Personaliseret vs. fast aktivitet 177LU-PSMA-617 Radiofarmaceutisk terapi (Prodigy-2) (PRODIGY-2)
Prostataspecifikt membranantigen dosimetri-guidet endoradioterapi: En randomiseret kontrolleret, enkeltblind, pilotundersøgelse af personlig vs. fastaktivitet 177LU-PSMA-617 Radiopharmaceutical Therapy (Prodigy-2)
The goal of this clinical trial is to assess if a personalized regime of 177Lu-PSMA-617 (Lutetium Lu 177 vipivotide tetraxetan, also known as Pluvicto) is feasible and safe in a population of patients with metastatic castrate-resistant prostate cancer (mCRPC). The main questions it aims to answer are:
- Can the administered activity (cumulative or per-cycle) be increased in a majority of participants?
- What is the incidence of some specific adverse reactions during the treatment?
Researchers will compare participants receiving a personalized regime to participants receiving the standard fixed-activity regime of 177Lu-PSMA-617 to see if the activity can be safely increased through personalization based on renal dosimetry (i.e. the measure of how much radiation is actually delivered to the kidney).
Participants will receive up to 6 treatments of 177Lu-PSMA-617 every 6 weeks and be regularly evaluated with imaging and laboratory tests, as well as with questionnaires.
Studieoversigt
Status
Intervention / Behandling
Undersøgelsestype
Tilmelding (Anslået)
Fase
- Fase 1
Kontakter og lokationer
Studiekontakt
- Navn: Marie-Christine Dubé, Ph.D.
- Telefonnummer: 418-525-4444
- E-mail: marie-christine.dube@crchudequebec.ulaval.ca
Studiesteder
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Quebec
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Québec, Quebec, Canada, G1R2J6
- Rekruttering
- CHU de Québec-Université Laval
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Kontakt:
- Marie-Christine Dubé, Ph.D.
- Telefonnummer: 418-525-4444
- E-mail: marie-christine.dube@crchudequebec.ulaval.ca
-
Ledende efterforsker:
- Jean-Mathieu Beauregard, MD
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Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Patient aged ≥18 years with metastatic adenocarcinoma of the prostate, defined by documented histopathology of prostate adenocarcinoma;
- Castration-resistant prostate cancer, as defined as disease progressing despite castration by orchiectomy or ongoing androgen deprivation therapy (serum testosterone level ≤ 1.7 nmol/dL within 60 days from first cycle);
- Biochemically progressive mCRPC with rising PSA level, defined by PCWG3 criteria (sequence of two rising values above a baseline at a minimum of 1-week intervals, with the second of these within 60 days from first cycle);
- PSA ≥2 ng/mL ;
- Prior treatment with at least one ARPI;
- PSMA-expressing cancer, with significant PSMA expression defined as SUVpeak in at least one lesion that is superior to SUVmean of the liver on PSMA-PET (68Ga-PSMA-11 or 18F-DCFPyL), within 45 days prior to randomization;
- ECOG Performance status 0 to 2;
- Calculated eGFR (by CKD-EPI formula) ≥ 45 mL/min/1.73m^2;
- Albumin ≥ 25 g/L;
- Platelets ≥ 100x10^9/L;
- Neutrophils ≥ 1.5x10^9/L;
- Hemoglobin ≥ 90 g/L without transfusion in the past 4 weeks;
- Signed, written informed consent
Exclusion Criteria:
- PSMA-PET "superscan" (i.e. extensive/diffuse PSMA-positive bone involvement);
- Site(s) of disease that are FDG-positive, defined as SUVpeak in at least one lesion that is superior to twice (2x) SUVmean of the liver, and PSMA-negative (as above), within 45 days prior to randomization;
- Prior treatment with more than two lines of chemotherapy for mHSPC and/or mCRPC (a line is counted if at least 2 cycles were administered; adjuvant and neoadjuvant chemotherapy does not count towards the maximum of two lines);
- Prior PSMA-directed radiopharmaceutical therapy (radium-223 is allowed);
- Known CNS metastasis unless they are deemed to be non-progressive, asymptomatic and off corticosteroid therapy for at least four weeks, as per investigator's assessment;
- Active malignancy other than prostate cancer;
- Patients who are sexually active and not willing/able to use medically acceptable forms of barrier contraception;
- Any other condition, diagnosis or finding that may in the investigator's opinion interfere with trial conduct;
- Known hypersensitivity to 177Lu-PSMA-617 or to any ingredient in the formulation, including any non-medicinal ingredient, or component of the container.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
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Eksperimentel: Personlig aktivitet
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6 cycles of personalized activity (1st cycle based on BSA and eGFR; cycles 2-6 based on renal dosimetry), maximum 22.2 GBq, every 6 weeks 6 cycles of 7.4 GBq every 6 weeks |
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Aktiv komparator: Fast aktivitet
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6 cycles of personalized activity (1st cycle based on BSA and eGFR; cycles 2-6 based on renal dosimetry), maximum 22.2 GBq, every 6 weeks 6 cycles of 7.4 GBq every 6 weeks |
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Administered activity of 177Lu-PSMA-617
Tidsramme: From first administration to the end of treatment (each cycle is 6 weeks, up to 6 cycles)
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In GBq, cumulative and average per cycle. |
From first administration to the end of treatment (each cycle is 6 weeks, up to 6 cycles)
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Number of participants with subacute adverse events of special interest (AESIs)
Tidsramme: From first administration to the end of treatment (each cycle is 6 weeks, up to 6 cycles)
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Subacute AESIs are:
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From first administration to the end of treatment (each cycle is 6 weeks, up to 6 cycles)
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Variation af score på Euroqol-5 Dimension-5 niveau (EQ-5D-5L) spørgeskema ved baseline
Tidsramme: Ved baseline, 18 uger og ved afslutningen af behandlingen (hver cyklus er 6 uger, op til 6 på hinanden følgende cyklusser)
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Ved baseline, 18 uger og ved afslutningen af behandlingen (hver cyklus er 6 uger, op til 6 på hinanden følgende cyklusser)
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Variation af score ved funktionel vurdering af kræftterapi - Prostata (FACT -P) Spørgeskema ved baseline
Tidsramme: Ved baseline, 18 uger og ved afslutningen af behandlingen (hver cyklus er 6 uger, op til 6 på hinanden følgende cyklusser)
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Ved baseline, 18 uger og ved afslutningen af behandlingen (hver cyklus er 6 uger, op til 6 på hinanden følgende cyklusser)
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Variation af score på kort smerteinventar (BPI-SF) spørgeskema ved baseline
Tidsramme: Ved baseline, 18 uger og ved afslutningen af behandlingen (hver cyklus er 6 uger, op til 6 på hinanden følgende cyklusser)
|
Ved baseline, 18 uger og ved afslutningen af behandlingen (hver cyklus er 6 uger, op til 6 på hinanden følgende cyklusser)
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Variation af score på multidisciplinær spytkirtelsamfund (MSGS) spørgeskema ved baseline
Tidsramme: Ved baseline, 18 uger og ved afslutningen af behandlingen (hver cyklus er 6 uger, op til 6 på hinanden følgende cyklusser)
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Ved baseline, 18 uger og ved afslutningen af behandlingen (hver cyklus er 6 uger, op til 6 på hinanden følgende cyklusser)
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Best biochemical response
Tidsramme: From first administration until 52 weeks or the start of another anti-cancer treatment or death, whichever is earliest
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Maximum percent decrease of serum prostate-specific antigen (PSA) after first administration. |
From first administration until 52 weeks or the start of another anti-cancer treatment or death, whichever is earliest
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PSA progression-free survival (PSA-PFS)
Tidsramme: From date of first administration until the date of PSA progression or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
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Time from first administration to an increase in PSA greater than 25%, and greater than 2 ng/ml, above nadir, confirmed at least 3 weeks later. |
From date of first administration until the date of PSA progression or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
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Radiological progression-free survival (rPFS)
Tidsramme: From date of first administration until the date of radiological progression or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
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Time from first administration to the date of radiographic disease progression based on RECIST 1.1/PCWG3. |
From date of first administration until the date of radiological progression or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
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Investigator-assessed overall PFS
Tidsramme: From date of first administration until the date of investigator-assessed progression or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
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Time from first administration to the earliest of clinical (worsening of a patient's clinical status attributed to disease progression), biochemical or radiological progression considering all data (scheduled and unscheduled) available to the investigator. |
From date of first administration until the date of investigator-assessed progression or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
|
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Time to first symptomatic skeletal event (SSE)
Tidsramme: From date of first administration until the date of first SSE or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
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Time to first Symptomatic Skeletal Event (SSE) is defined as the time from first administration to the date of the SSE. The SSE date is the date of first new symptomatic pathological bone fracture, spinal cord compression, tumor-related orthopedic surgical intervention, requirement for radiation therapy to relieve bone pain, or death due to any cause, whichever occurred first. |
From date of first administration until the date of first SSE or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
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Overall survival (OS)
Tidsramme: From date of first administration until the date of death, assessed over a minimum of 60 months
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Overall Survival (OS) is defined as the time from the date of the first administration to the date of death due to any cause. |
From date of first administration until the date of death, assessed over a minimum of 60 months
|
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Metabolic response on FDG-PET/CT
Tidsramme: At baseline and at 12 weeks
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Metabolic response is defined as complete metabolic response (CMR, disappearance of all lesions on FDG PET), partial metabolic response (PMR, decrease of uptake by ≥30%), stable metabolic disease (SMD, variation of FDG uptake by <30%), progressive metabolic disease (PMD, increase of FDG uptake by ≥30%) |
At baseline and at 12 weeks
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Molecular response on PSMA-PET/CT
Tidsramme: At baseline and at the end of treatment (each cycle is 6 weeks, up to 6 consecutive cycles)
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Molecular response is defined as the variation of molecular tumor volume (MTV) on PSMA-PET/CT |
At baseline and at the end of treatment (each cycle is 6 weeks, up to 6 consecutive cycles)
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Best molecular response on quantitative 177Lu SPECT/CT during treatment
Tidsramme: From first cycle's Day 3 until the last cycle's Day 3 (each cycle is 6 weeks, up to 6 consecutive cycles)
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Best molecular response is defined as the maximum percent decrease of molecular tumor volume (MTV) at any time after post-treatment quantitative 177Lu SPECT/CT performed on the first cycle's Day 3, up to the post-treatment quantitative 177Lu SPECT/CT performed on the last cycle's Day 3 |
From first cycle's Day 3 until the last cycle's Day 3 (each cycle is 6 weeks, up to 6 consecutive cycles)
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Number of participants with any adverse events (AEs)
Tidsramme: From first administration to the end of treatment (each cycle is 6 weeks, up to 6 cycles)
|
All adverse events that occur from the first administration of 177Lu-PSMA-617 until 6 weeks after the last administration of 177Lu-PSMA-617 or prior to the initiation of subsequent anticancer treatment. |
From first administration to the end of treatment (each cycle is 6 weeks, up to 6 cycles)
|
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Number of participants with laboratory adverse events (AEs)
Tidsramme: From date of first administration until the date of investigator-assessed progression or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
|
Adverse events seen on laboratory (hematology, biochemistry) that occur from the first administration of 177Lu-PSMA-617 until progression or until the initiation of subsequent anticancer treatment if earlier. |
From date of first administration until the date of investigator-assessed progression or of the start of another anti-cancer treatment or of death, whichever came first, assessed over a minimum of 60 months
|
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Number of participants with delayed adverse events of special interest (AESIs)
Tidsramme: From date of first administration until the date of death, assessed over a minimum of 60 months
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Delayed AESIs (renal impairment and secondary hematological malignancies) that occur from the first administration of 177Lu-PSMA-617 until death (or study termination) |
From date of first administration until the date of death, assessed over a minimum of 60 months
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Samarbejdspartnere og efterforskere
Sponsor
Samarbejdspartnere
Efterforskere
- Ledende efterforsker: Jean-Mathieu Beauregard, MD, CHU de Québec-Université Laval
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Primær færdiggørelse (Anslået)
Studieafslutning (Anslået)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- 2025-7829
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
There is an intent to create an imaging and data bank from this study.
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
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