Clinical trial NCT06943495: Personalized vs. Fixed-Activity 177Lu-PSMA-617 Radiopharmaceutical Therapy (PRODIGY-2)
Official title: PROstate-specific Membrane Antigen DosImetry- Guided endoradiotherapY: A Randomized- Controlled, Single-blind, Pilot Study of Personalized vs. Fixed-activity 177Lu-PSMA-617 Radiopharmaceutical Therapy (PRODIGY-2)
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: PHASE1
Conditions: Metastatic Castrate Resistant Prostate Cancer (mCRPC)
Lead sponsor: CHU de Quebec-Universite Laval
Sponsor class: OTHER
Collaborators: name: CHU de Quebec-Universite Laval
name: Novartis
name: Canadian Institutes of Health Research (CIHR)
First posted: 2025-04-24
Enrollment: 60
Sex: MALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The goal of this clinical trial is to assess if a personalized regime of 177Lu-PSMA-617 (Lutetium Lu 177 vipivotide tetraxetan, also known as Pluvicto) is feasible and safe in a population of patients with metastatic castrate-resistant prostate cancer (mCRPC). The main questions it aims to answer are:

1. Can the administered activity (cumulative or per-cycle) be increased in a majority of participants?
2. What is the incidence of some specific adverse reactions during the treatment?

Researchers will compare participants receiving a personalized regime to participants receiving the standard fixed-activity regime of 177Lu-PSMA-617 to see if the activity can be safely increased through personalization based on renal dosimetry (i.e. the measure of how much radiation is actually delivered to the kidney).

Participants will receive up to 6 treatments of 177Lu-PSMA-617 every 6 weeks and be regularly evaluated with imaging and laboratory tests, as well as with questionnaires.


Eligibility criteria: Inclusion Criteria:

1. Patient aged ≥18 years with metastatic adenocarcinoma of the prostate, defined by documented histopathology of prostate adenocarcinoma;
2. Castration-resistant prostate cancer, as defined as disease progressing despite castration by orchiectomy or ongoing androgen deprivation therapy;
3. Progressive mCRPC with rising PSA level, defined by PCWG3 criteria (sequence of two rising values above a baseline at a minimum of 1-week intervals, with serum testosterone level ≤ 1.7 nmol/dL);
4. PSA ≥2 ng/mL ;
5. Prior treatment with at least one ARPI;
6. PSMA-expressing cancer, with significant PSMA expression defined as SUVpeak in at least one lesion that is superior to SUVmean of the liver on PSMA-PET (68Ga-PSMA-11 or 18F-DCFPyL), within 45 days prior to randomization;
7. ECOG Performance status 0 to 2;
8. Calculated eGFR (by CKD-EPI formula) ≥ 45 mL/min/1.73m\^2;
9. Albumin ≥ 25 g/L;
10. Platelets ≥ 100x10\^9/L;
11. Neutrophils ≥ 1.5x10\^9/L;
12. Hemoglobin ≥ 90 g/L without transfusion in the past 4 weeks;
13. Signed, written informed consent

Exclusion Criteria:

1. PSMA-PET "superscan" (i.e. extensive/diffuse PSMA-positive bone involvement);
2. Site(s) of disease that are FDG-positive, defined as SUVpeak in at least one lesion that is superior to twice (2x) SUVmean of the liver, and PSMA-negative (as above), within 45 days prior to randomization;
3. Prior treatment with more than two lines of chemotherapy for mHSPC and/or mCRPC (adjuvant and neoadjuvant chemotherapy does not count) towards the maximum of two regimens);
4. Prior radiopharmaceutical therapy;
5. Known CNS metastasis unless they are deemed to be non-progressive, asymptomatic and off corticosteroid therapy for at least four weeks, as per investigator's assessment;
6. Active malignancy other than prostate cancer;
7. Patients who are sexually active and not willing/able to use medically acceptable forms of barrier contraception;
8. Any other condition, diagnosis or finding that may in the investigator's opinion interfere with trial conduct;
9. Known hypersensitivity to 177Lu-PSMA-617 or to any ingredient in the formulation, including any non-medicinal ingredient, or component of the container.

Primary outcomes:
measure: Administered activity of 177Lu-PSMA-617
timeFrame: From first administration to the end of treatment (each cycle is 6 weeks, up to 6 cycles)
measure: Number of participants with subacute adverse events of special interest (AESIs)
timeFrame: From first administration to the end of treatment (each cycle is 6 weeks, up to 6 cycles)
Secondary outcomes:
measure: Best biochemical response
timeFrame: From first administration until 52 weeks or the start of another anti-cancer treatment or death, whichever is earliest
measure: PSA progression-free survival (PSA-PFS)
timeFrame: From date of first administration until the date of PSA progression or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
measure: Best radiological response rates
timeFrame: From first administration to the end of treatment (each cycle is 6 weeks, up to 6 cycles)
measure: Radiological progression-free survival (rPFS)
timeFrame: From date of first administration until the date of radiological progression or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
measure: Investigator-assessed overall PFS
timeFrame: From date of first administration until the date of investigator-assessed progression or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
measure: Time to first symptomatic skeletal event (SSE)
timeFrame: From date of first administration until the date of first SSE or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
measure: Overall survival (OS)
timeFrame: From date of first administration until the date of death, assessed over a minimum of 60 months
measure: Metabolic response on FDG-PET/CT
timeFrame: At baseline and at 12 weeks
measure: Molecular response on PSMA-PET/CT
timeFrame: At baseline and at the end of treatment (each cycle is 6 weeks, up to 6 consecutive cycles)
measure: Best molecular response on quantitative 177Lu SPECT/CT during treatment
timeFrame: From first cycle's Day 3 until the last cycle's Day 3 (each cycle is 6 weeks, up to 6 consecutive cycles)
measure: Number of participants with any adverse events (AEs)
timeFrame: From first administration to the end of treatment (each cycle is 6 weeks, up to 6 cycles)
measure: Number of participants with laboratory adverse events (AEs)
timeFrame: From date of first administration until the date of investigator-assessed progression or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
measure: Number of participants with delayed adverse events of special interest (AESIs)
timeFrame: From date of first administration until the date of death, assessed over a minimum of 60 months
measure: Variation of score on EuroQol-5 Dimension-5 Level (EQ-5D-5L) questionnaire at baseline
timeFrame: At baseline, at 18 weeks, and at the end of treatment (each cycle is 6 weeks, up to 6 consecutive cycles)
measure: Variation of score on Functional Assessment of Cancer Therapy - Prostate (FACT-P) questionnaire at baseline
timeFrame: At baseline, at 18 weeks, and at the end of treatment (each cycle is 6 weeks, up to 6 consecutive cycles)
measure: Variation of score on Brief Pain Inventory (BPI-SF) questionnaire at baseline
timeFrame: At baseline, at 18 weeks, and at the end of treatment (each cycle is 6 weeks, up to 6 consecutive cycles)
measure: Variation of score on Multidisciplinary Salivary Gland Society (MSGS) questionnaire at baseline
timeFrame: At baseline, at 18 weeks, and at the end of treatment (each cycle is 6 weeks, up to 6 consecutive cycles)
Other outcomes:
Locations:
city: Quebec
country: Canada
facility: CHU de Québec-Université Laval
Study officials:
affiliation: CHU de Québec-Université Laval
name: Jean-Mathieu Beauregard, MD
role: PRINCIPAL_INVESTIGATOR
References: