Salvage Therapeutic Radiation With Enzalutamide and ADT in Men With Recurrent Prostate Cancer (STREAM)

Prostate Cancer Clinical Trial

— STREAM  

Official title:

Salvage Therapeutic Radiation With Enzalutamide and ADT in Men With Recurrent Prostate Cancer (STREAM)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02057939
• Other study ID #: Pro00049865
• Status: Completed
• Phase: Phase 2
• Start date: April 2014
• Est. completion date: June 5, 2019

Study information

• Verified date: June 2019
• Source: Duke University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to describe the 2 year progression-free survival in men with recurrent PSA-only disease after prostatectomy receiving combined enzalutamide and standard androgen-deprivation therapy (ADT) with salvage radiation therapy. Eligible men will have recurrent PSA-only prostate cancer within 4 years of prostatectomy, and a PSA of 0.2 - 4 in the absence of metastatic disease on CT and bone scans. In addition to standard ADT and radiation therapy, research participants will take enzalutamide once daily for six months. It is primarily hypothesized the 2 year PFS rate will be improved with the combined therapy compared to the historical control data in a similar patients setting.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 38
• Est. completion date: June 5, 2019
• Est. primary completion date: March 2, 2018
• Accepts healthy volunteers: No
• Gender: Male
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Histologically confirmed diagnosis of prostate adenocarcinoma. Variants of prostate cancer, including neuroendocrine features and small cell carcinoma of the prostate, are not permitted.

• Gleason sum of 7, 8, 9, or 10 at the time of prostatectomy.

• PSA relapse within 4 years of prostatectomy defined by persistently detectable or rising PSA after surgery.

• Evidence of disease recurrence or progression as evidenced by a PSA > 0.20. This requires 2 consecutive rises in PSA, at least 1 week apart, over the post-prostatectomy nadir or one PSA value above 0.20 ng/mL if the patient failed to achieve a post-prostatectomy nadir of < 0.2 ng/mL.

• Age = 18 years

• Karnofsky performance status = 70

• Adequate laboratory parameters

• Adequate bone marrow function: ANC =1.5 x 109/L, Platelets =100 x 109/L, Hb >9g/dL

• AST/SGOT and ALT/SGPT = 2.5 x Institutional Upper Limit of Normal (ULN)

• Serum bilirubin = 1.5 x Institutional ULN

• Serum creatinine = 1.5 x Institutional ULN or 24-hour clearance = 50 mL/min

• A minimum of 4 weeks from any major surgery prior to registration.

• Ability to swallow, retain, and absorb oral medication.

• Ability to understand and the willingness to sign a written informed consent document.

• Must use a condom if having sex with a pregnant woman.

• Male patient and his female partner who is of childbearing potential must use 2 acceptable methods of birth control (one of which must include a condom as a barrier method of contraception) starting at screening and continuing throughout the study period and for 3 months after final study drug administration.

Exclusion Criteria:

• Radiographic evidence of metastatic disease. Patients with node-positive disease (<2 positive nodes) at the time of radical prostatectomy are eligible. Patients with pelvic nodes up to 2 cm by short axis at the time of screening are eligible. Patients with any enlarged lymph nodes in the retroperitoneum or above the aortic bifurcation or with pelvic nodes = 2 cm must be excluded.

• PSA > 4.0 ng/mL.

• Testosterone level = 100 ng/dL.

• More than 1 month of prior hormone exposure or hormone exposure within 30 days of registration. Prior enzalutamide, ketoconazole, abiraterone, or TAK700 prohibited. Prior 5a reductase inhibitors are allowed.

• Prior immunotherapy including sipuleucel-T.

• Prior systemic chemotherapy (docetaxel, cabazitaxel, estramustine, other cytotoxic agents)

• History of solid organ or stem cell transplantation.

• History of seizure or any condition that may predispose to seizure (e.g., prior cortical stroke, prior head or traumatic brain injury with loss of consciousness, prior or current space-occupying lesion in the brain). Also, history of loss of consciousness or transient ischemic attack within 12 months of Day 1 visit.

• Known or suspected brain metastasis or active leptomeningeal disease.

• Other concurrent severe and/or uncontrolled concomitant medical conditions (e.g., active or uncontrolled infection) that could cause unacceptable safety risks or compromise compliance with the protocol.

• Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of enzalutamide or increase the risk of radiation (e.g., uncontrolled nausea, vomiting, diarrhea, malabsorption syndromes, prior small bowel resection, or inflammatory bowel disease).

• Patients who have received prior prostate or pelvic radiotherapy, including external beam or brachytherapy.

• Patients who have undergone major surgery = 4 weeks prior to starting study drug or who have not recovered from side effects of such therapy prior to registration.

• Patients unable or unwilling to abide by the study protocol or cooperate fully with the investigator.

Related Conditions & MeSH terms

• Prostate Cancer
• Prostatic Neoplasms

Intervention

Drug:
• enzalutamide
160 mg orally once daily for six months
• Androgen Deprivation
Two injections each lasting three months, for a total of six months of androgen deprivation therapy. Doctor will help determine which androgen deprivation drug to use.

Radiation:
• Radiation Therapy
Daily (Monday-Friday) for 6-8 weeks, final dose of approximately 66 Gy

Locations

Country	Name	City	State
United States	Duke University Medical Center	Durham	North Carolina
United States	Rutgers Cancer Institute of New Jersey	New Brunswick	New Jersey
United States	Wake Forest Baptist Health	Winston-Salem	North Carolina

Sponsors (3)

Lead Sponsor	Collaborator
Duke University	Astellas Pharma Inc, Medivation, Inc.

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Two Year Progression-free Survival	Percentage of patients surviving 2 years from the start of study treatment without progression of disease. PFS was defined as the time from the date of study treatment initiation to the date of first documented progression or death due to any cause. Progression-free was defined as being without one of the following: serum PSA value of 0.2 ng/mL or more above post-radiotherapy PSA nadir that continues to increase 4 weeks later OR if no nadir is experienced, two rising PSA values over 4 or more weeks OR evidence of clinical progression or initiation of systemic therapy for progressive disease	2 years
Secondary	PSA Less Than 0.1	The percentage of men with PSA less than 0.1 ng/mL and testosterone greater than 100	every year, up to 3 years
Secondary	Three Year Progression-free Survival	Percentage of patients surviving 3 years from the start of study treatment without progression of disease. PFS was defined as the time from the date of study treatment initiation to the date of first documented progression or death due to any cause. Progression-free was defined as being without one of the following: serum PSA value of 0.2 ng/mL or more above post-radiotherapy PSA nadir that continues to increase 4 weeks later OR if no nadir is experienced, two rising PSA values over 4 or more weeks OR evidence of clinical progression or initiation of systemic therapy for progressive disease	3 years
Secondary	Biochemical Progression-free Survival	Percentage of patients surviving 2 and 3 years from the start of study treatment without progression of disease. Biochemical PFS was defined as the time from the date of study treatment initiation to the date of first documented progression or death due to any cause. Progression-free was defined as being without one of the following: serum PSA value of 0.2 ng/mL or more above post-radiotherapy PSA nadir that continues to increase 4 weeks later OR if no nadir is experienced, two rising PSA values over 4 or more weeks	3 years
Secondary	PSA Nadir	Median PSA nadir post-radiation therapy	8 weeks
Secondary	Time to Testosterone Recovery	Percentage of patients with recovering testosterone to > 100 at 1, 2, and 3 years.	3 years
Secondary	Number of Patients With Adverse Events Related to Combination Enzalutamide, ADT, and XRT	Safety and tolerability will be assessed using CTCAE v4.0	3 years