PET/CT and WB MRI for Staging and Response in CRPC Patients Receiving Enzalutamide

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)

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.

Study Overview

• Status: Completed
• Conditions: Prostate Cancer Metastatic
• Intervention / Treatment: Drug: Enzalutamide; Device: 18-FDG PET/CT; Device: Whole body MRI; Device: Bone scan

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.

• Study Type: Interventional
• Enrollment (Actual): 66
• Phase: Phase 2

Contacts and Locations

Study Locations

• Netherlands
  • Leiden, Netherlands, 2333 ZA
    • Leiden University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

Description

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).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Single arm; Subjects will receive 1 dd 160 mg Enzalutamide orally continuously until progressive disease occurs. Serial PSA measurements, PET/CT scans, Whole Body MRI, bone scans will be performed to assess metastatic tumour load, progressive disease and response to treatment.	Drug: Enzalutamide; Other Names: Xtandi; Device: 18-FDG PET/CT; Device: Whole body MRI; Device: Bone scan

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression-Free Survival (PFS) at 6 months	Defined as the time from the date of randomization to the date of radiological progression or death (patients will be followed beyond the fixed time point of 12 months for continued response cq recurrence, but 12 month is the last fixed primary endpoint assessment). Radiological progression is defined by any of the following criteria: Soft tissue lesions: Progressive disease on 18F-FDG PET/CT or MRI by RECIST 1.1. Bone or bone marrow lesions: Progressive disease on PET/CT or MRI as evidenced by new lesions or an increase in size of 25% of the sum of target lesions.; Conversion of the 18F-FDG PET signal of the metastases at 2 weeks, 2 or 6 months compared to baseline PET which by comparing it to PFS at 6 and 12 months may be an indicator or drug response. Radiological PFS at 6 months will be compared to a) PET signal conversion and to b) PSA measurements, and changes in number of lesions on the bone scan (conventional work up).	6 months
Progression-Free Survival (PFS) at 12 months	Defined as the time from the date of randomization to the date of radiological progression or death (patients will be followed beyond the fixed time point of 12 months for continued response cq recurrence, but 12 month is the last fixed primary endpoint assessment). Radiological progression is defined by any of the following criteria: Soft tissue lesions: Progressive disease on 18F-FDG PET/CT or MRI by RECIST 1.1. Bone or bone marrow lesions: Progressive disease on PET/CT or MRI as evidenced by new lesions or an increase in size of 25% of the sum of target lesions.; Conversion of the 18F-FDG PET signal of the metastases at 2 weeks, 2 or 6 months compared to baseline PET which by comparing it to PFS at 6 and 12 months may be an indicator or drug response. Radiological PFS at 12 months will be compared to a) PET signal conversion and to b) PSA measurements, and changes in number of lesions on the bone scan (conventional work up).	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Biochemical (PSA) response defined as prostate-specific antigen (PSA) nadir.	Response as PSA nadir.	12 months
PSA progression. PSA kinetics measured by PSA doubling time (regular PSA measurements).	PSA doubling time	12 months
Progression of bone lesions detected with bone scan according to Prostate Cancer Working Group 2 (PCWG2) criteria.	Progression of bone lesions	6 and 12 months
Radiologically confirmed spinal cord compression or pathological fracture due to malignant progression.	Radiological assessment of spinal cord compression or pathological fracture	6 and 12 months
Occurrence of Symptomatic Skeletal Events (SSE) evaluated by combination of clinical and radiological assessments	Assessment of external beam radiation therapy to relieve skeletal pain, occurrence of a new symptomatic pathologic bone fracture, spinal cord compression, tumour-related orthopedic surgical intervention or change of anti-neoplastic therapy to treat bone pain	12 months
Number of participants with change in CTC measurements correlated to radiological PFS.	Assessment of radiological PFS	6 and 12 months
Percent change from baseline in serum concentration of circulating testosterone (T).	Change in circulating testosterone	12 months
Percent change from baseline in serum concentration of dihydrotestosterone (DHT).	Change in serum concentration of dihydrotestosterone	12 months
Percent change from baseline in serum concentration of sex hormone binding globulin (SHBG).	Changes of SHBG	12 months
Percent change from baseline in serum concentration of androstenedione (A).	Changes of androstenedione from baseline	12 months
Number of participants with changes in biomarkers of bone turnover correlated to PSA.	Changes in biomarkers	12 months
Number of participants with adverse events (AEs) and serious adverse events (SAEs) leading to treatment discontinuation.	Assessment of AE and SAEs	6 and 12 months
Time to symptomatic progression (including death due to prostate cancer).	Time to progression	12 months
Time to initiation of salvage systemic therapy, including chemotherapy, or palliative radiation.	Time to chemotherapy or palliative radiation.	12 months
Quality of life measured by the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire.	Quality of life assessment	6 and 12 months
Quality of life measured by the EuroQol 5-Dimension QoL Instrument (EQ-5D).	Quality of life assessment	6 and 12 months
Changes in Karnofsky score	Changes in Karnofsky score	6 and 12 months
Changes in visual analogue scale (VAS) for tumour-related pain.	Pain changes from baseline (QoL)	6 and 12 months
Changes in bone mineral density (BMD) as measured by Dual-energy X-ray absorptiometry (DXA) scan.	Bone mineral density changes	6 and 12 months

Collaborators and Investigators

• Sponsor: The European Uro-Oncology Group
• Collaborators: Centre for Human Drug Research, Netherlands
• Investigators: Study Chair: Susanne Osanto, MD PhD, The European Uro-Oncology Group (EUOG)

Publications and helpful links

Helpful Links

• The European Uro-Oncology Group

Study record dates

Study Major Dates

• Study Start: February 1, 2015
• Primary Completion (ACTUAL): June 1, 2020
• Study Completion (ACTUAL): December 1, 2020

Study Registration Dates

• First Submitted: June 18, 2016
• First Submitted That Met QC Criteria: June 23, 2016
• First Posted (ESTIMATE): June 28, 2016

Study Record Updates

• Last Update Posted (ACTUAL): April 14, 2022
• Last Update Submitted That Met QC Criteria: April 6, 2022
• Last Verified: February 1, 2021

More Information

Terms related to this study

• Keywords: Imaging; PET/CT; Castration-resistant prostate cancer; Enzalutamide; Circulating tumour cells; Whole body MRI; Cell-free tumour DNA
• Additional Relevant MeSH Terms: Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Genital Neoplasms, Male; Prostatic Diseases; Prostatic Neoplasms; Molecular Mechanisms of Pharmacological Action; Radiopharmaceuticals; Fluorodeoxyglucose F18
• Other Study ID Numbers: EudraCT Number 2014-001161-27