Prostate Oligometastatic Cancer Management Driven by Disease Biology et/or Immunoactivity (PROMETEO)

Centro di Riferimento Oncologico - Aviano104 enrolled

Overview

Currently, despite the advent of next-generation imaging has improved the detection of Oligometastatic prostate cancer (OMPC), prognostic biomarkers able to stratify patients and monitor treatment response are lacking and urgently needed. Mounting evidence suggests that molecular profiling of the disease and host immune activity evaluation can reveal OMPC heterogeneity and address the above unmet clinical need. Liquid biopsy, defined as the sampling and analysis of tumor-derived analytes \[i.e.: circulating tumor cells (CTCs), or circulating tumor DNA (ctDNA)\] from blood, represents a powerful tool to assess in real-time the evolving landscape of cancer, identify prognostic and predictive biomarkers and detect resistance to therapies in several cancers, including Prostate Cancer (PC). Additionally, the same blood sample allows the profiling of tumor-associated components, such as circulating immune cells, which may give clues at the systemic level about the dynamic and complex host-tumor interaction. It is non-invasive, easily repeatable, and cost-effective. In this regard, preliminary results derived from clinical studies indicate that the analysis of tumor material circulating in peripheral blood, combined with the study of the host immune response might be pivotal. This study aims at combining the analysis of several biomarkers, associated with both tumor (CTC and cfDNA) and host (TCR), with a micro-invasive approach, such as liquid biopsy, to improve the prognostic stratification of OMPC patients compared to conventional laboratory test (PSA) and imaging exams (Choline- or PSMA-PET imaging).

Study Type

OBSERVATIONAL

Enrollment

104

Conditions

Eligibility

Sex: MALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion criteria Retrospective cohort * \>18 years old; * Patients previously included in the ADAPT-CTC trial * Signing written informed consentInclusion Criteria: Prospective cohort * \>18 years old * Histologic confirmation (primary or metastatic tumor) of Acinar Adenocarcinoma of Prostate * Hormone-sensitive OMPC defined as ≤3 metachronous metastases (bone and/or lymph node) detected within the past 6 months with Choline/PSMA PET-CT following prostate specific antigen (PSA) rising after primary treatment (surgery and/or radiotherapy) with curative intent as defined by European Association of Urology criteria (EAU). * Controlled primary tumor * Prior salvage treatment to the primary prostate cancer is allowed. * PSA ≤ 50 ng/mL * Testosterone ≥ 0.5 ng/mL * ADT associated to the primary treatment concluded more than 6 months prior to the enrollment. * Patients eligible for a course of SBRT on bone and/or lymph node metastatic sites * Patients must have a life expectancy ≥ 12 months and an ECOG performance status ≤ 2 * Patients must have normal organ and marrow function defined as: * Leukocytes ≥2000/µL * Absolute Neutrophil Count ≥1000/µL * Platelets ≥50000/µL * Patients amenable to understand and sign written informed consent documents Exclusion Criteria: Prospective cohort * Spinal cord compression or impending spinal cord compression. * Suspected pulmonary and/or liver metastases * Patient receiving any other investigational agents * Patient is participating in a concurrent treatment protocol * Prior treatments for hormone-sensitive OMPC * Serum creatinine \> 3 times the upper limit of normal. * Total bilirubin \> 3 times the upper limit of normal. * Liver Transaminases \> 5-times the upper limit of normal. * Unable to lie flat during or tolerate PET/CT or SBRT. * Previous history of cancer other than non-melanoma skin cancer in the last 5 years * Traumatic bone events in the 4 weeks before PET

Outcomes

Primary Outcomes

Validation of the prognostic significance of CTCs in a prospective cohort of OMPC patients undergoing SBRT

To verify if a cut-off value of ≥5 CTC/7.5 mL of blood is prognostic of worst outcome in terms of distant progression-free survival (DPFS). Prognostic value will be measured as hazard ratio and relative 95% confidence intervals. DPFS will be defined as the time between the first day of SBRT and the detection at restaging imaging of clinical disease outside the treatment field

Time frame: up to 3 years

Secondary Outcomes

Biochemical-PSF and CTC

Evaluate the relation between CTC number and its variation and biochemical PFS defined as the time between the first day of SBRT to the PSA increase ≥ 25% and ≥ 2 ng/mL if PSA was ≥ 2 ng/mL from baseline, or a PSA increase ≥ 25% if PSA was \< 2 ng/mL.

Time frame: up to 3 years

Biochemical-PSF and TCR

Evaluate the relation between TCR values and biochemical PFS defined as the time between the first day of SBRT to the PSA increase ≥ 25% and ≥ 2 ng/mL if PSA was ≥ 2 ng/mL from baseline, or a PSA increase ≥ 25% if PSA was \< 2 ng/mL.

Time frame: up to 3 years

Identify signatures in cfDNA of prognostic significance in terms of Biochemical-PSF

Association between the presence of a combination of specific tumour mutations detected in cfDNA and Biochemical-PSF defined as the time between the first day of SBRT to the PSA increase ≥ 25% and ≥ 2 ng/mL if PSA was ≥ 2 ng/mL from baseline, or a PSA increase ≥ 25% if PSA was \< 2 ng/mL.

Time frame: up to 3 years

Distant-PSF and CTC

Evaluate the relation between CTC number and its variation and distant PFS defined as the time between the first day of SBRT to the detection at restaging imaging of clinical disease outside the treatment field obtained after biochemical progression

Time frame: up to 3 years

Distant-PSF and TCR

Evaluate the relation between TCR values and distant PFS defined as the time between the first day of SBRT to the detection at restaging imaging of clinical disease outside the treatment field obtained after biochemical progression

Time frame: up to 3 years

Identify signatures in cfDNA of prognostic significance in terms of Distant-PSF

association between the presence of a combination of specific tumour mutations detected in cfDNA and distant PFS defined as the time between the first day of SBRT to the detection at restaging imaging of clinical disease outside the treatment field obtained after biochemical progression

Time frame: up to 3 years

Local control and CTC

Evaluate the relation between CTC number and its variation and local control defined as no evidence of disease in the treatment field at restaging imaging obtained after biochemical progression

Time frame: up to 3 years

Local control and TCR

Evaluate the relation between TCR values and local control defined as no evidence of disease in the treatment field at restaging imaging obtained after biochemical progression

Time frame: up to 3 years

Identify signatures in cfDNA of prognostic significance in terms of Local control

association between the presence of a combination of specific tumour mutations detected in cfDNA and local control defined as no evidence of disease in the treatment field at restaging imaging obtained after biochemical progression

Time frame: up to 3 years

ADT-free survival and CTC

Evaluate the relation between CTC number and its variation and ADT-FS defined as time between the first day of SBRT to the start of palliative ADT

Time frame: up to 3 years

ADT-free survival and TCR

Evaluate the relation between TCR values and ADT-FS defined as time between the first day of SBRT to the start of palliative ADT

Time frame: up to 3 years

Identify signatures in cfDNA of prognostic significance in terms of ADT-free survival

association between the presence of a combination of specific tumour mutations detected in cfDNA and ADT-FS defined as time between the first day of SBRT to the start of palliative ADT

Time frame: up to 3 years

time to castration resistant Prostate Cancer and CTC

Evaluate the relation between CTC number and its variation and TTCR defined as the time between the first day of SBRT to the PSA ≥ 2 ng/mL and Testosterone levels \< 0.5 ng/mL

Time frame: up to 3 years

time to castration resistant Prostate Cancer and TCR

Evaluate the relation between TCR values and TTCR defined as the time between the first day of SBRT to the PSA ≥ 2 ng/mL and Testosterone levels \< 0.5 ng/mL

Time frame: up to 3 years

Identify signatures in cfDNA of prognostic significance in terms of time to castration resistant Prostate Cancer

association between the presence of a combination of specific tumour mutations detected in cfDNA and TTCR defined as the time between the first day of SBRT to the PSA ≥ 2 ng/mL and Testosterone levels \< 0.5 ng/mL

Time frame: up to 3 years

Overall survival and CTC

Evaluate the relation between CTC number and its variation and OS defined as the time between the first day of SBRT to the time of death.

Time frame: up to 3 years

Overall survival and TCR

Evaluate the relation between TCR values and OS defined as the time between the first day of SBRT to the time of death.

Time frame: up to 3 years

Identify signatures in cfDNA of prognostic significance in terms of Overall survival

association between the presence of a combination of specific tumour mutations detected in cfDNA and OS defined as the time between the first day of SBRT to the time of death.

Time frame: up to 3 years

TCR values

Median of TCR diversity, clonality and fold change before and after SBRT

Time frame: up to 3 years

cfDNA

Frequency of selected tumour mutations in cfDNA

Time frame: up to 3 years

prognostic value of the combination of different biomarkers

difference in distant-PFS probability between subgroups of patients carrying different combination of circulating biomarkers. Distant PFS will be defined as the time between the first day of SBRT to the detection at restaging imaging of clinical disease outside the treatment field obtained after biochemical progression

Time frame: up to 3 years

Prostate Oligometastatic Cancer Management Driven by Disease Biology et/or Immunoactivity (PROMETEO)

Overview

Conditions

Eligibility

Locations (2)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts