Study with apalutamide in patients with prostate cancer in whom the prostate has been removed who are at high risk of disease recurrence

Phase 2

Recruiting

• Conditions: High risk adenocarcinoma of the prostate after radical prostatectomy (RPE)

• Registration Number: 2024-511832-29-00
• Lead Sponsor: Universitaet Muenster

Brief Summary

To determine if adjuvant apalutamide in prostate cancer patients at high risk of developing subsequent metastatic disease results in prolonged biochemically recurrence-free survival after radical prostatectomy (RPE)

in comparison to standard of care (SOC).

Detailed Description

Not available

Study Timeline

• Study First Posted: 2024-09-20
• Last Update Posted: 2025-03-26

Recruitment & Eligibility

• Status: Ongoing, recruiting
• Sex: Male
• Target Recruitment: 190

Inclusion Criteria

Signed informed consent form (ICF)

Ability to swallow study medication tablets

In case of apalutamide treatment: Agrees to use a condom and another highly effective method of birth control if he is having sex with a woman of childbearing potential or to use a condom if he is having sex with a woman who is pregnant

Men ≥ 18 years of age

Patients with histologically confirmed adenocarcinoma of the prostate after radical prostatectomy

Eastern Cooperative Oncology Group (ECOG) performance status grade of 0 or 1

Exclusion of metastatic disease by CT-scan of abdomen (MRI of abdomen is possible) and bone scan prior to study inclusion. A PSMA PET-CT/MRI is possible. In this case it has to be done with a diagnostic CT/MRI with contrast media and not with a low dose CT-scan only. In case PSMA-PET imaging has been done, a bone scan can be omitted. CT/MRI, and bone-scan imaging or PSMA PET-CT/MRI administered ≤12 weeks before RPE may be used for screening

Patients after RPE must meet the d'Amico criteria for high risk of disease recurrence (T-stage and Gleason-score determined after radical prostatectomy) i.e. 1 of the following after RPE: 1) Gleason score ≥8, any T-stage, any iPSA or 2) Gleason score 6 or 7, any iPSA and ≥pT3 or 3) iPSA >20 ng/ml, any Gleason score, any T-stage.

Patients have to have recovered from radical prostatectomy within eight weeks to be able to take part in the study

PSA must have declined below 0.2 ng/ml prior to randomization

Adequate hematologic, hepatic, and renal function: • Hematologic i) Haemoglobin ≥ 9.0 g/dL independent of transfusions ii) Neutrophils ≥ 1.5 Ths./μL • Hepatic i) Total Bilirubin =< 1.5X upper limit of normal (ULN) [except for subjects with documented Gilbert's disease in which case total bilirubin not to exceed 10X ULN] ii) Alanine (ALT) and aspartate (AST) aminotransferase =< 2.5X ULN • Renal: i) Serum creatinine <1.5X ULN or calculated creatinine clearance ≥ 50 mL/min ii) Serum potassium ≥ 3.5 mM iii) Serum albumin ≥ 3.0 g/dL

Exclusion Criteria

Any chronic medical condition requiring a higher dose of corticosteroid than 10mg prednisone/prednisolone q.d.

Any lymph node or distant metastasis

History of seizures or condition that may predispose to seizure (including, but not limited to prior stroke, transient ischemic attack or loss of consciousness ≤1 year prior to randomization; brain arteriovenous malformation; or intracranial masses such as schwannomas and meningiomas that are causing edema or mass effect).

Current or prior treatment with anti-epileptic medications for the treatment of seizures

Management of cardiovascular risk factors, such as hypertension, diabetes or dyslipidaemia should be optimised as per standard of care before treatment with apalutamide will be initiated 13.1. Uncontrolled hypertension (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg. For patients with relevant comorbidities (e.g. diabetes) systolic BP ≥130 mmHg or diastolic BP ≥80 mmHg). Patients with a history of hypertension are allowed provided that blood pressure is controlled by anti-hypertensive treatment 13.2. Patients with uncontrolled diabetes defined as HbA1c ≥7.5% 13.3. Patients with a dyslipidemia defined as LDL cholesterol >100 mg/dl. For patients with a dyslipidemia defined as LDL cholesterol >100 mg/dl and SCORE-value of 1-5%: In case of a SCORE-value of <1% a LDL cholesterol level of up to 115 mg/dl is acceptable. In case of increased LDL cholesterol above these values a statin-therapy can be initiated and a rescreening within 4 weeks is possible 13.4. Cardiovascular risk assessment via an appropriate score (e.g. the SCORE-Chart for the European high/low risk score from the European Society of Cardiology) and ≥ borderline risk i.e. 10% of developing cardiovascular events within 10 years without prior cardiovascular disease

Active or symptomatic viral hepatitis or chronic liver disease or HIV

History of pituitary or adrenal dysfunction

Clinically significant heart disease as evidenced by myocardial infarction, or arterial thrombotic events in the past 12 months, severe or unstable angina, or New York Heart Association (NYHA) Class II-IV heart disease or cardiac ejection fraction measurement of <50% at baseline, or clinically relevant pelvic lymphocele after radical prostatectomy as evaluated by clinical examination and/or pelvic ultrasound (if a risk is present, patients may be allowed to be enrolled after adaptive risk management).

Any condition that requires treatment with digoxin, digitoxin, and other digitalis drugs

Long QT Syndrome

Atrial Fibrillation, or other cardiac arrhythmia requiring therapy

Prior cytotoxic chemotherapy or biologic therapy for the treatment of prostate cancer

Other malignancy with a ≥30% probability of recurrence within 24 months, except non-melanoma skin cancer

Any condition, which, in the opinion of the investigator, would preclude participation in this trial.

Gastrointestinal conditions affecting absorption

Hypersensitivity to the active substance, or to any of the excipients of the study medication

Any psychological, cognitive, familial, sociological or geographical condition that, in the investigator's opinion, compromises the patient's ability to understand the patient information, to give informed consent or to comply with the study protocol.

Participation in another interventional clinical trial during this trial or within 4 weeks before entry into this trial. There may be exceptions at the discretion of the (coordinating) investigator.

Prior or current treatment of prostate cancer with apalutamide, enzalutamide, darolutamide, or other investigational agents targeting the androgen receptor

Prior therapy with Sipuleucel-T or other vaccination or immunogenic therapy for the treatment of prostate cancer

Prior treatment with abiraterone acetate or other androgen synthesis inhibitors (e. g. ketoconazole, TAK700, TOK001)

Use of 5-α reductase inhibitors (eg, dutasteride, finasteride) ≤4 weeks prior to randomization

Prior surgical castration or medical castration using LHRH-Agonists or GnRH-Antagonists

Prior or current radiation or radionuclide (including radium-223 dichloride) therapy for treatment of prostate cancer (adjuvant radiation of the prostate bed without involvement of the regional lymph node template as by standard of care in case of positive surgical margins (R1) is allowed)

Prior or current systemic treatment with an azole drug (e.g. fluconazole, itraconazole) within 4 weeks of Cycle 1, Day 1

Study & Design

• Study Type: Interventional clinical trial of medicinal product
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Progression-free survival (PFS). This endpoint is defined as time interval from randomization until BCR, metastases, or death from any cause, whichever occurs first.		Progression-free survival (PFS). This endpoint is defined as time interval from randomization until BCR, metastases, or death from any cause, whichever occurs first.

Trial Locations

Locations (16)

Medizinische Universitaet Innsbruck; 🇦🇹 Innsbruck, Austria

Ordensklinikum Linz GmbH; 🇦🇹 Linz, Austria

Hanusch Krankenhaus Der Wiener Gebietskrankenkasse; 🇦🇹 Vienna, Austria

Otto Von Guericke Universitaet Magdeburg; 🇩🇪 Magdeburg, Germany

Universitaetsklinikum Schleswig-Holstein AöR; 🇩🇪 Luebeck, Germany

Goethe University Frankfurt; 🇩🇪 Frankfurt Am Main, Germany

Universitaetsklinikum Jena KöR; 🇩🇪 Jena, Germany

Universitaetsklinikum Augsburg; 🇩🇪 Augsburg, Germany

Universitaetsklinikum Regensburg AöR; 🇩🇪 Regensburg, Germany

Urologicum Duisburg; 🇩🇪 Duisburg, Germany

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Medizinische Universitaet Innsbruck

🇦🇹Innsbruck, Austria

Isabel Heidegger-Pircher

Site contact

+4351250424808

isabel.heidegger@tirol-kliniken.at