- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04838899
Stereotactic Ablative Radiation Therapy for Abiraterone-Resistant, Oligoprogressive Metastatic Prostate Cancer
Stereotactic Ablative Radiotherapy for Oligoprogressive Metastatic Castration-Resistant Prostate Cancer During Abiraterone Therapy
Study Overview
Status
Intervention / Treatment
Detailed Description
There is increasing worldwide interest in exploring the use of SABR for metastatic, treatment-naive prostate cancer, eg for delaying the need to start androgen deprivation therapy (ADT), and ultimately to improve patient outcome.
Another potential use of SABR for metastatic prostate cancer is in the setting of oligoprogression. In patients undergoing systemic therapy, oligoprogression describes the clinical situation where a solitary or a few metastatic tumors progress, while all other metastases are stable or responding. The usual practice would be to change systemic therapy at this point, but another approach is to locally ablate the "rogue" metastases and continue the same systemic therapy. There is limited clinical evidence for such an approach, eg in renal cell and non-small cell lung cancer.
While there is a lack of published evidence of such an approach in metastatic castration-resistant prostate cancer (mCPRC), SABR for oligoprogressive mCRPC in men undergoing abiraterone therapy may delay the need to switch to another line of systemic therapy, such as chemotherapy, and thereby to improve progression-free survival while patients stay on the same systemic therapy.
mCRPC is a unique solid tumor to study the oligoprogressive setting for several reasons. First, there still remains a limited number of proven systemic agents in the CRPC setting. Second, serum prostate specific antigen (PSA) is an excellent biomarker of prostate cancer activity, which is easy to collect and analyze to monitor treatment response and disease progression. Third, because of the low α/β value of prostate cancer, hypofractionated SABR may be a very effective and convenient way to eradicate areas of known disease.
The primary objective of this phase I study is to determine the incidence of acute and late toxicities associated with delivering SABR to all progressive metastatic sites in patients with metastatic CRPC who present with oligoprogression while on abiraterone. We also aim to obtain preliminary efficacy data of this novel approach. Patients will remain on abiraterone after SABR to measure the added progression-free survival.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Urban Emmenegger, MD
- Phone Number: +416-480-4928
- Email: urban.emmenegger@sunnybrook.ca
Study Locations
-
-
Ontario
-
Toronto, Ontario, Canada, M4N3M5
- Recruiting
- Odette Cancer Centre
-
Contact:
- Urban Emmenegger, MD
- Phone Number: +1-416-480-4928
- Email: urban.emmenegger@sunnybrook.ca
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- ECOG performance status 0-1.
- Histologic confirmation of prostate adenocarcinoma.
- Documentation of metastatic, castration-resistant prostate cancer.
- Patient being treated with abiraterone.
- Evidence of oligoprogression (according to RECIST [V1.1] and/or Prostate Cancer Working Group criteria [PCWG3], as applicable), applying any of the following: (i) ≤ 5 metastatic lesions progressing on conventional imaging (≤ 3 progressing metastases in any one organ system) while all other metastases are controlled or responding; (ii) PSA progression only, but in the setting of oligometastases (≤ 5 metastatic lesions seen on imaging, with ≤ 3 metastases in any one organ system); in this setting, all metastases will be irradiated.
- All metastases of interest amenable to SABR.
Exclusion Criteria:
- Patients presenting with unequivocal clinical progression, defined as one of the following: (i) cancer pain requiring the initiation of opioid therapy; (ii) immediate need for cytotoxic chemotherapy as per treating physician's discretion; or (iii) deterioration of performance status to grade ≥ 3 according to ECOG.
- Evidence of spinal cord compression.
- Prior malignancy within the past 5 years, excluding non-melanoma skin cancer, and in-situ cancer.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Treatment Arm
All metastases that fulfill the definition of oligoprogression seen on conventional imaging will be treated with standard SABR dose fractionation schemes routinely used at Sunnybrook Odette Cancer Centre.
The prostate (if present and not previously treated) will be treated to a dose of 35 Gy in 5 fractions.
Non-spine bone metastases will be treated to a dose of 30-40 Gy in 5 fractions.
Spine metastases will be treated to a dose of 24 Gy in 2-3 fractions or 30-40 Gy in 5 fractions.
Involved lymphadenopathy will be treated to a dose of 30-40 Gy in 5 fractions.
Similarly, brain, lung, liver, and adrenal metastases will be treated with standard Sunnybrook SABR doses.
Patients will remain on abiraterone during and after SABR treatments.
|
SABR to oligoprogressive metastases while continuing abiraterone therapy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
SABR-related toxicities
Time Frame: 12 months
|
Incidence of acute and late toxicities (including radiation induced bone fractures) after comprehensive SABR to all progressing metastases seen on conventional imaging.
|
12 months
|
Progression-free survival
Time Frame: 24 months
|
Time to clinical (i.e., radiological and/or symptomatic) progression following SABR.
|
24 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Biochemical progression-free survival
Time Frame: 24 months
|
Time to PSA progression
|
24 months
|
Time to changing systemic therapy
Time Frame: 24 months
|
Time to starting subsequent line of systemic therapy
|
24 months
|
Radiographic local control rate of the SABR-treated areas
Time Frame: 24 months
|
Monitoring lack of progression of oligoprogressive sites of disease
|
24 months
|
Radiographic distant progression-free survival
Time Frame: 24 months
|
Time to metastatic progression outside of SABR-treated areas
|
24 months
|
Overall survival
Time Frame: 36 months
|
Time to death from prostate cancer or other cause
|
36 months
|
Quality of Life (QoL) assessment
Time Frame: 12 months
|
QoL assessment using EORTC QLQ-C30 at baseline, plus 1, 3, 6, 9 and 12 months after SABR
|
12 months
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- #351
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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 Oligoprogressive
-
ImmuneSensor Therapeutics Inc.RecruitingOligoprogressiveUnited States
-
University of California, DavisNational Cancer Institute (NCI)RecruitingSarcoma | Breast Cancer | Head and Neck Cancer | Oligoprogressive | Other CancerUnited States
-
M.D. Anderson Cancer CenterRecruitingOligoProgressive Metastatic DiseaseUnited States
-
Istituto Clinico HumanitasRecruitingOligorecurrent and Oligoprogressive Prostate Cancer PatientsItaly
-
The Netherlands Cancer InstituteMaarten van de Weijden FoundationRecruitingOligoprogressive | Metastatic Cancer | Breast Cancer InvasiveNetherlands
-
University of California, DavisNational Cancer Institute (NCI)RecruitingOligoprogressive | Non-small Cell Lung Cancer | Small-cell Lung CancerUnited States
-
Wake Forest University Health SciencesNational Cancer Institute (NCI)WithdrawnOligoprogressive | Non Small Cell Lung Cancer
-
Centre hospitalier de l'Université de Montréal...RecruitingHead and Neck Cancer | Oligoprogressive | Metastatic CancerCanada
-
University of Texas Southwestern Medical CenterActive, not recruiting
-
University of California, DavisNational Cancer Institute (NCI)RecruitingRenal Cell Carcinoma | Oligoprogressive | Prostate Cancer | Urothelial CarcinomaUnited States
Clinical Trials on Stereotactic Body Radiation Therapy (SABR)
-
M.D. Anderson Cancer CenterVarian Medical SystemsCompleted
-
Luhua WangUnknownNon-Small Cell Lung CancerChina
-
Radiation Therapy Oncology GroupNational Cancer Institute (NCI); NRG OncologyCompleted
-
University of California, San FranciscoJanssen PharmaceuticalsActive, not recruitingCastration-Resistant Prostate Carcinoma | PSA Progression | Stage IV Prostate Adenocarcinoma AJCC v7 | Castration Levels of TestosteroneUnited States
-
Jonsson Comprehensive Cancer CenterRecruitingProstate Adenocarcinoma | Stage IIIA Prostate Cancer AJCC v8 | Stage IIIB Prostate Cancer AJCC v8 | Stage IIC Prostate Cancer AJCC v8 | Stage III Prostate Cancer AJCC v8 | Stage IIIC Prostate Cancer AJCC v8 | Stage IVA Prostate Cancer AJCC v8 | Stage IIB Prostate Cancer American Joint Committee on...United States
-
Mayo ClinicNational Cancer Institute (NCI)RecruitingStage IV Pancreatic Cancer AJCC v8 | Metastatic Pancreatic AdenocarcinomaUnited States
-
Mayo ClinicActive, not recruitingProstate CancerUnited States
-
NRG OncologyNational Cancer Institute (NCI)Active, not recruitingStage II Prostate AdenocarcinomaUnited States, Canada, Hong Kong, Switzerland, India, Ireland
-
University of Texas Southwestern Medical CenterActive, not recruiting
-
Indiana UniversityIndiana University School of MedicineTerminatedLung CancerUnited States