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Darolutamide + Consolidation Radiotherapy in Advanced Prostate Cancer Detected by PSMA

PHASE2RECRUITING

Darolutamide is a drug that has a proven survival benefit in non-metastatic (M0) castrate resistant prostate cancer when using conventional imaging. However, it is estimated that \>90% of patients have disease apparent when using PSMA PET. This study investigates the use of local consolidation radiotherapy in this cohort of men.

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Study details:

This study explores the use of local consolidation therapy in the setting of Darolutamide in the initial diagnosis of metastatic castrate resistant prostate cancer (mCRPC). In the chemotherapy naïve mCRPC setting, the pattern of disease is of limited volume metastases (1-5) in 34%-40% of cases. As progression at known sites of macroscopic disease is the predominant cause of failure on systemic therapies, local consolidation therapy with stereotactic ablative body radiotherapy (SABR) may improve progression free survival (PFS) and overall survival (OS).

This approach has been tested in the setting of lung cancer, in which consolidation SABR has resulted in OS benefit (HR of 0. 40) in phase II studies. The novel approach of local consolidation therapy has not been tested as yet in mCRPC.

The secondary objective of this study proposal is to better understand the pattern of disease distribution at first diagnosis of CRPC. Previous studies have used conventional bone scan and CT imaging, and with these investigations the proportion of patients that are 'M0' is \~35%1. However, in the new era of PSMA PET, which is far more sensitive than conventional imaging, there exists a new group of men who are M0 on conventional imaging but are M1 on PSMA PET staging.

Thus, in the DECREASE study population, we expect the vast majority of patients with conventionally imaged 'M0 CRPC' will have disease detectable on PSMA PET scanning. In this context, the central hypothesis of this trial is that the addition of consolidation radiotherapy to darolutamide to PSMA detected sites of disease will improve the clinical outcome of patients compared to those patients receiving darolutamide alone.

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Eligibility criteria

Researchers look for people who fit a certain description, called eligibility criteria. See if you qualify.

Inclusion criteria

  • ≥ 18 years of age and provided written Informed Consent
  • Histologically or cytologically confirmed adenocarcinoma of the prostate without neuroendocrine differentiation or small cell features
  • Castration-resistant prostate cancer, defined as at least 2 consecutive PSA rises obtained at least 1 week apart in the setting of castrate testosterone levels
  • Castrate level of serum testosterone (<1.7 nmol/l [50 ng/dl]) on gonadotrophin - releasing hormone (GnRH) agonist or antagonist therapy or after bilateral orchiectomy
  • A baseline PSA level of at least 1ng per millilitre and a PSA doubling time of 10 months or less
  • Adequate bone marrow reserve and organ function Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
  • At least 1 site of PSMA-avid disease on PSMA-PET/CT imaging in any of the following regions; At least 1 site of PSMA-avid disease on PSMA-PET/CT imaging in any of the following regions: Local recurrence within the prostate gland or prostate bed; Regional lymph node disease (below the aortic bifurcation); Extra-pelvic lymph node, bone or soft tissue metastatic disease
  • Exclusion criteria

  • Patients with detectable metastases or a history of metastatic disease on conventional imaging
  • Prior treatment with second-generation androgen receptor (AR) antagonists, CYP17 enzyme inhibitors or oral ketoconazole
  • Use of oestrogens or 5-α reductase inhibitors or anti-androgens within 28 days before randomisation
  • Use of systemic corticosteroid with a dose greater than the equivalent 10 mg of prednisone/day within 28 days before randomisation
  • Radiotherapy within 12 weeks prior to randomisation
  • Initiation of treatment with an osteoclast-targeted therapy to prevent skeletal-related events within 12 weeks before randomisation
  • Any of the following within 6 months before randomisation: stroke, myocardial infarction, severe/unstable angina pectoris, coronary/peripheral artery bypass graft; congestive heart failure New York Heart Association (NYHA) Class III or IV
  • Uncontrolled hypertension
  • Prior malignancy
  • Gastrointestinal disorder or procedure that expects to interfere significantly with the absorption of study treatment
  • Unable to swallow study medications and comply with study requirements
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    Eligibility

    Age eligible for study : 18 and older

    Healthy volunteers accepted : No

    Gender eligible for study: Male

    Things to know

    Study dates

    Study start: 2021-06-02

    Primary completion: 2026-06-01

    Study completion finish: 2026-06-01

    study type

    Study type

    TREATMENT

    phase

    Phase

      PHASE2

    trial

    Trial ID

    NCT04319783

    Intervention or treatment

    DRUG: Darolutamide

    RADIATION: Radiotherapy

    Conditions

    • Advanced Prostate Carcinoma
    • Cancer of Prostate
    • PSA
    • Castrate Resistant Prostate Cancer
    Image related to Advanced Prostate Carcinoma
    • Condition: Advanced Prostate Carcinoma, Cancer of Prostate and more

    • DRUG: Darolutamide and other drugs

    • Waratah, New South Wales, Australia and more

    • Sponsor: Trans Tasman Radiation Oncology Group

    Find a site

    Closest Location:

    Calvary Mater Newcastle

    Research sites nearby

    Select from list below to view details:

    • Calvary Mater Newcastle

      Waratah, New South Wales, Australia

    • Townsville University Hospital

      Douglas, Queensland, Australia

    • Royal Brisbane and Women's Hospital

      Herston, Queensland, Australia

    • Royal Adelaide Hospital

      Adelaide, South Australia, Australia

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    Study Plan

    This section provides details of the study plan, including how the study is designed and what the study is measuring.

    How is the study designed?

    Participant Group/ArmIntervention/Treatment
    EXPERIMENTAL: Darolutamide
    • Darolutimide 600mg BD
    DRUG: Darolutamide
    • Darolutamide alone
    EXPERIMENTAL: Local consolidation Radiotherapy + Darolutamide
    • Darolutimide 600mg BD + local consolidative radiotherapy, with a biological equivalent dose of 30Gy/10fx or greater if delivered with SABR. SABR is the preferred treatment approach, however conventional radiotherapy is acceptable. To up to 5 sites of disease
    DRUG: Darolutamide
    • Darolutamide alone

    What is the study measuring?

    Primary outcome

    Primary Outcome MeasurePrimary Outcome DescriptionPrimary Outcome Time Frame
    Undetectable PSA at 12 monthsUndetectable PSA at 12 months12 months

    Secondary outcome

    Secondary Outcome MeasureSecondary Outcome DescriptionSecondary Outcome Time Frame
    Radiological progression free survivalRadiological progression free survival36 months
    Distribution of disease on baseline PSMA-PET/CT imagingDistribution of bone, nodal, visceral and recurrent primary disease on PSMA-PET/CT36 months
    Biochemical progression free survivalBiochemical progression free survival36 months
    Treatment related adverse eventTreatment related adverse events (CTCAE v 5.0)36 months
    Overall survivalOverall survival36 months
    Patterns of disease on PSMA PET/CT after 12 weeks of commencing Darolutamide, and at time of disease progressionPSMA avid disease at irradiated site / unirradiated site / bone / local / nodal / visceral3 months

    Frequently Asked Questions

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    References

    Clinical Trials Gov: Darolutamide + Consolidation Radiotherapy in Advanced Prostate Cancer Detected by PSMA

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