Prostate cancer (PCa) is the most frequently diagnosed cancer in Canadian men. While the majority of PCa is slow growing and responds well to first line treatment, a proportion of cases (10%) progress to metastatic form resulting in more than 4 000 deaths annually in Canada and 250 000 worldwide. Currently, first line treatment for PCa includes surgery, radiation and androgen deprivation therapy (ADT). A rapid evolution in the understanding of disease biology, combined with approvals of new therapies including immunotherapy, novel chemotherapy, hormonal agents and a bone calcium matrix-targeted radionuclide, along with further drugs in development, have made treatment decisions for metastatic castration-resistant prostate cancer (mCRPC) increasingly complex and challenging. This is a Phase II Study of Cabazitaxel plus prednisone in patients with metastatic castration-resistant prostate cancer (mCRPC). The current study is designed to determine if cabazitaxel will improve progression free survival (PFS) or overall survival (OS). This study will enroll patients with mCRPC, who have been previously treated and progressed under docetaxel or abiraterone regimen. Patients must meet the study eligibility criteria and must be competent to give informed consent.
This is a prospective, multicenter, national, randomized, open label study, comparing the efficacy of cabazitaxel at 25 mg/m² plus prednisone (Arm A) over docetaxel at 75mg/m2 plus prednisone (Arm B) after enzalutamide at 160 mg once daily or abiraterone acetate at 1000 mg once daily plus prednisone in chemotherapy-naïve patients with mCRPC who have progressed on abiraterone acetate or enzalutamide. Each patient will be treated until disease progression, unacceptable toxicity, or patient's refusal of further study treatment. All eligible patients will be randomly assigned to either arm A or B in a 1:1 proportion.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
57
Cabazitaxel 25 mg/m² intravenously on day 1 of each cycle, plus prednisone 10 mg orally given daily. A cycle is defined as a 3-weeks period for a maximum of 10 cycles.
Docetaxel 75 mg/m² intravenously on day 1 of each cycle, plus prednisone 10 mg orally given daily. A cycle is defined as a 3-weeks period for a maximum of 10 cycles.
Centre Hospitalier de l'Université de Montréal
Montreal, Quebec, Canada
PSA response rate at 6 and 12 months
Change from baseline PSA level of at least 50%, PSA partial response is defined as a ≥ 50% decline in PSA from cycle 1 day 1 (baseline) PSA value. This PSA change must be confirmed as sustained by a second PSA value obtained ≥ 3 weeks later.
Time frame: through study completion, an average of 1 year
Radiological progression-free survival (rPFS)
Time interval between the date of randomization and the date of the first documentation of any of the following event. Radiological tumor progression by RECIST 1.1 and PCWG2,
Time frame: through study completion, an average of 1 year
Overall Survival
Time interval from the date of randomization to the date of death due to any cause
Time frame: through study completion, an average of 1 year
Time to PSA progression (TTPP)
Time interval between the date of randomization and the date of first documented PSA progression.
Time frame: through study completion, an average of 1 year
Tumor response
Measurable by RECIST 1.1
Time frame: through study completion, an average of 1 year
Duration of tumor response
Time between the first evaluation at which the tumor response criteria are met and the first documentation of tumor progression.
Time frame: hrough study completion, an average of 1 year
Pain response: BPI-SF pain intensity item scores
Decrease by \<30% from baseline in the average of BPI-SF pain intensity item scores (items 3, 4, 5, and 6) observed at 2 consecutive evaluations ≥3 weeks apart without increase in analgesic usage score.
Time frame: through study completion, an average of 1 year
Time to Pain progression
Time interval between the date of randomization and the date of the first documented pain progression
Time frame: through study completion, an average of 1 year
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