RADAR Trial - Randomised Androgen Deprivation and Radiotherapy

Prostate Cancer Clinical Trial

Official title:

A Randomised Trial Investigating the Effect on Biochemical (PSA) Control and Survival of Different Durations of Adjuvant Androgen Deprivation in Association With Definitive Radiation Treatment for Localised Carcinoma of the Prostate.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00193856
• Other study ID #: TROG 03.04
• Secondary ID: ACTRN12607000097
• Status: Completed
• Phase: Phase 3
• First received: September 12, 2005
• Last updated: October 10, 2017
• Start date: October 2003
• Est. completion date: August 2017

Study information

• Verified date: October 2017
• Source: Trans-Tasman Radiation Oncology Group (TROG)
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The principal objectives of the RADAR trial is to address the hypotheses; 1) that 18 months androgen deprivation in conjunction with radiotherapy is superior to 6 months androgen deprivation prior to and during radiotherapy; 2) that 18 months Bisphosphonate therapy will prevent bone loss caused by androgen deprivation therapy and further reduce relapse risk by impeding the development of bony metastases.

Description:

Traditionally androgen deprivation (by orchidectomy, or more recently by medication) has been reserved for the palliative treatment of men with advanced, incurable prostate cancer. However, evidence from large scale trials is beginning to suggest that androgen deprivation (AD) may be helpful in preventing relapse in patients with more localised disease who are treated surgically or by radiotherapy. Of the 8000 patients per annum who are treated with curative intent, one half (4000) have cancers where 'adjuvant' AD may be prescribed according to interpretation of the registered indications. There are, however, enormous variations in prescribing practices which reflect uncertainty as to the appropriate indications. An important issue is osteopenia.

The increasing use of AD in men with earlier stages of cancer, whose life expectancies exceed 3 years, has exposed many unwanted metabolic sequelae of prolonged AD, the most important being osteopenia. In 1996, with the funding support of the NHMRC and the pharmaceutical industry, TROG therefore launched a large randomised three-arm trial. Two of the arms repeated the two arms of the US Radiation Therapy Oncology Group (RTOG) 86.01 trial which, at the time, was showing early indications of benefit for the addition of two months maximal androgen deprivation (MAD), using Goserelin (Zoladex) and Flutamide, before radiation therapy and one month during. Since work from Canada had indicated that continued AD for periods longer than three months produced additional shrinkage of the prostatic tumour, the TROG 96.01 trial incorporated a third arm: six months MAD prior to and during radiotherapy. The trial completed its recruitment target of 800 eligible patients in early 2000. Although in August 2001 the median follow up time was still very short, a preliminary analysis indicated that significant increases in time to biochemical relapse had been produced by AD. In fact, the benefits of AD were independent of stage, tumour grade and initial PSA value which were confirmed also to predict time to biochemical failure. The hazard of relapse reduced to 0.75 (0.55 - 0.97, 95% confidence intervals) with 3 months AD, and still further to 0.6 (0.45 - 0.82) with six months AD.

Subsequent international developments in this area of research encouraged the design of a 'follow on' trial. A European Organisation for Research and Treatment of Cancer (EORTC) trial reported that 3 years of adjuvant ('post hoc') AD (using Goserelin alone), administered after radiotherapy, reduced relapse and improved survival in patients with locally advanced prostate cancer. The US Radiation Therapy Oncology Group (RTOG) 85.31 trial indicated that indefinite Goserelin administration after radiotherapy reduced treatment failure rates at all sites when compared with radiotherapy alone. The RTOG 92.02 trial showed that 24 months of adjuvant Goserelin also reduced failure rates in patients treated with 4 months of MAD prior to and during radiotherapy. Subset analyses of the RTOG trials, suggested that patients who gain most from prolonged AD in terms of survival are those with high grade cancers.

It was therefore logical for TROG to propose a second trial with the intention of finding out whether an additional 12 months of AD administered after radiotherapy (aka 'intermediate term' AD [ITAD]) would reduce relapse and mortality in patients treated with six months of AD prior to and during radiotherapy (aka 'short term' AD [STAD]) as in the 'best' arm of its first (96.01) trial. The availability of the potent bisphosphonate, zoledronic acid, also made it possible to find out whether or not osteopenia induced in the two arms of the proposed second trial would be prevented by a second random assignment to 18 months' bisphosphonate therapy (BP).

This is a randomised phase III multicentre clinical trial.

After informed consent is given and eligibility is checked patients will be randomised to one of four trial arms:

1. 6 months of androgen blockade with an LH-RH analogue (5 months before start of radiotherapy) (STAD),

2. 18 months of androgen blockade with an LH-RH analogue (starting 5 months before start of radiotherapy) (ITAD),

3. 18 months of therapy with zoledronic acid 4 mg by intravenous infusion every 3 months for 18 months beginning concurrently with STAD

4. 18 months of therapy with zoledronic acid beginning concurrently with ITAD.

Stratification will be according to the following criteria:

T2 / T3, 4 Gleason score 2 - 6 / 7+ Presenting PSA <10 / 10 - 20 / >20 Treatment centre

Radiation Treatment will be delivered using a conventional technique, unless the treatment centre of the participating clinician demonstrates an ability to deliver the treatment using a CRT, IMRT, or HDRB technique verified by the trial TACT.

Drug Treatment:

LH-RH analogue (LH-RHa) (Leuprorelin acetate 22.5 mg) will be delivered as a depot injection every 3 months. This will be administered as an Intramuscular injection (IMI).

Zoledronic acid 4 mg will be delivered as an intravenous infusion over 15 minutes once every 3 months for 18 months, in patients randomised to this therapy. No placebo therapy will be given to patients randomised to 'no bisphosphonate therapy' treatment arm.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 1071
• Est. completion date: August 2017
• Est. primary completion date: August 2017
• Accepts healthy volunteers: No
• Gender: Male
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Histological confirmation of adenocarcinoma of the prostate in the three months prior to randomisation

• Gleason primary and secondary pattern reported. If the volume of tumour in biopsies is too small for the pathologist to allocate a secondary pattern, the primary pattern alone is sufficient.

• Primary tumour stage T2b - 4 (UICC 2002), or T2a providing biopsies demonstrate Gleason score 7 or more, and presenting PSA 10 or more

• PSA value obtained within one month of randomisation

• No evidence of lymphatic or haematogenous metastases, as determined by negative chest x-ray, CT scan of abdomen and pelvis, and bone scan in the 3 months prior to randomisation

• ECOG performance status 0 - 1

• No concurrent medical conditions likely to significantly reduce prospects of 5 year survival

• Patient accessible to follow up at intervals specified in protocol

• Written informed consent given (signed by both patient and investigator prior to randomisation)

Exclusion Criteria:

• Previous or concurrent malignancy within previous 5 years except for non-melanomatous skin cancer

• Prostatectomy

• Prior pelvic radiotherapy

• Prior hormone treatment for prostate cancer

• Inability to complete self administered QOL questionnaire

• Prior bisphosphonate therapy

• Serum creatinine > 2 x ULN

• Osteoporosis resulting in >30% loss in vertebral height in one or more thoraco-lumbar vertebrae

• Liver disease resulting in ALT or AST levels >3 x ULN

• Prolonged continuous glucocorticoid therapy > 10 mg/day of prednisone equivalent (>6 months)

• Current treatment with bisphosphonate

• Inability to attend for follow-up at the Investigator's clinic

Related Conditions & MeSH terms

• Prostate Cancer
• Prostatic Neoplasms

Intervention

Drug:
• Leuprorelin Acetate
LH-RH analogue (LH-RHa) (Leuprorelin acetate 22.5 mg) will be delivered as a depot injection every 3 months. This will be administered as an intramuscular injection (IMI).
• Zoledronic Acid
Zoledronic acid 4 mg will be delivered as an intravenous infusion over 15 minutes once every 3 months for 18 months, in patients randomised to bisphosphonate therapy.

Radiation:
• Conventional external beam therapy
The prescribed dose will be 66 Gy in 33 fractions of 2 Gy to the ICRU 50 point utilising a minimum of three fields with >= 6 MV photons.

Locations

Country	Name	City	State
Australia	Campbelltown Hospital	Campbelltown	New South Wales
Australia	Peter MacCallum Cancer Centre	East Melbourne	Victoria
Australia	Andrew Love Cancer Care Centre, Geelong Hospital	Geelong	Victoria
Australia	Royal Brisbane Hospital	Herston	Queensland
Australia	St George Hospital	Kogarah	New South Wales
Australia	Launceston General Hospital	Launceston	Tasmania
Australia	Lismore Hospital	Lismore	New South Wales
Australia	Liverpool Hospital	Liverpool	New South Wales
Australia	Sir Charles Gairdner Hospital	Nedlands	Western Australia
Australia	Calvary Mater Newcastle	Newcastle	New South Wales
Australia	Nepean Cancer Care Centre	Penrith	New South Wales
Australia	Mater QRI	South Brisbane	Queensland
Australia	Royal North Shore Hospital	Sydney	New South Wales
Australia	John Flynn Private Hospital	Tugun	Queensland
Australia	Riverina Cancer Care Centre	Wagga Wagga	New South Wales
Australia	Westmead Hospital	Wentworthville	New South Wales
Australia	Illawarra Cancer Care Centre	Wollongong	New South Wales
Australia	Princess Alexandra Hospital	Woolloongabba	Queensland
New Zealand	Auckland Hospital	Auckland
New Zealand	Christchurch Hospital	Christchurch
New Zealand	Dunedin Hospital	Dunedin
New Zealand	Waikato Hospital	Hamilton
New Zealand	Palmerston North Hospital	Palmerston North
New Zealand	Wellington Hospital	Wellington

Sponsors (10)

Lead Sponsor	Collaborator
Trans-Tasman Radiation Oncology Group (TROG)	Abbott, Calvary Mater Newcastle, Australia, Cancer Society of New Zealand, Health Research Council, New Zealand, Hunter Medical Research Institute (HMRI), Maitland Cancer Appeal, National Health and Medical Research Council, Australia, Novartis Pharmaceuticals, University of Newcastle, Australia

Countries where clinical trial is conducted

Australia,  New Zealand, 

References & Publications (1)

Haworth A, Kearvell R, Greer PB, Hooton B, Denham JW, Lamb D, Duchesne G, Murray J, Joseph D. Assuring high quality treatment delivery in clinical trials - Results from the Trans-Tasman Radiation Oncology Group (TROG) study 03.04 "RADAR" set-up accuracy s — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Prostate cancer-specific mortality.		Two main endpoint analyses are planned when 6.5 and 10 years have elapsed from randomisation of the last participant
Secondary	Cumulative incidence of PSA progression		Two main endpoint analyses are planned when 6.5 and 10 years have elapsed from randomisation of the last participant
Secondary	Cumulative incidence of local, distant and bony progression and associated patterns of clinical progression		Two main endpoint analyses are planned when 6.5 and 10 years have elapsed from randomisation of the last participant
Secondary	All-cause mortality		Two main endpoint analyses are planned when 6.5 and 10 years have elapsed from randomisation of the last participant
Secondary	Changes in bone mineral density and osteopenic fracture		One endpoint analysis is planned when 4.5 years have elapsed from randomisation of the last participant
Secondary	Quality of life assessment		One endpoint analysis is planned when 3 years have elapsed from randomisation of the last participant
Secondary	Treatment related morbidity		One endpoint analysis is planned when 4 years have elapsed from randomisation of the last participant
Secondary	Cumulative incidence of secondary therapeutic intervention		Two main endpoint analyses are planned when 6.5 and 10 years have elapsed from randomization of the last participant

External Links

•   Click here for more information about this study on the TROG official website