Assessment of Multi-Modality Quantitative Imaging for Evaluation of Response of Metastatic Prostate Cancer to Therapy

Phase 1TerminatedNCT03619655

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins3 enrolled

Overview

The study is an open label, non-randomized study designed to evaluate the diagnostic performance of SPECT CT.

The study is an open label, non-randomized study designed to evaluate the diagnostic performance of SPECT CT. The study will consist of 3 cohorts, and a subset of the patients in cohort C will participate in a test-retest study, where the baseline SPECT/CT will be repeated. SPECT CT will be performed in all cohorts. Cohort A will evaluate SPECT CT by comparison to a Positron Emission Tomography (PET) scan using NaF. Cohort B will evaluate SPECT CT by comparison to 18F-DCFPyL PET/CT. Cohort C will evaluate SPECT CT by comparison to Whole Body Magnetic Resonance Imaging (WB-MRI). Eligible subjects will be enrolled in a non-randomized manner per the treating physician discretion.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Conditions

Prostate Cancer

Interventions

SPECT CTPROCEDURE

MDP (99mTc-MDP) administration, about 180 min post-injection: whole body scan followed by a SPECT CT of regions designated by a board certified Nuclear Medicine physician after review of the whole body scan.

18F-DCFPyL PET/CTDRUG

A bolus of \~9 mCi (333 MBq) of 18F-DCFPyL will be injected by slow IV push.

18F-NaF PET/CTDRUG

A dose of 5 mCi 18F-NaF is injected through the IV and followed by at least 10 ml of saline to flush the IV line of the remaining dose. At the 1 hour post injection time, total Whole Body Images take approximately 40 - 60 minutes depending on the height of the patient.

Eligibility

Sex: MALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: Males ≥18 years of age. Subjects provide signed informed consent and confirm that they are able and willing to comply with all protocol requirements. Histologically confirmed adenocarcinoma of the prostate. Metastatic castration-resistant prostate cancer (mCRPC) with Bone metastases as manifested by one or more lesions on bone scan. Documented castrate level of serum testosterone (≤50 ng/dl). Documented progressive mCRPC based on at least one of the following criteria: 1. PSA progression defined as 25% increase over baseline value or nadir. 2. Radiographic progression for soft tissue lesions as per Response Evaluation Criteria in Solid Tumors (RECIST 1.1), and/ or radiographic progression for bone lesions as determined by radionuclide bone scan using the consensus guidelines of the PCWG3 criteria. Planning to receive first line novel hormonal therapy with Abiraterone or Enzalutamide for the first time for mCRPC within 4 weeks of documented progression. Baseline scans will be obtained prior to starting new therapy. Exclusion Criteria: Subjects who are unable to give valid informed consent Subjects who are unwilling or unable to undergo an SPECT, PET or MR exam, including subjects with contra-indications to MR exams. Subjects with prior Enzalutamide and Abiraterone for mCRPC Subjects with prior taxane chemotherapy for mCRPC Subjects administered any radioisotope within five physical half-lives or any IV X-ray contrast medium within 24 hours or any high density oral contrast medium (oral water contrast is acceptable) within 5 days prior to study drug injection. Subjects with any medical condition or other circumstances that, in the opinion of the investigator, compromise obtaining reliable data, achieving study objectives, or completion. Patients with a history reaction to gadolinium contrast agent. For cohort C, patients with renal failure (eGFR \< 60ml/min/1.73m2) or patients on dialysis.

Locations (2)

Johns Hopkins University

Baltimore, Maryland, United States

Thomas Jefferson University

Philadelphia, Pennsylvania, United States

Outcomes

Primary Outcomes

Accuracy for Prediction of Progression Free Survival as determined by Quantitative bone SPECT indices (QBSIs)

QBSI will be measured on SPECT scans at pre-defined intervals. A lower QBSI would mean likelier progression free survival.

Time frame: Baseline, 3 months post-treatment, 6 months post-treatment, at time of disease progression assessed up to 5 years

Secondary Outcomes

Reproducibility of the QBSIs using test-retest studies in 12 patients

Reproducibility measured by difference in QBSI between test-retest in 12 patients, as defined by the protocol. A smaller difference in QBSI reflects greater reproducibility.

Time frame: 5 years

Ability of QBSPECT to detect recurrence of metastatic disease as determined by QBSI in 60 patients.

QBSI will be measured on QBSPECT images obtained at the same time as standard-of-care bone scans. A higher QBSI would predict earlier recurrence of metastasis.

Time frame: Baseline, 3 months post-treatment, 6 months post-treatment, at time of disease progression assessed up to 5 years

Accuracy of NaF PET/CT as determined by difference in QBSI from SPECT versus QBSI from NaF PET/CT in 20 patients

Difference in QBSI from SPECT versus NaF PET/CT. A smaller difference in the measured QBSI would reflect a higher accuracy of Na18F PET/CT. These images will be acquired within 32 hours of the bone scintigraphy scans at the pre-defined time points, per protocol.

Time frame: Baseline, 3 months post-treatment, 6 months post-treatment, at time of disease progression assessed up to 5 years

Accuracy of PSMA PET/CT as determined by difference in QBSI from SPECT versus QBSI from PSMA PET/CT in 20 patients

Difference in QBSI from SPECT versus PSMA PET/CT. A smaller difference in the measured QBSI would reflect a higher accuracy of PSMA PET/CT. These images will be acquired within 32 hours of the bone scintigraphy scans at the pre-defined time points, per protocol.

Data from ClinicalTrials.gov

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