In this research study, we aim to evaluate the feasibility, toxicity and efficacy of early multimodality systemic therapy (a combination of docetaxe, bevacizumab, and androgen deprivation therapy(ADT) in men with biochemical recurrence (BCR) or who have a rising Prostate Specific Antigen (PSA) after treatment of their prostate cancer with surgery or radiation)
A single arm phase 2 study designed to evaluate the rate of patients free from Prostate Specific Antigen (PSA) progression (TTP) one year after completing ADT for men with BCR after definitive local therapy for prostate cancer. The null and alternative TTP rate were 41% and 60% respectively. A sample size of 42 would provide 80% power to detect the difference with a 2-sided type I error rate of 0.05.' The primary objective was to evaluate the proportion of patients free from PSA progression after completing one year of ADT The secondary objectives included 1. PSA response (\< 0.2 ng/mL and \< 0.01) at completion of docetaxel/bevacizumab, at completion of ADT and one year off ADT 2. Correlation of PSA response and TTP 3. Toxicity 4. Testosterone recovery at 6, 12 months off ADT Treatment schedule details are as follows: * Each treatment cycle lasts three weeks. During the first three months, participants will receive the Avastin and docetaxel on day 1 of each three-week cycle for a total of four doses of docetaxel/Avastin. Avastin and docetaxel are administered intravenously. The Avastin will continue to be given every three weeks after the docetaxel is completed for a total of 17 doses (one year) of Avastin therapy. * Participants will receive zoladex (or lupron) on day 1 of the first cycle and then every 3 months for a total of 18 months. Zoladex is administered subcutaneously and Lupron is administered intramuscularly. * Bicalutamide pills will be started at the completion of docetaxel chemotherapy (start of month 4) and will be taken once daily until hormone therapy is completed (total of 15 months). * During all treatment cycles, the participant will have a physical exam and will be asked questions about their general health and specific questions about any problems they might be experiencing. Blood work will be performed every three weeks for the first three months and then every three months while on hormone therapy and during follow-up. * After the final treatment participants will have a follow-up visit every three months for the first two years, every 4 months for the third year and every 6 months for years 4 and 5.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
42
Intravenously given at 75 mg/m2 on day 1 of every 3 weeks for 4 cycles
Intravenously given at (15 mg/kg) on day 1 of every 3 weeks for 8 cycles
Either subcutaneously or intramuscularly every three months for a total of 6 doses (total of 18 months)
University of Maryland - Greenebaum Cancer Center
Baltimore, Maryland, United States
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States
Dana-Farber Cancer Institute
Boston, Massachusetts, United States
Prostate-Specific Antigen (PSA) Progression at 1 Year After Completing Androgen Deprivation Therapy (ADT)
For prostatectomy patients: at least two serial rising PSA from treatment nadir and PSA \> 0.2 ng/mL. For patient receiving radiation therapy alone as primary local therapy, at least two serial rising PSA from treatment nadir and PSA \>2.0 ng/mL. Any new site of metastatic disease on imagining would be considered progression regardless of PSA value Clinical assessments (Vitals, Physical Exam, Performance Status, PSA and testosterone) were performed every 3 months starting at completion of hormone therapy until PSA progression.
Time frame: participants were followed for the duration of the study, an average of 2 years
Proportion of Patients With PSA Responses at One Year After the Completion of ADT
The PSA response was defined using two cut-offs: PSA \<0.2 ng/mL or PSA \<0.01 ng/mL at the one year after completion of ADT.
Time frame: 1 year + 3 month off last ADT injection
Time to PSA Progression (TTP)
For prostatectomy patients: at least two serial rising PSA from treatment nadir and PSA \> 0.2 ng/mL. For patient receiving radiation therapy alone as primary local therapy, at least two serial rising PSA from treatment nadir and PSA \> 2.0 ng/mL. Any new site of metastatic disease on imagining would be considered progression regardless of PSA value
Time frame: participants were followed for the duration of the study, an average of 2 years
Testosterone Recovery
Testosterone recovery was defined as \>100 or within DFCI institute normal range (240-950) at one year after the completion of ADT
Time frame: 2 years
Toxicity
Treatment related adverse events were graded based on CTCAE v. 3.0.
Time frame: Assessed each cycle throughout treatment form time of first dose to 30 days post-treatment, up to 2 years
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Starting on day 84 orally once daily until hormone therapy is completed