STereotActic Body Radiotherapy and 177Lutetium PSMA in Locally Advanced Prostate Cancer
NCT Number: NCT06574880
Acronym: STARLiT
Status: NOT_YET_RECRUITING
Study Type: INTERVENTIONAL
Phases: PHASE1|PHASE2
Conditions: Malignant Neoplasm of Prostate|Locally Advanced Prostate Cancer
Interventions: DRUG: Lu-PSMA-617|RADIATION: 5-fraction Stereotactic Body Radiation Therapy (SBRT)
Sponsor: Angela Y. Jia, MD PhD
Sex: MALE
Age: ADULT, OLDER_ADULT
Enrollment: 45
Study Design: Allocation: NA|Intervention Model: SINGLE_GROUP|Masking: NONE|Primary Purpose: TREATMENT
Start Date: 2024-09-11
Completion Date: 2026-09-11
Locations: University Hospitals Cleveland Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio, 44106, United States

Summary:
The goal of this clinical trial is to is to investigate if it is possible to lower the chance of cancer reoccurrence and also preserve quality of life by using the drug Pluvicto instead of androgen-deprivation therapy to the usual radiation therapy for advanced local prostate cancer.

Participants will receive one dose of Pluvicto, followed by radiation about 6 weeks later. Radiation therapy will be completed in 5 treatments over the period of 2 weeks. A second dose of Pluvicto will be given 6 weeks after radiation is complete. Some participants may also receive a third dose of Pluvicto, and this would be given 6 weeks after the second dose of Pluvicto.

Primary Outcome Measures: Phase I: Maximum tolerated dose (MTD) of Lu-PSMA-617, The Phase I goal is to determine the maximally tolerated dose (MTD) of Lu-PSMA-617 when administered with prostate SBRT treatment. The MTD will be captured by analyzing the incidence of dose limiting toxicities occurring within the four weeks after the last dose of treatment., 4 weeks after final dose of treatment (treatment expected to last up to six months)|Phase II: Androgen deprivation therapy (ADT)-free survival, The Phase II goal is to determine the 3-year rate of ADT-free survival., 3 years post treatment
Secondary Outcome Measures: PSA Progression Free Survival, PSA progression-free survival will be analyzed at 24 months post last dose of treatment., 2 years post treatment|Overall Survival (OS), Overall Survival (OS) is defined as the time from Day 1 until death due to any cause. For subjects who do not die, time to death will be censored at the time of last contact., 5 years post treatment|Prostate Cancer-specific Survival (PCSM), Prostate cancer specific mortality (PCSM) is defined the time from Day 1 to death directly attributable to prostate cancer, death from treatment complications, or death from unknown causes in participants with active prostate cancer or previously documented clinical or biochemical relapse., 5 years post treatment|Cumulative incidence of distant metastases, Distant metastases (DM) is defined as the time from Day 1 until development of distant metastases on CT, MRI, bone scan or PSMA PET, or death from prostate cancer., 5 years post treatment|Time to any salvage therapy, The time to any salvage therapy, or Time-to-next-intervention (TTNI), is defined as is defined as the time from Day 1 to the time of initiation of any additional (i.e., outside of planned protocol treatment) cancer-directed therapy, including but not limited to androgen deprivation, other systemic prostate cancer therapeutics, palliative radiotherapy, or surgical intervention specifically addressing complications of metastases. In the absence of a defining event, TTNI will be censored at the date of last visit documenting absence of interventions., 5 years post treatment|Change in Quality of life score as measured by EPIC-26, EPIC-26 is a short form version of the full Expanded Prostate Cancer Index Composite (EPIC). This version contains 26 items and the same 5 domains as the full version of EPIC: urinary incontinence, urinary irritative/obstructive, bowel, sexual, and hormonal. Response options for each EPIC item for a Likert scale, and multi-item scare scores are transported linearly to a 0-100 scale with higher scores representing better QoL. The time frame asked in the question relates to symptoms experienced within the prior 4 weeks., Baseline to 5 years post treatment|Change in Quality of life score as measured by XeQoLS, Xerostomia-related Quality of Life Questionnaire (XeQoLS) is a questionnaire used to measure how dry mouth and salivary dysfunction affect participants' quality of life (QoL). This questionnaire consists of 15 questions across four major domains: physical functioning, personal/psychological functioning, social functioning, and pain/discomfort issues. The XeQoLS is a self-administered tool, and participants are asked to rate each symptom on a 5-point Likert scale from 0 to 4, with higher scores indicating increased xerostomia burden. An average of scores in each domain is calculated, and the average score ranges from 0 to 4. A total score is calculated as an average of the scores from each of the domain., Baseline to 5 years post treatment|Change in Quality of life score as measured by FACT-RNT, FACT-RNT is a patient-reported outcomes (PRO) measure for PCa participants receiving radionuclide therapy. It has not yet been validated in a prospective manner. It consists of 15 questions on a 5-point Likert scale, in a recall period of the past 7 days. Each item score is added, and the sum is linearly transformed to produce the final summary score ranging from 0 to 100, with higher scores representing better QoL., Baseline to 5 years post treatment|Time-to-castration-resistant prostate cancer, To determine the average time-to-castration-resistant prostate cancer., 5 years post treatment|Rate of participants with post treatment PSA in goal range, Rate of obtaining a post-treatment PSA of ≤ 0.5 ng/mL following treatment with 177Lu-PSMA-617 and prostate and nodal SBRT., 12 weeks post treatment|Incidence of acute toxicity, The goal is to describe acute toxicity following treatment with Lu-PSMA-617 and prostate and nodal SBRT., 5 years post treatment|Incidence of late toxicity, The goal is to describe late treatment toxicity following treatment with Lu-PSMA-617 and prostate and nodal SBRT., 5 years post treatment|Biochemical recurrence (BCR), To determine the rate of biochemical recurrence (BCR), defined as PSA nadir + 2 ng/mL., 5 years post treatment|Proportion of participants with PSA50-RR, The proportion of participants with PSA50-RR at 12 weeks post all treatment will be summarized with 95% confidence interval (CI), where PSA50-RR is defined as the proportion of men with a PSA reduction of at least 50% at 6 weeks after the last 177Lu-PSMA-617 treatment, compared with baseline PSA prior to 177Lu-PSMA-617 treatment., 12 weeks post treatment