This study will test whether BNT324 is safe and works better against metastatic castration-resistant prostate cancer (mCRPC) than the current standard of care (SoC) chemotherapy, which is docetaxel (given together with the steroid medicines prednisone or prednisolone). The study will include participants with mCRPC that have been previously treated with androgen receptor pathway inhibitor, but with no previous taxane-based systematic chemotherapy for mCRPC. The main goals of this study are: * To find out if BNT324 helps participants live longer without their cancer getting worse (radiographic progression-free survival \[rPFS\]). * To find out if BNT324 helps participants live longer overall (overall survival \[OS\]).
The study consists of a screening period (up to 28 days), a treatment period with 21-day cycles, and an after-treatment period that includes a 30-day safety follow-up period and a long-term survival follow-up period. Treatment continues until the cancer clearly gets worse (in scans, based on blinded independent central review \[BICR\] assessment or investigator's decision), side effects become unacceptable, the participant chooses to stop, or the study ends. Participants are put into one of two groups in a 1:1 ratio, which means they will have an equal chance to be in either treatment group, i.e., BNT324 group, or docetaxel plus prednisone/prednisolone group (current SoC). An independent committee will help ensure participant safety, by regularly reviewing safety and early results. For each participant, the treatment and follow-up periods are projected to be up to \~58 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
736
rPFS assessed by BICR
By arm. rPFS is defined as time from randomization to radiographic disease progression per Prostate Cancer Working Group 3 (PCWG3)-modified Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) criteria, or death from any cause, whichever occurs first.
Time frame: From randomization to end of study, i.e., up to 58 months
OS
By arm. OS is defined as time from randomization to death from any cause.
Time frame: From randomization to end of study, i.e., up to 58 months
Time to first subsequent therapy (TFTS)
By arm. TFST is defined as time from randomization to initiation of the first subsequent systemic anticancer therapy or death, whichever occurs first.
Time frame: From randomization to end of study, i.e., up to 58 months
Objective response rate (ORR)
By arm. ORR is defined as the proportion of participants in whom a confirmed complete response (CR) or partial response (PR) (per PCWG3-modifed RECIST v1.1 as assessed by BICR) is observed as best overall response.
Time frame: From randomization to end of study, i.e., up to 58 months
Duration of response (DOR)
By arm. DOR is defined as time from first objective response (confirmed CR or PR per PCWG3-modified RECIST v1.1 criteria as assessed by BICR) to first occurrence of objective tumor progression (progressive disease per PCWG3-modified RECIST v1.1 criteria as assessed by BICR) or death from any cause, whichever occurs first.
Time frame: From randomization to end of study, i.e., up to 58 months
Time to pain progression (TTPP)
By arm. TTPP is defined as time from randomization to pain progression as determined by Brief Pain Inventory-Short Form Item 3 "worst pain in 24 hours" and opiate analgesic use (Analgesic Quantification Algorithm score).
Time frame: From randomization to safety follow-up visit (30 days after the last dose), i.e., up to 58 months
rPFS as assessed by investigator
By arm. rPFS is defined as time from randomization to radiographic disease progression per PCWG3-modified RECIST v1.1 criteria, or death from any cause, whichever occurs first.
Time frame: From randomization to end of study, i.e., up to 58 months
Time to first symptomatic skeletal-related event (SSRE)
By arm. Time to first SSRE is defined as time from randomization to first occurrence of any of the following SSREs: * Use of external beam radiation therapy to prevent or relieve skeletal symptoms. * New symptomatic pathologic bone fracture (vertebral or non-vertebral). * Spinal cord compression. * Tumor-related orthopedic surgical intervention.
Time frame: From randomization to end of study, i.e., up to 58 months
Time to prostate-specific antigen (PSA) progression (by central lab testing results)
By arm. Time to PSA progression is defined as time from randomization to PSA progression per PCWG3 criteria.
Time frame: From baseline to end of treatment visit, i.e., up to 58 months
PSA response (by central lab testing results)
By arm. PSA response is defined as having a post-baseline PSA reduction ≥50% from baseline with a consecutive confirmation assessment at least 3 weeks later per PCWG3 criteria.
Time frame: From baseline to end of treatment visit, i.e., up to 58 months
Number and percentage of participants with treatment-emergent adverse events (TEAEs) including Grade ≥3, serious, and fatal TEAEs
TEAEs by relationship and by arm.
Time frame: From the start of study treatment until 30 days after the last dose of study treatment or until start of new systemic anticancer therapy, whichever occurs first, i.e., up to 58 months
Number and percentage of participants with dose interruptions, reductions or discontinuations of study treatment due to TEAEs
By arm.
Time frame: From the start of study treatment until 30 days after the last dose of study treatment or until start of new systemic anticancer therapy, whichever occurs first, i.e., up to 58 months
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