Clinical trial NCT06029036: A Phase II Neoadjuvant Study of Darolutamide Plus ADT in Men With Localized Prostate Cancer
Official title: A Phase II, Multi-center, Single-arm, Prospective Study of Darolutamide + ADT Prior to Radical Prostatectomy (RP) in High-risk/Very High-risk Localized Prostate Cancer
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE2
Conditions: Prostate Cancer
Lead sponsor: Peking University First Hospital
Sponsor class: OTHER
Collaborators: name: The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School
name: The First Affiliated Hospital of Air Force Medicial University
First posted: 2023-09-08
Enrollment: 53
Sex: MALE
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: Scientific Rationale: High risk localized prostate cancer (PCa) is associated with higher rates of biochemical recurrence, clinical recurrence, metastasis and PCa-specific death. Novel hormone therapies(NHT) have shown a significant survival advantage with respect to classical ADT in later stages of PCa and have already been investigated in neoadjuvant setting.

PURPOSE: To assess antitumor effect by measuring pathological tumor volume with pathological downstaging following radical prostatectomy + pelvic lymph-node dissection (RP + PLND) for high-risk localized prostate cancer patients.


Eligibility criteria: Inclusion Criteria:

1. Male ≥18 years of age.
2. Able to Sign informed consent form independently.
3. Non-metastatic adenocarcinoma of the prostate.
4. Subjects must have as least one of the following features according to NCCN definition of high-risk: Gleason score ≥8, or PSA \>20ng/ml,or≥clinical T3a.
5. Subjects with pelvic lymph node involvement(N1) can be included.
6. Candidate for radical prostatectomy with or without pelvic lymph node dissection as per the investigator.
7. Eastern Cooperative Oncology Group (ECOG) Performance Status score of 0 or 1.
8. Subjects must have normal organ and marrow function as defined below:

Hemoglobin ≥ 9.0 g/dL;Absolute neutrophil count (ANC) ≥ 1,500/mcL; Platelets ≥ 100,000/mcL, independent of transfusions/growth factors within 3 months of treatment start; Serum potassium ≥ 3.5 mmol/L; Serum total bilirubin ≤ 2.0 x upper limit of normal (ULN) (except in subjects with Gilbert's syndrome who have a total bilirubin \> 1.5 x ULN, measure direct and indirect bilirubin and if direct bilirubin is ≤ 1.5 x ULN, subject may be eligible);Aspartate aminotransferase (AST), alanine aminotransferase (ALT) ≤ 2.5 x ULN;Serum albumin ≥ 3.0 g/dL;Serum creatinine \< 2.0 x ULN.

Exclusion Criteria:

1. Prostate cancer with neuroendocrine differentiation or small cell features
2. Distant metastasis based on conventional imaging (clinical stage M1). Nodal disease below the iliac bifurcation (clinical stage N1) is not an exclusion.
3. History of prior systemic or local therapy for prostate cancer, including pelvic radiation for prostate cancer.
4. Subjects who are planning bilateral orchidectomy during the treatment period of the study.
5. Intolerable with darolutamide or ADT treatment.
6. Candidates of other clinical trials.
7. Any prior malignancy within 5 years.
8. Complications include significant cardiovascular disease, active infection, astrointestinal disorders, or any other complications that in the opinion of the investigator.
9. Any condition that in the opinion of the investigator would preclude participation in this study.

Primary outcomes:
measure: Rate of pathological downstaging
timeFrame: 6 months
Secondary outcomes:
measure: pCR or MRD
timeFrame: 6 months
measure: PSM
timeFrame: 6 months
measure: Rate of peri-operative complications
timeFrame: within 30 days of surgery
measure: Biochemical complete response
timeFrame: 6 months
measure: PSA undetectable rate
timeFrame: 12 months post-RP
measure: 2-year biochemical progression-free survival, bPFS
timeFrame: 24 months post-RP
measure: AEs/SAEs
timeFrame: Baseline up to 30 days after the last dose of study drug or before initiation of a new antitumor treatment, whichever occurred first
Other outcomes:
Locations:
city: Beijing
country: China
facility: Peking University First Hospital
Study officials:
References: