Open-label, Single-arm, Efficacy and Imaging Study of Oral Enzalutamide in Chemo-Naïve Patients With Progressive Prostate Cancer Who Have Failed Androgen Deprivation Therapy (Castration-resistant Prostate Cancer Patients)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Prostate Cancer Metastatic
Keywords: Castration-resistant prostate cancer
Enzalutamide
Imaging
PET/CT
Whole body MRI
Circulating tumour cells
Cell-free tumour DNA
Lead sponsor: The European Uro-Oncology Group
Sponsor class: OTHER
Collaborators: name: Centre for Human Drug Research, Netherlands
First posted: 2016-06-28
Enrollment: 66
Sex: MALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The aim of the study is to assess the clinical utility of 18F-fluoro-deoxyglucose Positron Emission Tomography (PET)/Computed Tomography (CT) and Whole Body Magnetic Resonance Imaging (MRI) versus conventional bone scan and prostate-specific antigen (PSA) measurements in response prediction to treatment with Enzalutamide in castration-resistant prostate cancer patients.

The study will assess how these 2 imaging modalities perform compared to traditional serial PSA measurements and bone scan in assessing metastatic tumour load, progressive disease and response to treatment with Enzalutamide in castration-resistant prostate cancer patients.

In addition measurements of serially collected circulating tumour cell (CTC) samples, cell-free tumour DNA and RNA will be performed in order to evaluate their predictive value in terms of response measurement.

Detailed description: Castration-resistant prostate cancer patients eligible for 2nd line hormonal treatment will undergo treatment with Enzalutamide (XTANDI). Subjects will receive 1dd 160 mg Enzalutamide orally continuously until progressive disease occurs.

All subjects will undergo 18F-FDG PET/CT scans at baseline, 2 weeks, 2 and 6, 9 and 12 months after starting androgen receptor-directed treatment. All subjects will undergo Whole Body MRI at baseline, 6, 9 and 12 months. Bone scans will be performed at baseline, 3 months, 6 and 12 months. PSA will be measured at baseline and every 4 weeks thereafter until at 12 months. CTC counts and characteristics will be measured at baseline and during Enzalutamide treatment.

Eligibility criteria: Inclusion Criteria:

* Male aged 18 years or older;
* Histologically confirmed adenocarcinoma of the prostate without neuroendocrine differentiation or small cell features;
* Ongoing androgen deprivation therapy with a GnRH analogue or bilateral orchiectomy;
* Three consecutive rises of PSA, 1 week apart, resulting in two 50% increases over the nadir, with PSA of at least \> 5 ng/mL but preferably \>10 ng/mL;
* Progressive disease as defined by rising PSA levels plus by evidence of progressive and measurable soft tissue or bone disease by 18F-FDG PET/CT, Whole Body MRI or both;
* Castrate serum levels of testosterone \< 50 ng/dL or \< 1.7 nmol/L;
* Anti-androgen withdrawal for at least 6 weeks for bicalutamide, nilutamide or flutamide for at least 6 weeks;
* No prior treatment with cytotoxic chemotherapy;
* Eastern Cooperative Oncology Group (ECOG) score 0-2;
* A life expectancy of at least 12 months;
* Written informed consent.

Exclusion Criteria:

* Severe concurrent disease, infection, or co-morbidity that, in the judgment of the Investigator, would make the patient inappropriate for enrolment;
* Known or suspected brain metastasis or active leptomeningeal disease;
* History of another malignancy within the previous 5 years other than curatively treated non melanomatous skin cancer;
* Total bilirubin, alanine aminotransferase (ALT) or aspartate aminotransferase (AST) 2.5 times the upper limit of normal at the Screening visit;
* Creatinine \> 177 µmol/L (2 mg/dL) at the Screening visit;
* Hemoglobin \<6 mmol/L, White blood cells \< 4.0 x10\^9/L, platelets \< 100 x 10\^9/L;
* History of seizure or any condition that may predispose to seizure. Also, history of loss of consciousness or transient ischemic attack within 12 months of enrolment (Day 1 visit);
* Contra-indication for MRI (e.g. pacemaker).

Primary outcomes:
measure: Progression-Free Survival (PFS) at 6 months
timeFrame: 6 months
measure: Progression-Free Survival (PFS) at 12 months
timeFrame: 12 months
Secondary outcomes:
measure: Biochemical (PSA) response defined as prostate-specific antigen (PSA) nadir.
timeFrame: 12 months
measure: PSA progression. PSA kinetics measured by PSA doubling time (regular PSA measurements).
timeFrame: 12 months
measure: Progression of bone lesions detected with bone scan according to Prostate Cancer Working Group 2 (PCWG2) criteria.
timeFrame: 6 and 12 months
measure: Radiologically confirmed spinal cord compression or pathological fracture due to malignant progression.
timeFrame: 6 and 12 months
measure: Occurrence of Symptomatic Skeletal Events (SSE) evaluated by combination of clinical and radiological assessments
timeFrame: 12 months
measure: Number of participants with change in CTC measurements correlated to radiological PFS.
timeFrame: 6 and 12 months
measure: Percent change from baseline in serum concentration of circulating testosterone (T).
timeFrame: 12 months
measure: Percent change from baseline in serum concentration of dihydrotestosterone (DHT).
timeFrame: 12 months
measure: Percent change from baseline in serum concentration of sex hormone binding globulin (SHBG).
timeFrame: 12 months
measure: Percent change from baseline in serum concentration of androstenedione (A).
timeFrame: 12 months
measure: Number of participants with changes in biomarkers of bone turnover correlated to PSA.
timeFrame: 12 months
measure: Number of participants with adverse events (AEs) and serious adverse events (SAEs) leading to treatment discontinuation.
timeFrame: 6 and 12 months
measure: Time to symptomatic progression (including death due to prostate cancer).
timeFrame: 12 months
measure: Time to initiation of salvage systemic therapy, including chemotherapy, or palliative radiation.
timeFrame: 12 months
measure: Quality of life measured by the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire.
timeFrame: 6 and 12 months
measure: Quality of life measured by the EuroQol 5-Dimension QoL Instrument (EQ-5D).
timeFrame: 6 and 12 months
measure: Changes in Karnofsky score
timeFrame: 6 and 12 months
measure: Changes in visual analogue scale (VAS) for tumour-related pain.
timeFrame: 6 and 12 months
measure: Changes in bone mineral density (BMD) as measured by Dual-energy X-ray absorptiometry (DXA) scan.
timeFrame: 6 and 12 months
Other outcomes:
Locations:
city: Leiden
country: Netherlands
facility: Leiden University Medical Center
Study officials:
affiliation: The European Uro-Oncology Group (EUOG)
name: Susanne Osanto, MD PhD
role: STUDY_CHAIR
References: