Relapse in Previously Irradiated Prostate Bed : Stereotactic Ablative Reirradiation Potentiated by Metformin (REPAIR)

March 11, 2024 updated by: Institut Cancerologie de l'Ouest

Relapse in Previously Irradiated Prostate Bed : a Phase I/II Study of Stereotactic Ablative Reirradiation Potentiated by Metformin

This phase I/II escalation dose study is assessing the efficacy of the recommended dose of stereotactic re-irradiation (SBRT) of relapses within the prostatectomy bed, potentiated by metformin

Study Overview

Detailed Description

The purpose of this escalation study is, first to select the recommended dose of re-irradiation SBRT in combination with Metformin (based on treatment toxicity monitoring) and then to estimate the efficacy of re-irradiation SBRT in combination with Metformin.

Five or six fractions, at a level of 5 or 6 Gray (Gy) per session (either 5 x 6 Gy, 6 x 6 Gy, or 5 x 5 Gy), will be delivered over a maximum of 12 days (from day 1 to day 10 or 12) to provide a total dose of 25 to 36 Gy.

Patient receive oral Metformin treatment from Day -15 and Day 75.

Patient will be followed for 5 years: patients visits will be planned at week 2; 4; 8; 12; and month M6; M9; M12; M18; M24; M36; 4 years and 5 years.

Study Type

Interventional

Enrollment (Estimated)

44

Phase

  • Phase 2
  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

      • Angers, France, 49055
        • Recruiting
        • Institut de Cancérologie de l'Ouest
        • Contact:
        • Principal Investigator:
          • Nathalie MESGOUEZ-NEBOUT, MD
      • Brest, France, 29200
        • Recruiting
        • CHRU de Brest - Hopital Morvan
        • Contact:
        • Principal Investigator:
          • Ulrike SCHICK, MD
      • Chambray-lès-Tours, France, 37170
        • Not yet recruiting
        • Societe de Recherche Oncologique Clinique 37 (Roc 37)
        • Contact:
        • Principal Investigator:
          • Thomas BOISSERIE, MD
      • Dijon, France, 21079
        • Not yet recruiting
        • Centre Georges François Leclerc
        • Contact:
        • Principal Investigator:
          • Magali QUIVRIN, MD
      • Le Mans, France, 72100
        • Not yet recruiting
        • Clinique Victor Hugo
        • Contact:
        • Principal Investigator:
          • Amandine RUFFIER LOUBIERE, MD
      • Lille, France, 59020
        • Recruiting
        • Centre Oscar Lambret
        • Contact:
        • Principal Investigator:
          • David PASQUIER, MD
      • Lyon, France, 69373
        • Recruiting
        • Centre Leon Berard
        • Principal Investigator:
          • Pascal POMMIER
        • Contact:
      • Rennes, France, 35042
        • Not yet recruiting
        • Centre Eugène Marquis
        • Contact:
        • Principal Investigator:
          • Renaud DE CREVOISIER, MD
      • Rouen, France, 76038
      • Saint Herblain, France, 44805
        • Recruiting
        • Institut de Cancérologie de l'Ouest
        • Contact:
        • Principal Investigator:
          • Valentine GUIMAS, MD
      • Strasbourg, France, 67200
        • Recruiting
        • ICANS - Institut de cancérologie Strasbourg Europe
        • Contact:
        • Principal Investigator:
          • Jean-Baptiste Jean-Baptiste, MD
      • Tours, France, 37044
        • Not yet recruiting
        • CHRU Bretonneau
        • Contact:
        • Principal Investigator:
          • Gilles CALAIS

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

Description

Inclusion Criteria:

  • Written informed consent according to International Conference on Harmonisation (ICH)/ Good Clinical Practice (GCP) regulations before registration and prior to any trial specific procedures.
  • Biochemical recurrence occurring at least 2 years after external radiotherapy to the prostate lodge and the end of hormone therapy, for prostatic adenocarcinoma previously treated by radical prostatectomy.
  • Local recurrence in irradiated areas proven by biological (PSA > 0.2 ng/ml and ascending confirmed by at least 2 successive assays) and radiological (lesion visible on MRI and/or Choline PET and/or Prostate-Specific Membrane Antigen (PSMA) PET).
  • Recurrence without rectal invasion
  • Pelvic and prostate MRI evaluation
  • Absence of pelvic lymph node or metastatic recurrence proven by choline PET or PSMA PET scan
  • World Health Organisation (WHO) performance status 0-1
  • Low risk, intermediate risk and high risk with a single risk factor
  • PSA doubling time > 6 months
  • No anti-cancer treatments planned for the current relapse, including hormone therapy.
  • Age > 18 years old.
  • Life expectancy greater than or equal to 5 years.
  • Patient registered with a health insurance system.
  • Patients willing and able to comply with the planned visits, treatment plan, laboratory tests and other study procedures indicated in the protocol.

Exclusion Criteria:

  • Metastatic disease (bone, lymph node or other)
  • Late radiotherapy urinary or gastrointestinal toxicity (grade ≥ 2) (after radiotherapy of prostate lodge)
  • History of cancer in the 5 years prior to trial entry other than cutaneous basal cell carcinoma
  • Inflammatory bowel disease
  • Contraindications for performing MRI
  • Rectal surgery history
  • Patient treated for Diabetes
  • Creatinine clearance < 45 mL/min
  • Treatment with metformin in the last 3 months prior to inclusion
  • Severe comorbidity that may affect treatment, for example :

    • Acute bacterial or fungal infection requiring intravenous antibiotics at the time of inclusion.
    • Unstable angina, myocardial infarction and/or congestive heart failure requiring hospitalization within the last 6 months
    • Myocardial infarction in the last 6 months.
    • Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) or other respiratory conditions requiring hospitalization or preventing metformin therapy at the time of inclusion.
  • Any condition associated with an increased risk of lactic acidosis (e.g., alcohol abuse, New York Heart Association (NYHA) III or IV congestive heart failure).
  • Clinically significant history of hepatopathy with Child-Pugh B or C score, including viral infection or hepatitis, alcohol abuse or cirrhosis.
  • Any acute or chronic condition that may result in tissue hypoxia (e.g. heart or respiratory failure, shock).
  • Bilateral hip prosthesis
  • Treatment with any investigational drug or participation in a clinical trial within 30 days prior to inclusion.
  • Known hypersensitivity to metformin or any of its components
  • Inability or reluctance to swallow oral medications
  • Persons deprived of liberty, under a measure of safeguard of justice, under guardianship or under the tutor authority
  • Inability to undergo medical monitoring of the trial for geographical, social or psychological reasons.

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

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Sequential Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Metformin + SBRT at total dose of 30 Gray (Gy)

Metformin: 850 mg per day (day -15 to day 0) 1700 mg per day (day 1 to day 75)

Stereotactic Body Radiation Therapy (SBRT): Dose escalation 5 x 6 Gy, (day 0 to day 10)

Metformin: 850 mg per day (day -15 to day 0) 1700 mg per day (day 1 to day 75)
Stereotactic Body Radiation Therapy (SBRT): Dose escalation 5 x 6 Gy day 0 to day 10
Other Names:
  • SBRT
Experimental: Metformin + SBRT at total dose of 36 Gy

Metformin: 850 mg per day (day -15 to day 0) 1700 mg per day (day 1 to day 75)

Stereotactic Body Radiation Therapy (SBRT): Dose escalation 6 x 6 Gy (day 0 to day 12)

Metformin: 850 mg per day (day -15 to day 0) 1700 mg per day (day 1 to day 75)
Stereotactic Body Radiation Therapy (SBRT): Dose escalation 6 x 6 Gy day 0 to day 12
Other Names:
  • SBRT
Experimental: Metformin + SBRT at total dose of 25 Gy

Metformin: 850 mg per day (day -15 to day 0) 1700 mg per day (day 1 to day 75)

Stereotactic Body Radiation Therapy (SBRT): Dose escalation 5 x 5 Gy (day 0 to day 10)

Metformin: 850 mg per day (day -15 to day 0) 1700 mg per day (day 1 to day 75)
Stereotactic Body Radiation Therapy (SBRT): Dose escalation 5x 5 Gy day 0 to day 10

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
For phase 1:. Select the recommended dose for SBRT (either 5 x 6 Gy, 6 x 6 Gy, or 5 x 5 Gy), in combination with Metformin
Time Frame: 12 weeks
SBRT toxicity will be reported during the 12 weeks following the initiation of SBRT.
12 weeks
For phase 2: estimate the efficacy of re-irradiation SBRT in combination with Metformin in terms of biochemical relapse-free survival rate.
Time Frame: 3 years
PSA levels will be assessed every 3 months within 3 years after SBRT.
3 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Estimate the efficacy of re-irradiation SBRT in combination with Metformin in terms of biochemical relapse-free survival and biochemical response
Time Frame: 5 years

PSA levels will be assessed every 3 months within 5 years after SBRT.

For all patients, visits will be made at 6, 9, 12, 18, 24, 36 months, 4 years, and 5 years will be made from the start of SBRT. The end of the trial is defined by the last visit of the last included patient.

5 years
Estimation of the efficacy of SBRT re-irradiation in combination with Metformin in terms of progression-free survival and overall survival
Time Frame: 5 years
Clinical progression-free survival is defined as the time interval between the date of SBRT start and the date of clinical progression (local progression assessed by the physical examination, or appearance of metastatic lesions), start of hormonal therapy or death irrespective of the cause.
5 years
Evaluation of acute and late genitourinary and gastrointestinal toxicities of the SBRT re-irradiation
Time Frame: 5 years
Acute and late genitourinary toxicities over the first 5 years will be assessed according to the NCI-CTCAE V5.0 classification
5 years
Evaluation of Quality of life after SBRT re-irradiation in combination with Metformin
Time Frame: 5 years
Quality of life will be assessed based on EORTC Quality of life questionnaire (QLQ)-C30 scale at week 4; 8; 12; and month M6; M9; M12; M18; M24; M36; 4 years and 5 years. The Time Until Definitive Deterioration (TUDD) will be computed from registration until the first observation of a definitive deterioration of the quality of life, defined as a score decreased by 10 points (in the case of global health scale and functional scales) or increased by 10 points (in the case of symptom scales) compared to the score at baseline, without later improvement superior to 10 points compared to baseline score.
5 years
Evaluation of Quality of life after SBRT re-irradiation in combination with Metformin
Time Frame: 5 years
Quality of life will be assessed based on EORTC Quality of life questionnaire in prostate cancer (QLQ-PR25) scale at week 4; 8; 12; and month M6; M9; M12; M18; M24; M36; 4 years and 5 years. The Time Until Definitive Deterioration (TUDD) will be computed from registration until the first observation of a definitive deterioration of the quality of life, defined as a score decreased by 10 points (in the case of global health scale and functional scales) or increased by 10 points (in the case of symptom scales) compared to the score at baseline, without later improvement superior to 10 points compared to baseline score.
5 years
Evaluation of erectile function
Time Frame: 5 years

Erectile function will be assessed by International Index of Erectile Function (IIEF5). This score assesses erectile function over the past 6 months on a scale of 1 to 25 (total of 5 items rated 0/1 to 5). The distributions of this score will be described at baseline, at follow-up visits (M6 M12 M18, M24,M36 4 and 5 years old) and at the end of the study visit according to the following categories:

1 - 4: Non-interpretable ; 5 - 10: Severe erectile dysfunction ; 11 - 15: Moderate erectile dysfunction ; 16 - 20: Mild erectile dysfunction ; 21 - 25: Normal erectile function.

5 years
Evaluation of urinary symptoms
Time Frame: 5 years

Urinary symptoms over the first 5 years will be assessed by International Prostatic Symptom Score (IPSS). This score evaluates the severity of prostate symptoms in the last month on a scale of 0 to 35 (total of 7 items rated 0 to 5).The distributions of this score will be described at inclusion, at follow-up visits (M6 M9 M12 M18 M24 M36 4 and 5 years) and at the end of the study visit according to the following categories:

0 - 7: Poorly symptomatic ; 8 - 19: Moderately symptomatic ; 20 - 35: Severe symptoms.

5 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Valentine GUIMAS, MD, Institut de Cancérologie de l'Ouest

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)

November 17, 2020

Primary Completion (Estimated)

November 1, 2028

Study Completion (Estimated)

November 1, 2030

Study Registration Dates

First Submitted

August 17, 2020

First Submitted That Met QC Criteria

August 27, 2020

First Posted (Actual)

September 3, 2020

Study Record Updates

Last Update Posted (Actual)

March 13, 2024

Last Update Submitted That Met QC Criteria

March 11, 2024

Last Verified

February 1, 2024

More Information

Terms related to this study

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.

Clinical Trials on Prostate Cancer

Clinical Trials on Metformin

3
Subscribe