A Prospective, Randomized Trial Comparing Metformin Plus Androgen Deprivation Therapy (ADT) and Abiraterone With ADT Plus Abiraterone in Metastatic Castration-resistant Prostate Cancer
试验速览
- 阶段
- 2 期
- 状态
- 尚未招募
- 发起方
- 入组人数
- 234
- 试验地点
- 1
- 主要终点
- Progression-free survival defined from randomization to time till biochemical progression or radiographic progression
研究概览
简要总结
The purpose of this study is to assess the effect of the addition of metformin to abiraterone on survival in patients with metastatic castration-resistant prostate cancer (mCRPC). The half the patients will receive metformin in combination with androgen deprivation therapy (ADT) and abiraterone, and the other half will receive ADT and abiraterone only.
详细描述
Metastatic castration-resistant prostate cancer (mCRPC) can be treated with ADT plus abiraterone, ADT plus enzalutamide, ADT plus cabazitaxel, ADT plus docetaxel, ADT plus olaparib. However, patients have short overall survival after progression to CRPC, although multiple options are available for mCRPC. Therefore, there is still a need to improve the therapeutic effect for mCRPC.
Many studies have shown that metabolic syndrome and its components are associated with increased development and progression of aggressive prostate cancer. Metformin, a common well-tolerated oral biguanide prescribed for type II diabetes, could be used to decrease the risk of prostate cancer development and improve the efficacy of treatment. Some studies reported that metformin could enhance the effectiveness of ADT, and improve recurrence-free survival, overall survival and cancer-specific survival. A prospective randomized study reported that metformin potentially lengthen time to CRPC in advanced prostate cancer patients when combined with ADT especially in those with high risk localized prostate cancer, clinically node positive and in those with low tumor volume metastatic hormone-sensitive patients.
After extensive research, there is no published results from prospective randomized trials evaluating the effect of metformin in combination with ADT and abiraterone among patients with mCRPC.
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
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- Male
- 接受健康志愿者
- 否
入选标准
- •Histologically confirmed and newly diagnosed metastatic hormone-sensitive adenocarcinoma of the prostate without small cell carcinoma or small cell components.
- •Metastatic adenocarcinoma of the prostate proved by imaging (CT/MRI and/or bone scan).
- •Patients must meet the criteria of CRPC.
- •No prior treatment with chemotherapy and new-generation hormonal therapy including abiraterone, enzalutamide, apalutamide.
- •Patient must give written informed consent before registration and prior to any trial related investigations.
- •Age ≥18 years.
- •Serum potassium ≥3.5mmol/ L.
- •ECOG performance status 0-2
- •Ongoing androgen deprivation therapy with drugs or bilateral orchiectomy, and continuous abiraterone plus prednisone.
- •Patient agrees not to father a child during participation in the trial and during 3 months thereafter.
- •Patient agrees not to participate other interventional trials.
- •Patients are able to swallow study drug as whole tablet.
排除标准
- •Diagnosed diabetes or fasting blood-glucose ≥ 6.1mmol/L, or glycosylated hemoglobin ≥ 5.6%.
- •Previous malignancy within 2 years prior to randomization, with the exception of localized non-melanoma skin cancer and Ta bladder cancer.
- •Major surgery within 4 weeks prior to randomization.
- •Treatments with 5a-reductase inhibitors, estrogen, cyproterone acetate, and androgen within 4 weeks prior to randomization.
- •Known or suspected Central nervous system CNS metastases or active leptomeningeal disease.
- •Equivalent dosage of >10mg/day prednisone of glucocorticoids for the treatment of prostate cancer within 4 weeks prior to randomization, or treatment with glucocorticoids for other reasons.
- •Prior treatment for prostate cancer with flutamide, bicalutamide, ketoconazole, abiraterone, enzalutamide, apalutamide, docetaxel chemotherapy, or other interventional drugs for prostate cancer.
- •Neutrophils < 1.5 x 109/L, platelets < 75 x 109/L, hemoglobin < 100 g/L.
- •ALT and AST ≥ 2.5 x ULN, bilirubin ≥ 1.5 x ULN.
- •eGFR<45 ml/min/1.73m
- •Allergic to metformin or any ingredients of this tablet.
- •Acute or chronic metabolic acidosis, including diabetic ketoacidosis. Albumin< 30 g/L.
- •Clinically significant cardiovascular disease including:
- •Myocardial infarction within 6 months prior to randomization.
- •Uncontrolled angina within 3 months prior to registration.
- •Congestive heart failure NYHA class III or IV.
- •History of clinically significant ventricular arrhythmias (e.g. ventricular tachycardia, ventricular fibrillation, torsades de pointes).
- •History of Mobitz II second or third degree heart block without a permanent pacemaker in place.
- •Systolic pressure< 86 mmHg.
- •Bradycardia, heart rate<45/min.
- •Uncontrolled hypertension as indicated by systolic blood pressure > 170 mmHg OR diastolic blood pressure > 105 mmHg.
- •Prior treatment with metformin after diagnosis of prostate cancer.
- •Allergic to metformin or any drugs used in this trial.
- •Serious underlying medical condition (at the judgment of the investigator) which could impair the ability of the patient to participate in the trial (e.g. uncontrolled or acute severe infection, uncontrolled diabetes).
- •Active or symptomatic viral hepatitis or chronic liver disease. History of pituitary or adrenal dysfunction.
- •Gastrointestinal disorder affecting absorption.
研究组 & 干预措施
Metformin+ADT+abiraterone
Patients in this arm will be treatet with metformin plus ADT and abiraterone
干预措施: Metformin (Drug)
结局指标
主要结局
Progression-free survival defined from randomization to time till biochemical progression or radiographic progression
时间窗: start of treatment to disease progression, up to 36 months
次要结局
- Radiographic progression-free survival defined from randomization until radiographic progression(start of treatment to radiographic progression, up to 36 months)
- Adverse events which will be assessed according to NCI-CTC AE 5.0(start of treatment to study completion, up to 36 months)
- Overall survival defined from randomization until death due to any reason(start of treatment to death, up to 36 months)
研究者
Yonghong Li
Prinicipal Investigator
Sun Yat-sen University