Stage IV Prostate Cancer AJCC v8 Clinical Trial
Official title:
Randomized Phase III Trial of SBRT Versus Hypofractionated Radiotherapy for Salvage of Biochemically Recurrent or Oligometastatic Prostate Adenocarcinoma After Radical Prostatectomy
This phase III trial tests the side effects of stereotactic body radiation therapy (SBRT) compared to hypofractionated radiotherapy for treating patients with prostate adenocarcinoma that has come back after a period of improvement (recurrent) or that has spread from where it first started (primary site) to a limited number of sites (oligometastatic). SBRT is a type of external radiation therapy that uses special equipment to position a patient and precisely deliver radiation to tumors in the body (except the brain). The total dose of radiation is divided into smaller doses given over several days. This type of radiation therapy helps spare normal tissue. Hypofractionated radiation therapy delivers higher doses of radiation therapy over a shorter period of time and may kill more tumors cells and have fewer side effects. SBRT may work just as well as hypofractionated radiation therapy at treating patients with biochemically recurrent or oligometastatic prostate cancer, but with a shorter treatment time and possibly fewer side effects.
PRIMARY OBJECTIVE: I. To determine if salvage SBRT is non-inferior to moderately hypofractionated radiation therapy regarding treatment related rates of genitourinary (GU) and gastrointestinal (GI) grade 3 or higher within 2-years. EXPLORATORY OBJECTIVES: I. After completion of radiation therapy, determine the incidence of: Ia. Disease free survival (DFS), defined as the first occurrence of new clinical failure (local recurrence, regional recurrence, or distant metastasis) after salvage radiation therapy (RT); Ib. Grade 2 or greater GU and GI toxicity at 3 years (Common Terminology Criteria for Adverse Events [CTCAE] version 4); Ic. Grade 3 or greater GU and GI toxicity at 3 years (CTCAE version 4); Id. Quality of life following completion of radiation therapy; Ie. Impotence after the use of radiation therapy at 3 years; If. Freedom from biochemical failure (FFBF) at 5 years; Ig. Local failure at 5 years; Ih. Regional failure at 5 years; Ii. Distant failure at 5 years; Ij. Salvage androgen deprivation therapy (ADT) use (SAD) at 5 years; Ik. Progression free survival: using clinical, biochemical and SAD as events at 5 years; Il. Overall survival at 5 years; Im. Disease-specific survival at 5 years. II. Determine the impact of salvage SBRT and hypofractionated radiation therapy (HFRT) on quality of life. III. Determine prostate and normal structure movement during RT with the use of scans. IV. Correlate pathologic and radiologic findings with outcomes. V. Correlate pre-RT prostate specific antigen (PSA) levels with outcomes. VI. Prospectively collect information that will help to define dose-volume relationships of normal structures with acute and chronic toxicity. VII. Allow for future research of pathologic risk factors that may influence prognosis; this information will help us to attempt to characterize their presence in prostate cancer with high-risk features after prostatectomy and their potential effect on outcomes. VIII. Prospectively record contours that were manually drawn versus (vs.) edited from artificial intelligence (AI)-generated contours. IX. Determine the impact of using artificial intelligence (AI) tools for automatic segmenting prostate bed and other organs at risk, in terms of toxicities and outcome. X. Determine if there are any significant differences in dose-volumes results for cases that involved AI-autosegmentation vs. cases without. XI. Determine the relationship between the use of AI-autosegmentation tools with toxicities and outcome. XII. Different online daily imaging guidance systems are allowed in this trial, including x-rays, conventional Feldkamp-Davis-Kress (FDK)-based cone beam computed tomography (CBCT), and iterative CBCT. Subgroup analysis will be performed to determine patient alignment accuracy and toxicities rates with respect to different online daily imaging systems. OUTLINE: Patients are randomized to 1 of 2 groups. GROUP I: Patients undergo SBRT over 15-20 minutes every other day for a total of 5 treatments over 1-2 weeks in the absence of disease progression or unacceptable toxicity. Patients may receive androgen deprivation therapy for up to 18 months, as clinically indicated. Patients undergo bone scan and positron emission tomography (PET) at screening and treatment failure, and undergo magnetic resonance imaging (MRI) and blood sample collection throughout the study. GROUP II: Patients undergo hypofractionated radiation therapy over 15-20 minutes once per day for a total of 20 treatments over 4-6 weeks in the absence of disease progression or unacceptable toxicity. Patients may receive androgen deprivation therapy for up to 18 months, as clinically indicated. Patients undergo bone scan and PET at screening and treatment failure, and undergo MRI and blood sample collection throughout the study. After completion of study treatment, patients follow up at 3 months, 12 months, annually until year 5 and then every other year until death. ;
Status | Clinical Trial | Phase | |
---|---|---|---|
Active, not recruiting |
NCT04716725 -
68Ga-PSMA-11 PET for the Diagnosis of Metastatic Castration Resistant Prostate Cancer
|
Phase 2 | |
Withdrawn |
NCT05034562 -
Gallium-68 PSMA-11 PET in Participants With Prostate Cancer
|
Phase 2 | |
Recruiting |
NCT03678025 -
Standard Systemic Therapy With or Without Definitive Treatment in Treating Participants With Metastatic Prostate Cancer
|
Phase 3 | |
Active, not recruiting |
NCT03218826 -
PI3Kbeta Inhibitor AZD8186 and Docetaxel in Treating Patients Advanced Solid Tumors With PTEN or PIK3CB Mutations That Are Metastatic or Cannot Be Removed by Surgery
|
Phase 1 | |
Recruiting |
NCT04071236 -
Radiation Medication (Radium-223 Dichloride) Versus Radium-223 Dichloride Plus Radiation Enhancing Medication (M3814) Versus Radium-223 Dichloride Plus M3814 Plus Avelumab (a Type of Immunotherapy) for Advanced Prostate Cancer Not Responsive to Hormonal Therapy
|
Phase 1/Phase 2 | |
Completed |
NCT04976257 -
Pharmacokinetics of IA and IV Ga68-PSMA-11 Infusion
|
Early Phase 1 | |
Recruiting |
NCT06173362 -
Abiraterone and Prednisone or Darolutamide for the Treatment of Advanced Prostate Cancer
|
Phase 2 | |
Withdrawn |
NCT04585932 -
Androgen Deprivation Therapy and Apalutamide With or Without Radiation Therapy for the Treatment of Biochemically Recurrent Prostate Cancer, RESTART Study
|
Phase 2 | |
Active, not recruiting |
NCT04514484 -
Testing the Combination of the Anti-cancer Drugs XL184 (Cabozantinib) and Nivolumab in Patients With Advanced Cancer and HIV
|
Phase 1 | |
Active, not recruiting |
NCT05241860 -
Testing Interruption of Hormonal Medications in Patients Responding Exceptionally to Therapy for Metastatic Prostate Cancer, (A-DREAM)
|
Phase 2 | |
Not yet recruiting |
NCT06129851 -
Relugolix in Combination With Radiation Therapy for Treating Patients With High Risk Prostate Cancer
|
Phase 2 | |
Not yet recruiting |
NCT05487846 -
Peer Navigation for the Support of Metastatic Prostate Cancer Patients Undergoing Genetic Evaluation
|
N/A | |
Recruiting |
NCT04314401 -
National Cancer Institute "Cancer Moonshot Biobank"
|
||
Recruiting |
NCT04734730 -
Talazoparib With Androgen Deprivation Therapy and Abiraterone for the Treatment of Castration Sensitive Prostate Cancer
|
Phase 2 | |
Active, not recruiting |
NCT03517969 -
M6620 and Carboplatin With or Without Docetaxel in Treating Patients With Metastatic Castration-Resistant Prostate Cancer
|
Phase 2 | |
Recruiting |
NCT04777071 -
An Investigational Scan (68Ga-PSMA-11 PET) for the Imaging of Prostate Cancer
|
Phase 2 | |
Active, not recruiting |
NCT03360721 -
Apalutamide, Abiraterone Acetate, and Prednisone in Treating Participants With Metastatic Castration Resistant Prostate Cancer
|
Phase 2 | |
Recruiting |
NCT05054296 -
Modifying Metabolic Syndrome and Cardiovascular Risk for Prostate Cancer Patients on ADT Using a Risk Factor Modification Program and Continuous Fitbit Monitoring
|
Phase 2 | |
Recruiting |
NCT04693377 -
Cryoablation Combined With Stereotactic Body Radiation Therapy for the Treatment of Painful Bone Metastases, the CROME Trial
|
N/A | |
Recruiting |
NCT05168618 -
Cabozantinib and Atezolizumab for the Treatment of Metastatic Castration-Resistant Prostate Cancer, The AtezoCab Trial
|
Phase 2 |