PROstate Cancer TReatment Optimization Via Analysis of Circulating Tumour DNA

  • Recruiting
  • Treatment
  • Interventional
  • Randomized
  • Drug
  • PHASE2
  • British Columbia Cancer Agency
  • 18 Years -


Study Purpose

The purpose of this study is to assess the strategy in treatment selection using ctDNA fraction as a predictive biomarker to direct treatment decision (ctDNA fraction \<2% receives enzalutamide, and ctDNA fraction ≥2% receives docetaxel) versus clinician's choice of enzalutamide or docetaxel, in subjects with metastatic castration-resistant prostate cancer post abiraterone setting.

Intervention

Drug : Enzalutamide

Drug : Docetaxel


Eligibility Requirements

info icon Patients must meet ALL of the following criteria:

info icon Willing and able to provide informed consent

info icon Adult males ≥ 18 years age

info icon History of histologically confirmed adenocarcinoma of the prostate without evidence of neuroendocrine or small cell differentiation. If histology is not available, patients must have metastatic disease typical of prostate cancer (i.e., involving bone or pelvic lymph nodes or para-aortic lymph nodes) AND a serum concentration of PSA that is rising and \>20ng/mL at the time prostate cancer was diagnosed clinically

info icon Consent to analysis of archival tissue collected at diagnosis is mandatory

info icon Prior surgical orchiectomy or if on LHRH agonist/antagonist then testosterone \< 1.7 nmol/L at screening visit (patients must maintain LHRH agonist/antagonist therapy for duration of study treatment if not surgically castrated)

info icon Evidence of metastatic disease on bone scan or CT scan

info icon Evidence of biochemical or imaging progression in the setting of surgical or medical castration while on abiraterone. Progressive disease for study entry is defined by one of the following three criteria as per PCWG317: 1. PSA progression: minimum of two rising PSA values from a baseline measurement of one week interval. Minimum PSA at screening visit is 1.0 ng/mL 2. Soft tissue or visceral disease progression: an increase ≥20% in the sum of the diameter (short axis for nodal lesions and long axis for non-nodal lesions) from the smallest sum of the diameter since treatment started, or appearance of any new lesions (see Appendix B for definition of measurable disease as per RECIST 1.1 criteria). 3. Bone progression: ≥ 2 new lesions on bone scan confirmed on subsequent bone scan at least 8 weeks apart (2+2 rule as per PCWG317)

info icon ECOG performance status 0-2 (see Appendix C)

info icon Prior treatment with abiraterone, in either castration-sensitive or castration-resistant setting.

info icon Eligible for treatment with either enzalutamide or docetaxel as per standard of care guidelines

info icon Adequate organ function defined as: 1. Absolute neutrophil count ≥ 1.5 x 109/L, platelet count ≥ 100 x 109/L and hemoglobin ≥ 90 g/L 2. Creatinine clearance ≥ 30 ml/min (calculated by Cockcroft-Gault formula, see Appendix D) 3. Total bilirubin ≤ 1.5 x upper limit of normal (ULN) except for patients with known Gilbert's syndrome (direct bilirubin ≤ 1.5 x ULN) 4. Alanine aminotransferase (ALT) ≤ 5 x ULN

info icon Able to swallow study drug and comply with study requirements including provision of peripheral blood samples at specified time points for correlative studies

info icon Recovery from all prior treatment-related toxicity to grade ≤ 2 (as per CTCAE 5.0)

info icon Patients must NOT meet any of the following criteria:

info icon Severe concurrent illness or co-morbid disease that would make the subject unsuitable for enrolment

info icon Prior therapy with enzalutamide or other experimental anti-androgens (e.g. ARN-509, TOK-001)

info icon Prior systemic chemotherapy with docetaxel or cabazitaxel (with the exception of: patients who were treated with docetaxel for castration sensitive disease and did not progress for at least 12 months after completion of docetaxel)

info icon Active concurrent malignancy (with the exception of non-melanomatous skin cancer, or other solid tumours curatively treated with no evidence of disease for ≥3 years)

info icon Wide-field radiotherapy or radioisotopes such as Strontium-89, or Radium-223 ≤ 28 days prior to starting study drug (limited-field palliative radiotherapy for up to 5 fractions prior to starting study drug is permitted)

info icon Brain metastases or active epidural disease (treated epidural disease is permitted)

info icon Contraindication to prednisone therapy including poorly controlled diabetes mellitus

info icon History of seizure or seizure disorder, or history of any cerebrovascular event within 6 months of study entry.

info icon Uncontrolled hypertension Grade ≥3 (i.e. systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mmHg)

info icon Gastrointestinal disorder affecting absorption

info icon Major surgery within 4 weeks of starting study treatment

Recruiting status

Recruiting

Estimated enrollment

100

 
Study start date

Oct 07, 2020

Study end date

Dec 01, 2025

Last updated

Mar 23, 2025

Primary purpose

Treatment

Design

Interventional

Intervention

Drug

Study phase

PHASE2

Allocation

Randomized

 

Sponsor:

British Columbia Cancer Agency

Collaborator:

N/A

Investigator:

Kim N Chi, MD

NCT04015622

Clinic Location Investigator Distance RECRUITING STATUS Contact