A Phase II Randomized Trial of RAdium-223 and SABR Versus SABR for oligomEtastatic Prostate caNcerS (RAVENS)
Overview
- Phase
- Phase 2
- Intervention
- Radium-223
- Conditions
- Prostate Cancer
- Sponsor
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
- Enrollment
- 64
- Locations
- 1
- Primary Endpoint
- Progression-free Survival
- Status
- Completed
- Last Updated
- 4 months ago
Overview
Brief Summary
This is a Phase II non-blinded randomized study evaluating men with oligometastatic prostate cancer lesions randomized (1:1) to stereotactic ablative radiation therapy (SABR) versus SBAR + Radium-223. We are looking to determine the progression-free survival of men who have oligometastatic prostate cancer with at least one bone metastasis with stereotactic ablative radiation therapy (SABR) versus SABR + Radium-223.
Detailed Description
The metastatic capacity of prostate cancer (PCa) behaves along a spectrum of disease that contains an oligometastatic state where metastases are limited in number and location. The importance of local consolidation of all tumor deposits in oligometastatic disease to forestall further metastatic dissemination is now backed by small randomized studies. Our previous Baltimore ORIOLE randomized trial of stereotactic ablative radiation (SABR) alone, highly focused, high-dose radiation, versus observation in oligometastatic PCa final data demonstrate a progression-free survival (PFS) benefit of SABR alone. The patterns of failure from our ORIOLE trial in combination with prior data suggest one dominant mode of failure is from microscopic disease particularly those with bone-tropic biology. These are important early clinical data suggesting the existence of an oligometastatic state and the importance of local therapies in the management of these patients. Radiopharmaceutical therapy (RPT) approaches have not been applied in the oligometastatic space and thus the opportunity to target micrometastatic disease in conjunction with local consolidation of macroscopic disease with SABR has the potential to provide a curative paradigm for patients with oligometastatic PCa. We introduce the successor trial to ORIOLE called RAVENS that is a phase II randomized trial of SABR +/- the bone metastasis seeking RPT Xofigo in men with oligometastatic PCa. We hypothesize macroscopic prostate tumors support the growth of and help nurture future distant metastases and this process can be impacted most by total, macro- and microscopic, tumor consolidation. In addition, we hypothesize that circulating biomarkers can identify men with oligometastasis that benefit the most from SABR and RPT.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Patient must have at least one and up to three asymptomatic metastatic tumor(s) of the bone or soft tissue (with at least one bone metastasis) develop within the past 6-months that are ≤ 5.0 cm or \<250 cm3
- •Patient must have had their primary tumor treated with surgery and/or radiation.
- •Histologic confirmation of malignancy (primary or metastatic tumor).
- •PSADT \<15 months. PSA doubling time (PSADT) will be calculated using as many PSA values that are available from time of relapse (PSA \> 0.2). To calculate PSADT, the Memorial Sloan Kettering Cancer Center Prostate Cancer Prediction Tool will be used. It can be found at the following web site: https://www.mskcc.org/nomograms/prostate/psa-doubling-time.
- •Patient may have had prior systemic therapy and/or ADT associated with treatment of their primary prostate cancer. Patient may have had ADT associated with salvage radiation therapy (to the primary prostate cancer or pelvis is allowed).
- •PSA \> 0.5 but \<
- •Testosterone \> 125 ng/dL.
- •Patient must be ≥ 18 years of age.
- •Patient must have a life expectancy ≥ 12 months.
- •Patient must have an ECOG performance status ≤
Exclusion Criteria
- •No more than 3 years of ADT is allowed, with the most recent ADT treatment having occurred greater than 6 months prior to enrollment.
- •PSMA-PET/MRI or PSMA-PET/CT scan within the past 6 months with results that demonstrate more disease lesions than baseline CT/Bone Scan
- •Castration-resistant prostate cancer (CRPC).
- •Spinal cord compression or impending spinal cord compression.
- •Suspected pulmonary and/or liver metastases (greater \>10 mm in largest axis).
- •Patient receiving any other investigational agents.
- •Patient receiving abiraterone and prednisone.
- •Patient is participating in a concurrent treatment protocol.
- •Serum creatinine \> 3 times the upper limit of normal.
- •Total bilirubin \> 3 times the upper limit of normal.
Arms & Interventions
Radium-223 and SABR
First radium-223 infusion will be within two weeks of SABR
Intervention: Radium-223
Radium-223 and SABR
First radium-223 infusion will be within two weeks of SABR
Intervention: stereotactic ablative radiotherapy (SABR)
SABR
SABR(1-5 fractions) will be administered for all men
Intervention: stereotactic ablative radiotherapy (SABR)
Outcomes
Primary Outcomes
Progression-free Survival
Time Frame: Up to 24 months
Time to progression in men who have oligometastatic prostate cancer after therapy. Progression is defined by PCWG2 criteria as follows: \>=25% increase in PSA from nadir (and by \>=2ng/mL), and/or clinical/radiographic progression (clinical progression = symptomatic progression, worsening of disease-related symptoms or new cancer-related complications; radiographic progression on CT scan defined by RECIST 1.1 criteria: \>=20% enlargement in sum diameter of soft-tissue target lesions; or on bone scan \>=1 new bone lesions), initiation of ADT or death due to any cause, whichever occurs first.
Secondary Outcomes
- Toxicity as Assessed by Number of Participants Who Experience Adverse Events Grade 3 or Greater (CTCAE v4.0)(Up to 24 months)
- Rate of Local Control at 12 Months(Up to 12 months)
- Time to Locoregional Progression(12 months)
- Time to Distant Progression(Up to 24 months)
- Metastasis-Free Survival(Up to 24 months)
- Androgen-deprivation Therapy (ADT)-Free Survival(Up to 24 months)
- Quality of Life as Assessed by Pain Severity and Pain Interference Score With Imputations Using the Brief Pain Inventory(Baseline, Day 360)
- Change in Quality of Life as Assessed by Pain Severity and Pain Interference With Imputations Using the Brief Pain Inventory(Baseline, Day 360)
- Time to New Metastatsis(12 months)
- Duration of Response(12 Months)