- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03677076
Clonal Emergence and Regression During Radium-223 Therapy for Metastatic Prostate Cancer
January 16, 2024 updated by: Medical University of South Carolina
This study is for patients with metastatic prostate cancer receiving radium-223 as their standard of care therapy.
The researchers will collect blood and urine samples from patients before, during and after the radium-223 therapy.
The researchers will compare these samples to observe how the treatment has affected different cancer markers.
Study Overview
Detailed Description
This study proposes to document the presence of clonal emergence and regression during radium-223 therapy for metastatic prostate cancer by serial ctDNA analysis of tumor-associated mutations, using the clinically-available Guardant 360 platform.
These data may provide important mechanistic insights into radium-223 therapy by 1) identifying mutations associated with radium-223 resistance or sensitivity, 2) providing new markers of treatment response in an individual, and 3) revealing antitumor effects from radium-223 that are not easily recognized with standard tumor response metrics.
Positive finding based on this clinically-available platform will be readily applied by the oncology treatment community.
Study Type
Observational
Enrollment (Actual)
14
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
South Carolina
-
Charleston, South Carolina, United States, 29425
- Medical University of South Carolina
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Sampling Method
Probability Sample
Study Population
adult males with prostate cancer receiving radium223 treatment
Description
INCLUSION CRITERIA
- Prostate adenocarcinoma by history or medical records.
- Two or more bone metastases as demonstrated by imaging studies (technetium bone scan, fluoride PET scan, FDG PET scan, fluciclovine PET scan, CT scan, or MRI scan) or by biopsy.
- Patients must be on ADT with a GnRH receptor agonist/antagonist or orchiectomy, with or without an anti-androgen or testosterone synthesis inhibitor. Patients must have a documented castrate level of testosterone (<50ng/dL) and be willing to continue their GnRH agonist/antagonist during the course of radium-223 therapy.
- Patients may have had localized external beam radiation to as much as 20% of the skeleton
Adequate hematopoietic, renal, and hepatic function. These parameters include:
- Hemoglobin ≥ 10gm/dL
- WBC ≥ 3.0K/mcL
- ANC ≥ 1.5K/mcL
- Platelet count ≥ 100K/mcL
- Creatinine < 1.5 ng/mL
- Total bilirubin <1.5 ng/mL.
- Albumin > 25 g/L
- Patients should have an elevated, relevant tumor marker such as PSA, CEA, or LDH.
- Age ≥18 years old
- Life expectancy of at least 24 weeks
- Subjects must be able to understand and be willing to sign the written informed consent form. A signed informed consent form must be appropriately obtained prior to the conduct of any trial-specific procedures. Subjects must be willing and able to comply with the protocol, including follow-up visits and examinations.
- Men of childbearing potential must agree to use adequate contraception beginning at the signing of the informed consent until at least 30 days after the last dose of radium-223 treatment or during the course of radium-223 treatment.
- Subjects must have had a Guardant 360 ctDNA-based genomic profile performed up to four months prior to the first dose of radium-223, with no new therapy started in the interim. This assay must show at least one single nucleotide variant, either missense or synonymous, or one amplification.
- Subjects should continue any previously-started bone-hardening agents (zoledronic acid or denosumab) during radium-223 therapy.
- All acute toxic effects of any prior treatment have resolved to NCI-CTCAE v 5.0 Grade 1 or less at the time of signing the Informed Consent Form (ICF).
EXCLUSION CRITERIA
- Initiation of any additional anti-tumor therapy within 2 months of starting radium-223 treatment
- Presence of only lytic bone metastases
- Prior cytotoxic chemotherapy for metastatic PCa
- Prior systemic therapy with radionuclides (e.g., strontium-89, samarium-153, rhenium-186, or rhenium-188, or Radium Ra 223 dichloride) for the treatment of bony metastases
- Other malignancy requiring systemic therapy within the last 3 years (except non melanoma skin cancer or low-grade superficial bladder cancer)
- Visceral (i.e. liver, lung, brain, adrenal, brain, but not lymph node) metastases as assessed by chest, abdominal, or pelvic computed tomography, or other imaging modality)
- Lymphadenopathy exceeding 6 cm in short-axis diameter, or any size pelvic lymphadenopathy if it is thought to be a contributor to concurrent hydronephrosis
- Imminent spinal cord compression based on clinical findings and/or MRI. Treatment should be completed for spinal cord compression.
- Any infection ≥ Grade 2 per NCI-CTCAE version 5.0
- Cardiac failure NYHA III or IV
- Crohn's disease or ulcerative colitis
- Bone marrow dysplasia, myelodysplasia
- Fecal incontinence
- Inability to comply with the protocol and/or not willing or not available for follow-up assessments.
- Any condition which, in the investigator's opinion, makes the subject unsuitable for trial participation.
- Concurrent use of abiraterone or enzalutamide. A 28-day washout period is required for both agents.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Observational Models: Case-Only
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Ancillary/Correlative
Patients will complete questionnaires and have research blood drawn.
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Collection of research blood and urine
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Minor allele frequency (MAF) in ctDNA
Time Frame: 24 months
|
The primary objective is to estimate average change in MAF in one or more clonal SNVs, comparing baseline to on-treatment, and baseline to post-treatment samples
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24 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in MAF of clonal SNV
Time Frame: 24 months
|
• Determine if changes from baseline in MAF of clonal SNVs during therapy and post-treatment differ significantly from 0.
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24 months
|
Change in clonal mutation MAF and change in pain
Time Frame: 24 months
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• Evaluate the association between change from baseline in clonal mutation MAF and change in pain (evaluated by VAS pain score and analgesic usage diary), measured both during therapy and post-treatment.
|
24 months
|
Change in clonal mutation MAF and change in tumor markers
Time Frame: 24 months
|
• Evaluate the association between change in clonal mutation MAF and change in tumor markers, including prostate specific antigen (PSA), CEA and LDH, measured by standard biochemical assays both during therapy and post-treatment.
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24 months
|
Change in clonal mutation MAF and markers of bone metabolism
Time Frame: 24 months
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• Evaluate the association between change in clonal mutation MAF and markers of bone metabolism including urine N-telopeptide and serum bone-specific alkaline phosphatase, measured by ELISA assays both during therapy and post-treatment.
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24 months
|
Change in clonal mutation MAF and presence of the TMPRSS2-ERG fusion gene
Time Frame: 24 months
|
• Evaluate the association between change in clonal mutation MAF and presence of the TMPRSS2-ERG fusion gene, measured in plasma/urine by digital PCR Evaluate the association between change in clonal mutation MAF and clinical benefit, (time from the last dose of radium-223 to the initiation of a new systemic therapy, measured at least 60 days after final dose) and change in QOL (measured by FACT-P instrument).
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24 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Michael Lilly, MD, Medical University of South Carolina
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
March 4, 2019
Primary Completion (Actual)
December 31, 2023
Study Completion (Actual)
December 31, 2023
Study Registration Dates
First Submitted
September 18, 2018
First Submitted That Met QC Criteria
September 18, 2018
First Posted (Actual)
September 19, 2018
Study Record Updates
Last Update Posted (Actual)
January 17, 2024
Last Update Submitted That Met QC Criteria
January 16, 2024
Last Verified
January 1, 2024
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 102691
- IIR-US-2017-4183 (Other Identifier: Bayer)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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