Newly diagnosed metastatic prostate cancer subjects with bone metastases will be accrued to this stratified randomized 2-arm Phase II trial. Subjects will be randomized 1:2 to ADT or ADT with Radium-223 dichloride respectively.
OUTLINE: This is a multi-center, randomized trial. STRATIFICATION FACTORS: Subjects will be stratified based on serum total alkaline phosphatase at baseline and extent of disease (described below). Randomization will occur within stratification group. * Extent of Disease: \<6 skeletal metastases with no visceral metastases versus ≥6 skeletal metastases or visceral metastases. * Serum total alkaline phosphatase at baseline: normal vs abnormal. Abnormal alkaline phosphatase is defined as \> 130 IU/L. Early Induction or Late Induction status will not be a stratification criterion. TREATMENT SCHEDULE: CONTROL ARM A All subjects will receive androgen deprivation therapy with a LHRH agonist (any LHRH agonist such as leuprolide acetate or goserelin acetate is acceptable) or a LHRH antagonist (degarelix) or bilateral orchiectomy, with dosage determined by the treating physician. Route of administration and cycle days will be administered as per package insert. Androgen deprivation therapy with LHRH agonist or LHRH antagonist will be given continuously. All subjects will receive bicalutamide, 50 mg Oral (PO) Daily TREATMENT SCHEDULE: EXPERIMENTAL ARM B All subjects will receive androgen deprivation therapy with a LHRH agonist (any LHRH agonist such as leuprolide acetate or goserelin acetate is acceptable) or a LHRH antagonist (degarelix) or bilateral orchiectomy, with dosage determined by the treating physician. Route of administration and cycle days will be administered as per package insert. Androgen deprivation therapy with LHRH agonist or LHRH antagonist will be given continuously. All subjects will receive bicalutamide, 50 mg oral (PO) daily All subjects will receive Radium-223 dichloride, 50 kBq (1.35 microcurie) per kg body weight, intravenous (IV bolus) every 28 days for 6 injections The following laboratory values must be obtained within 28 days prior to registration for protocol therapy: Hematopoietic: * Hemoglobin (Hgb) ≥ 8.0 g/dL (80 g/L) without packed RBC transfusion * Platelets ≥ 100 K/mm3 * Absolute neutrophil count (ANC) ≥ 1.5 K/mm3 Hepatic: * Total Bilirubin ≤ 2 x institutional upper limit of normal (ULN) except subjects with Gilbert's Syndrome, who must have a total bilirubin less than 3.0 mg/dL * Aspartate aminotransferase (AST, SGOT) ≤ 2.5 x institutional ULN (≤ 5 x institutional ULN in the presence of liver metastases). * Alanine aminotransferase (ALT, SGPT) ≤ 2.5 x institutional ULN (≤ 5 × institutional ULN in the presence of liver metastases). Renal: * Estimated Creatinine Clearance by Cockcroft-Gault formula ≥ 30 mL/min
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
16
Treating physician will determine LHRH agonist/antagonist, dosage and route of administration, per package insert, during each 28-day cycle.
Bicalutamide, 50 mg Oral (PO) will be administered daily in each 28-day cycle.
Radium-223 dichloride, 50 kBq (1.35 microcurie) per kg body weight intravenous (IV bolus) every 28 days for 6 injections
University of Arizona Cancer Center at Dignity Health St. Joseph's
Phoenix, Arizona, United States
Illinois CancerCare, P. C.
Peoria, Illinois, United States
Indiana University Melvin and Bren Simon Cancer Center
Indianapolis, Indiana, United States
Radiological Progression-Free Survival (rPFS)
rPFS assessed using Response Evaluation Criteria in Solid Tumors v1.1 (RECIST v1.1) to compare outcomes of subjects on experimental arm vs control arm
Time frame: From date of randomization to disease progression or death from any cause, up to a maximum of 24 months.
Number of Patients With Grade 3 Through Grade 5 Adverse Events That Are Related to Study Drug, Graded According to NCI Common Terminology Criteria for Adverse Events v 4.0 (CTCAE)
The intensity of AEs for subjects on both arms graded according to CTCAE v4.0 on a five-point scale (Grade 1 to 5: Mild, Moderate, Severe, Life-threatening and Death)
Time frame: From date of first dose until 30 days after the last treatment, assessed for a maximum of 24 months
Time to First Skeletal-Related Event (SRE)
SRE of subjects on both arms assessed by bone scan or axial imaging
Time frame: From date of first dose until 30 days after the last treatment, assessed for a maximum of 24 months
Secondary Neoplasms
Secondary neoplasms of subjects on both arms assessed by bone scan or axial imaging
Time frame: From date of first dose until 30 days after the last treatment, assessed for a maximum of 24 months
PSA Complete Response Rates
Subjects on both arms with PSA ≤ 0.2 ng/mL after 7 months of androgen deprivation therapy
Time frame: From date of first dose of androgen deprivation therapy (ADT) until completion of 7 cycles (28 weeks)
PSA Partial Response Rates
Subjects on both arms with PSA between 0.2 and ≤ 4 ng/mL after 7 months of androgen deprivation therapy.
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IU Health Central Indiana Cancer Centers
Indianapolis, Indiana, United States
University of Iowa Hopital and Clinics
Iowa City, Iowa, United States
University of Michigan Health System
Ann Arbor, Michigan, United States
Henry Ford Hospital
Detroit, Michigan, United States
Metro Health Cancer Center
Wyoming, Michigan, United States
GU Research Network, LLC
Omaha, Nebraska, United States
Integrated Medical Professionals, PLLC
Lake Success, New York, United States
...and 2 more locations
Time frame: From date of first dose of ADT until completion of 7 cycles (28 weeks)
Median Time to Castration Resistance
Castration resistance for subjects on both arms determined by first PSA level increase and/or radiographic progression by first imaging assessment showing progression
Time frame: From date of ADT (first LHRH agonist/antagonist/surgical castration) to date of PSA and/or radiographic progression, assessed for a maximum of 24 months
2-Year PSA Progression Free Survival (PFS)
PSA PFS for subjects on both arms defined as first PSA level increase
Time frame: From date of randomization to first occurrence of PSA progression, symptomatic deterioration, or death due to any cause, assessed up to 24 months
2-Year Overall Survival (OS)
OS for subjects on both arms
Time frame: From date of randomization to death from any cause, assessed up to 24 months
12-Week Alkaline Phosphatase (ALP) Normalization
ALP normalization for subjects with abnormal ALP at randomization
Time frame: From date of randomization until completion of 12 weeks of therapy
Time to ALP Progression
ALP progression of 25% or greater from baseline/nadir for subjects on both arms
Time frame: From date of randomization until date of ALP progression, assessed up to 24 months
Change in Pain Over Time
Subjects on both arms self-reported evaluation of worst pain item, as well as the subscale scores for pain severity and pain interference as determined by subject responses on the BPI-SF questionnaire.
Time frame: From baseline until 30 days after the last treatment, assessed for a maximum of 24 months
Analgesic Use by WHO Ladder Score
Analgesic use scores for subjects on both arms will be assigned by the treating physician based on the subject's daily analgesic use on average. A single numeric score (0, 1, 2 or 3) will be assigned based on the 3-step WHO pain ladder.
Time frame: From baseline until 30 days after the last treatment, assessed for a maximum of 24 months