External Beam Radiation With or Without Chemotherapy to Treat High Risk Prostate Cancer

Phase 2

Terminated

Conditions: Prostate Cancer

Interventions: Drug: Luteinizing hormone-releasing hormone (LHRH)
Other: Conformal Radiation Therapy (RT)
Drug: Docetaxel

Registration Number: NCT01603420

Lead Sponsor: Proton Collaborative Group

Brief Summary: The purpose of this study is to compare the effects on prostate cancer using radiation therapy with or without chemotherapy.

Detailed Description: The recommended treatment for a high risk prostate cancer consists of a combination of radiation therapy and androgen suppression for 2-3 years. Recent studies have shown a survival advantage for chemotherapy for prostate cancer. Chemotherapy has already been successfully integrated in the treatment of other cancer types and is our belief that chemotherapy will prove to be beneficial for patients with high risk prostate cancer. However, a clinical study is necessary to compare the results good or bad of chemotherapy with radiation therapy.

Recruitment & Eligibility

Status: TERMINATED

Sex: Male

Target Recruitment: 2

Inclusion Criteria

Histologically confirmed prostate adenocarcinoma (within 365 days of randomization.
High-risk for recurrence as determined by evidence of at least one of the following: Gleason score 8-10, PSA > 20, T state T3.
Histological evaluation of prostate biopsy with assignment of a Gleason score to the biopsy material: Gleason score must be in the range 2-10. > 6 cores are strongly recommended.
Clinical stages T1a- T3 N0 M0 as staged by the treating investigator. (AJCC Criteria 7th Ed.-appendix III).
PSA values < = 50 ng/ml within 90 days prior to randomization. Must be completed prior to biopsy or at least 21 days after prostate biopsy.
Absolute Neutrophil Count (ANC) > = 1,800 cells/mm³ within 90 days prior to randomization.
Platelets > = 100,000 cells/mm³ within 90 days prior to randomization.
Hemoglobin > 10 g/dl within 90 days prior to randomization.
ALT, AST, and total bilirubin within 1.5 X institutional upper normal limits within 90 days prior to randomization.
ECOG status 0-1 (appendix II) documented within 90 days of randomization.
Patient must sign study specific informed consent prior to randomization. Note: consent for legally authorized representative is not permitted.
Completed all requirements listed in section 4.0 within the specified time frames.
Able to start treatment within 56 days of randomization.
At least 18 years old and less than or equal to 75 years of age.
Men of child-producing potential must be willing to consent to use effective contraception while on treatment and for at least 3 months afterwards.
Medical oncology consultation prior to randomization and medically approved for chemotherapy treatment per protocol.

Exclusion Criteria

Evidence of distant metastasis.
Pelvic lymph nodes > 1.5 cm in greatest dimension unless the enlarged lymph node is biopsied and negative.
Prior prostate cancer surgery including but not limited to prostatectomy, hyperthermia and cryosurgery.
Prior pelvic radiation for their prostate cancer.
Prior androgen deprivation.
Severe, active co-morbidity, defined as follows:
Active rectal diverticulitis, Crohn's disease affecting the rectum or ulcerative colitis. (Non-active diverticulitis and Crohn's disease not affecting the rectum are allowed).
Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months.
Myocardial infarction within the last 6 months.
Acute bacterial or fungal infection requiring intravenous antibiotics at the time of randomization.
Acquired Immune Deficiency Syndrome (AIDS) based upon current CDC definition; note, however, that HIV testing is not required for entry into this protocol. The need to exclude patients with AIDS from this protocol is necessary because the treatments involved in this protocol may be significantly immunosuppressive.
Prior allergic reaction to the drugs involved in this protocol.
Existing peripheral neuropathy > = grade 2.
Prior systemic chemotherapy for prostate cancer.
History of proximal urethral stricture requiring dilatation.
Major medical, addictive or psychiatric illness which in the investigator's opinion, will prevent the consent process, completion of the treatment and/or interfere with follow-up.
Evidence of any other cancer within the past 5 years and < 50% probability of a 5 year survival. (Prior or concurrent diagnosis of basal cell or non-invasive squamous cell cancer of the skin is allowed.)

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Radiation + 24mo luteinizing hormone-releasing hormone (LHRH)	Luteinizing hormone-releasing hormone (LHRH)	Conformal RT 79.2 Gy(RBE) total dose + 24 months LHRH agonist (androgen suppression).
Radiation + 24mo luteinizing hormone-releasing hormone (LHRH)	Conformal Radiation Therapy (RT)	Conformal RT 79.2 Gy(RBE) total dose + 24 months LHRH agonist (androgen suppression).
Radiation + Chemo + 6mo luteinizing hormone-releasing hormone	Luteinizing hormone-releasing hormone (LHRH)	Conformal RT 79.2 Gy(RBE) total dose + Chemotherapy: Docetaxel 20mg/m2 x every 7 days x 8 weeks followed by 6 months LHRH (androgen suppression).
Radiation + Chemo + 6mo luteinizing hormone-releasing hormone	Conformal Radiation Therapy (RT)	Conformal RT 79.2 Gy(RBE) total dose + Chemotherapy: Docetaxel 20mg/m2 x every 7 days x 8 weeks followed by 6 months LHRH (androgen suppression).
Radiation + Chemo + 6mo luteinizing hormone-releasing hormone	Docetaxel	Conformal RT 79.2 Gy(RBE) total dose + Chemotherapy: Docetaxel 20mg/m2 x every 7 days x 8 weeks followed by 6 months LHRH (androgen suppression).

Primary Outcome Measures

Name	Time	Method
Phase 2 - Assessment of Number of Freedom From Failure Events in the Chemotherapy Arm	No failures were reported at the time of study termination (22 months). This outcome was originally written to assess failure at 2 years. However, that end point was not reached.	Measurement of Freedom from Failure i.e. the first occurence of clinical failure (local recurrence, regional recurrence, or distant metastasis), biochemical failure by the Phoenix definition (Prostate Specific Antigen \[PSA\] \> = 2 ng/ml over the nadir PSA discounting bounces per the investigators discretion), or the start of salvage therapy including androgen deprivation. This study was terminated prior to the time frame of 2 years being reached. Therefore, this outcome was assessed at time of study closure (22 months).
Phase 2 - Assessment of Number of Freedom From Failure Event Comparing Chemotherapy Arm to Standard Treatment Arm	at 5 years	This endpoint will be examined if decision is made to not move forward with phase 3 study. This study was terminated prior to a decision being made about moving on to a phase 3 study. Therefore, this outcome was not assessed.
Phase 2 - Cumulative Number of Incidences of Grade 3 or Higher Adverse Events.	2 years	Assessment will be performed using CTCAE v4 criteria. This study was terminated prior to the time frame of 2 years being reached. Therefore, this outcome was assessed at time of study closure (22 months).
Phase 3 - Assessment of the Number of Freedom From Failure (FFF) Events Comparing the Chemotherapy Arm to the Standard Treatment Arm.	at 5 years	The events for FFF will be the first occurence of clinical failure (local recurrence, regional recurrence, or distant metastasis), biochemical failure by the Phoenix definition (PSA \> = ng/ml over the nadir PSA discounting bounces per the investigators discretion), or the start of salvage androgen deprivation. This study was terminated prior to a decision being made about moving on to a phase 3 study. Therefore, this outcome was not assessed.

Secondary Outcome Measures

Name	Time	Method
Assessment of Total Number of Salvage Androgen Deprivation Use With Comparison of Arms.	At study closure (22 months)	The total number of subjects with salvage androgen deprivation use will be assessed.
Assessment of Total Number of Survival Events With Comparison of Group Arms	at study closure (22 months)	The number of deaths in both arms will be assessed.
Assessment of Total Number of Biochemical Failure Events	at study closure (22 months)	The number of biochemical failure events will be assessed on both arms.
Assessment of Number of Grade 2 or Higher Genitourinary (GU) and Gastrointestinal (GI) Adverse Events	at 6 months	Assessment will be performed using CTCAE v 4 criteria.
Assessment of Impotence by Summation of Relative Scores for Sexual Function From the EPIC Quality of Life Instrument.	Up to 10 years	unable to assess due to lack of data
Assessment of Number of GI and GU Adverse Events	at 3 years	Descriptive measurements of frequency will be compiled. This study was terminated prior to the time frame of 3 years being reached. Therefore, this outcome was not assessed. Data were collected on toxicities up until study closure at 22 months. However, this timepoint was not indicated as a secondary objective in the protocol. Therefore, data was not analyzed at time of study closure.
Assessment of Total Number of Local/Distant Failures	at time of study closure (22 months)	The total number of local/distant failures will be assessed.
Assessment of Quality of Life - Summation of Relative Scores From the EPIC Instrument.	Up to 10 years	unable to assess due to lack of data

Trial Locations

Locations (3): Hampton University Proton Therapy Institute
🇺🇸
Hampton, Virginia, United States
CDH Proton Center
🇺🇸
Warrenville, Illinois, United States
Procure Proton Therapy Center
🇺🇸
Oklahoma City, Oklahoma, United States