- 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
Patients must meet ALL of the following criteria:
Willing and able to provide informed consent
Adult males ≥ 18 years age
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
Consent to analysis of archival tissue collected at diagnosis is mandatory
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)
Evidence of metastatic disease on bone scan or CT scan
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)
ECOG performance status 0-2 (see Appendix C)
Prior treatment with abiraterone, in either castration-sensitive or castration-resistant setting.
Eligible for treatment with either enzalutamide or docetaxel as per standard of care guidelines
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
Able to swallow study drug and comply with study requirements including provision of peripheral blood samples at specified time points for correlative studies
Recovery from all prior treatment-related toxicity to grade ≤ 2 (as per CTCAE 5.0)
Patients must NOT meet any of the following criteria:
Severe concurrent illness or co-morbid disease that would make the subject unsuitable for enrolment
Prior therapy with enzalutamide or other experimental anti-androgens (e.g. ARN-509, TOK-001)
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)
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)
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)
Brain metastases or active epidural disease (treated epidural disease is permitted)
Contraindication to prednisone therapy including poorly controlled diabetes mellitus
History of seizure or seizure disorder, or history of any cerebrovascular event within 6 months of study entry.
Uncontrolled hypertension Grade ≥3 (i.e. systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mmHg)
Gastrointestinal disorder affecting absorption
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
Publications
Khalaf D, Annala M, Finch DL, et al. Phase 2 randomized cross-over trial of abiraterone + prednisone (ABI+P) vs enzalutamide (ENZ) for patients (pts) with metastatic castration resistant prostate cancer (mCPRC): Results for 2nd-line therapy. J Clin Oncol [Internet] 2018;36(15_suppl):5015.
Websites
N/A
NCT04015622
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