An Open-label, Multi-center, Randomized, Phase II Study Evaluating [177Lu]Lu-PSMA-617 vs. a Change of Androgen Receptor-directed Therapy in the Treatment of Taxane Naive Chinese Male Patients With Progressive Metastatic Castrate Resistant Prostate Cancer
试验速览
- 阶段
- 2 期
- 状态
- 进行中（未招募）
- 入组人数
- 63
- 试验地点
- 16
- 主要终点
- Radiographic progression free survival (rPFS)
研究概览
简要总结
The purpose of this study is to evaluate the efficacy of [177Lu]Lu-PSMA-617 over a change of androgen receptor-directed therapy (ARDT) treatment in prolonging radiographic progression free survival (rPFS) in Chinese metastatic castration-resistant prostate cancer patients, who were previously treated with another ARDT as last treatment and who have not been exposed to a taxane-containing regimen in castrate resistant prostate cancer (CRPC) or hormone-sensitive prostate cancer (HSPC) settings and who are considered appropriate for delaying taxane-based chemotherapy. The primary endpoint of rPFS will be assessed via blinded independent centralized review of radiographic images provided by the treating physician and as outlined in Prostate Cancer Working Group 3 (PCWG3) guidelines.
详细描述
The study contains a screening period to assess the eligibility of participants, only participants fulfilling the [68Ga]Ga-PSMA-11 PET scan interpretation criteria for eligibility and meeting all other inclusion/exclusion criteria will be enrolled. In the randomization period, approximately 60 participants will be randomized 1:1 to receive [177Lu]Lu-PSMA-617 treatment or a change of approved ARDT treatment. Randomization will be stratified by symptomatology i.e., Asymptomatic or mildly symptomatic vs. symptomatic.
Participants randomized to [177Lu]Lu-PSMA-617 treatment group will receive 7.4 GBq (200 mCi) ± 10% [177Lu]Lu-PSMA-617 once every 6 weeks (± 1 week) for 6 cycles. For participants randomized to the androgen receptor-directed therapy (ARDT) treatment arm, the change of ARDT treatment for each participant will be selected by the treating physician prior to randomization and will be administered per the physician's orders. Supportive care will be allowed in both arms at the discretion of the investigator. ARDT must not be administrated concomitantly with [177Lu]Lu-PSMA-617.
Efficacy assessment will be performed every 8 weeks after first dose of study treatment for the first 24 weeks (week 9, 17, 25) and then every 12 weeks (week 37, 49, etc) until confirmation of radiographic progression by BICR. Participants randomized to ARDT arm will be allowed to crossover to [177Lu]Lu-PSMA-617 treatment if the crossover criteria are met.
Post-treatment follow up period will have a 30-day safety follow up post end of treatment (EOT) visit and long-term survival follow up.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 100 Years（Adult, Older Adult）
- 性别
- Male
- 接受健康志愿者
- 否
入选标准
- •Participants must be Chinese adult men >= 18 years of age
- •Participants must have an ECOG performance status of 0 to 1
- •Participant must have histological pathological and/or cytological confirmation of adenocarcinoma of the prostate
- •Participants must be [68Ga]Ga-PSMA-11 PET/CT scan positive, and eligible as determined by the sponsor's central reader
- •Participants must have a castrate level of serum/plasma testosterone (< 50 ng/dl, or < 1.7 nmol/L)
- •Participants must have progressed only once on prior second generation ARDT (abiraterone, enzalutamide, darolutamide, or apalutamide)) in either HSPC or CRPC setting.
- •first generation androgen receptor inhibitor therapy (e.g. bicalutamide) is allowed but not considered as prior ARDT therapy
- •second generation ARDT must be the most recent therapy received
- •candidates for change in ARDT (eligible to receive abiraterone or enzalutamide) as assessed by the treating physician
- •Participants cannot have previously progressed nor had intolerable toxicity to both enzalutamide and abiraterone
- •Documented progressive mCRPC, based on at least 1 of the following criteria:
- •Serum/plasma PSA progression defined as 2 consecutive increases in PSA measured at least 1 week apart. the minimal start value is 2.0 ng/ml;
- •Soft-tissue progression defined based on PCWG3-modified RECIST v1.1(Eisenhauer et al 2009, Scher et al 2016)
- •Progression of bone disease: two new lesions; only positivity on the bone scan defines metastatic disease to bone (PCWG3 criteria Scher et al 2016)
- •Participants must have at least one metastatic lesion that is present on screening/baseline CT, MRI, or bone scan imaging obtained =< 28 days prior to randomization
- •Participants must have adequate organ function:
- •Bone marrow reserve:
- •ANC >= 1.5 x 109/L
- •Platelets >= 100 x 109/L
- •Hemoglobin >= 9 g/dL
- •Total bilirubin < 2 x the institutional upper limit of normal (ULN). For participants with known Gilbert's Syndrome =< 3 x ULN is permitted
- •ALT or AST =< 3.0 x ULN OR =< 5.0 x ULN for participants with liver metastases
- •Albumin >= 2.5 g/dL
- •eGFR >= 50 mL/min/1.73m2 using the Modification of Diet in Renal Disease (MDRD) equation
排除标准
- •Previous treatment with any of the following within 6 months of randomization: Strontium-89, Samarium-153, Rhenium-186, Rhenium-188, Radium-223, Lutitium-177, Actium-225, hemi-body irradiation
- •Previous PSMA-targeted radioligand therapy
- •Prior treatment with PARP inhibitor, cytotoxic chemotherapy for castration resistant or castration sensitive prostate cancer (i.e., taxanes, platinum, estramustine, vincristine, methotrexate, etc.), immunotherapy or biological therapy (including monoclonal antibodies). [Note: a maximum of 6 cycles of taxane exposure in the adjuvant or neo-adjuvant setting is allowed if 12 months have elapsed since completion of this adjuvant or neo-adjuvant therapy prior to randomization]
- •Concurrent cytotoxic chemotherapy, immunotherapy, radioligand therapy, PARP inhibitor, biological, or investigational therapy
- •Transfusion or use of bone marrow stimulating agents for the sole purpose of making a participant eligible for study inclusion
- •Participants with a history of CNS metastases who are neurologically unstable, symptomatic, or receiving corticosteroids for the purpose of maintaining neurologic integrity.
- •Participants with CNS metastases are eligible if received therapy (surgery, radiotherapy, gamma knife), asymptomatic and neurologically stable without corticosteroids.
- •Participants with epidural disease, canal disease and prior cord involvement are eligible if those areas have been treated, are stable, and not neurologically impaired.
- •Symptomatic cord compression, or clinical or radiologic findings indicative of impending cord compression
- •Cardiac or cardiac repolarization abnormality, including any of the following:
- •History of myocardial infarction (MI), angina pectoris, or coronary artery bypass graft (CABG) within 6 months prior to starting study treatment
- •Clinically significant cardiac arrhythmias (e.g., ventricular tachycardia), complete left bundle branch block, high-grade AV block (e.g., bifascicular block, Mobitz type II and third degree AV block) and QTc>=
- •Concurrent serious (as determined by the Principal Investigator) medical conditions, including, but not limited to New York Heart Association class III or IV congestive heart failure, history of congenital prolonged QT syndrome, uncontrolled infection, known active hepatitis B or C or other significant co-morbid conditions that in the opinion of the investigator would impair study participation or cooperation
- •Unmanageable concurrent bladder outflow obstruction or urinary incontinence. Note: Participants with bladder outflow obstruction or urinary incontinence, which is manageable and controlled with best available standard of care (incl. pads, drainage) are allowed.
研究组 & 干预措施
Androgen receptor-directed therapy (ARDT)
For participants randomized to the ARDT arm, the change of ARDT treatment will be administered per the physician's orders. Best supportive care, including ADT may be used.
干预措施: Best supportive care (Other)
[177Lu]Lu-PSMA-617
Participants will receive 7.4 GBq (200 mCi) +/- 10% [177Lu]Lu-PSMA-617 once every 6 weeks for 6 cycles. Best supportive care, including ADT may be used.
干预措施: [177Lu]Lu-PSMA-617 (Drug)
[177Lu]Lu-PSMA-617
Participants will receive 7.4 GBq (200 mCi) +/- 10% [177Lu]Lu-PSMA-617 once every 6 weeks for 6 cycles. Best supportive care, including ADT may be used.
干预措施: [68Ga]Ga-PSMA-11 (Drug)
[177Lu]Lu-PSMA-617
Participants will receive 7.4 GBq (200 mCi) +/- 10% [177Lu]Lu-PSMA-617 once every 6 weeks for 6 cycles. Best supportive care, including ADT may be used.
干预措施: Best supportive care (Other)
Androgen receptor-directed therapy (ARDT)
For participants randomized to the ARDT arm, the change of ARDT treatment will be administered per the physician's orders. Best supportive care, including ADT may be used.
干预措施: ARDT (Drug)
Androgen receptor-directed therapy (ARDT)
For participants randomized to the ARDT arm, the change of ARDT treatment will be administered per the physician's orders. Best supportive care, including ADT may be used.
干预措施: [68Ga]Ga-PSMA-11 (Drug)
结局指标
主要结局
Radiographic progression free survival (rPFS)
时间窗: From date of randomization until date of radiographic progression or date of death from any cause, whichever comes first, assessed up to 47 months (estimated final analysis)
Radiographic progression free survival (rPFS) is defined as the time of radiographic progression by Prostate Cancer Working Group 3 (PCWG3)-modified RECIST V1.1 as assessed by blinded independent central review, or death.
次要结局
- Prostate-specific antigen 50 response rate(Week 12, Week 24, Week 48)
- Overall survival (OS)(From date of randomization until date of death from any cause, assessed up to 47 months (estimated final analysis))
- Progression Free Survival (PFS)(From date of randomization until date of progression or date of death from any cause, whichever comes first, assessed up to 47 months (estimated final analysis))
- Time to a first symptomatic skeletal event (TTSSE)(From date of randomization till date of death from any cause, whichever happens first, assessed up to 47 months (estimated final analysis))
- Time to Prostate Specific Antigen (PSA) progression(From date of randomization till date of Prostate Specific Antigen (PSA) progression, assessed up to 47 months (estimated analysis))
- Time to chemotherapy (TTCT)(From date of randomization until date of subsequent chemotherapy or date of death from any cause, whichever comes first, assessed up to 47 months (estimated final analysis))
- Overall response rate (ORR)(From date of randomization till 30 day safety follow-up or end of long term FU for patients prematurely discontinued, assessed up to 47 months (estimated final analysis))
- Disease control rate (DCR)(From date of randomization till 30 day safety follow-up or end of long term FU for patients prematurely discontinued, assessed up to 47 months (estimated final analysis))
- Time to response (TTR)(From date of randomization till 30 day safety follow-up or end of long term FU for patients prematurely discontinued, assessed up to 47 months (estimated final analysis))
- Number of Participants with Treatment Emergent Adverse Events(From date of randomization till 30 days safety fup, assessed up to 47 months (estimated final analysis))
- Duration of response (DOR)(From date of randomization until date of progression or date of death from any cause, whichever come first, assessed up to 47 months (estimated final analysis))
- Time to soft tissue progression (TTSTP)(From date of randomization until date of soft tissue radiographic progression or date of death from any cause, whichever comes first, assessed up to 47 months (estimated final analysis))
- European Quality of Life (EuroQol) - 5 Domain 5 Level scale (EQ-5D- 5L)(From randomization up till 30 day safety follow-up or at LTFU2 (168 days after EOT) and LTFU4 (336 days after EOT) of long term FU for patients prematurely discontinued, assessed up to 47 months (estimated final analysis))
- Functional Assessment of Cancer Therapy - Prostate (FACT-P) Questionnaire(From randomization up till 30 day safety follow-up or at LTFU2 (168 days after EOT) and LTFU4 (336 days after EOT) of long term FU for patients prematurely discontinued, assessed up to 47 months (estimated final analysis))
- Brief Pain Inventory - Short Form (BPI-SF) Questionnaire(From randomization up till 30 day safety follow-up or at LTFU2 (168 days after EOT) and LTFU4 (336 days after EOT) of long term FU for patients prematurely discontinued, assessed up to 47 months (estimated final analysis))