Prostate Cancer Clinical Trial
Official title:
A Phase II Clinical Trial of Radium-223 Activity in Patients With Metastatic Castration-resistant Prostate Cancer (mCRPC) With Asymptomatic Progression While on Abiraterone Acetate or Enzalutamide Besides AR-V7 Mutational Status
Radium-223 is indicated for the treatment of patients with mCRPC with symptomatic bone metastases and no known visceral metastatic disease. However, very few data have been reported in patients with mCRPC who are asymptomatic or mildly symptomatic. Recently, results from an International Expanded Access Program have also suggested a benefit of radium-223 in asymptomatic patients with mCRPC. In addition, the mechanism of action of radium-223 should not be correlated with the presence/absence of the AR-V7 mutation, although this issue has not yet been evaluated. The aim of this study is to assess the efficacy of radium-223 in asymptomatic patients with mCRPC, and to establish the association between AR-V7 status and radium-223 activity.
Primary objective: To assess the efficacy of radium-223 in asymptomatic patients with mCRPC who have progressed while on abiraterone acetate or enzalutamide treatment. Primary endpoint: To determine the efficacy of radium-223 in terms of radiological rPFS. Secondary objectives: - Safety profile. - To determine the association between AR-V7 status (positive vs. negative) and PFS. - To establish the relationship between CTCs number with radium-223 efficacy. Secondary endpoints: Safety AEs will be evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) of the US National Cancer Institute (NCI) version 4.0 [20]. Grade 3 or 4 AEs and serious adverse events (SAEs) will be assessed to determine the safety and tolerability of the various combinations of drugs. Efficacy - Radiographic progression-free survival (rPFS) depending on AR-V7 status. - Overall survival (OS). - Time to first symptomatic skeletal event (SSE). - Time to PSA progression according to the ALSYMPCA study criteria. - Determination percentage of PSA progression. - Alkaline phosphatase level response (AF), normalization of alkaline phosphatase level, according to the ALSYMPCA study criteria. Molecular aspects - Assessment of AR-V7 mutation evolution during the study treatment. - Determination changes in CTCs number during the study treatment. ;
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