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Thalidomide for the Treatment of Hormone-Dependent Prostate Cancer
This study has been completed.

First Received on February 19, 2000.   Last Updated on January 20, 2011   History of Changes
Sponsor: National Cancer Institute (NCI)
Information provided by: National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier: NCT00004635
  Purpose

This multi-center study will evaluate whether thalidomide can improve the effectiveness of the drugs leuprolide or goserelin in treating testosterone-dependent prostate cancer. Leuprolide and goserelin-both approved to treat prostate cancer-reduce testosterone production, which, in most patients, reduces the size of the tumor. Thalidomide, a drug used for many years to treat leprosy, blocks the growth of blood vessels that may be important to disease progression.

Patients 18 years or older with testosterone-dependent prostate cancer that has persisted or recurred after having had surgery, radiation therapy, or cryosurgery, but whose disease has not metastasized (spread beyond the prostate) may be eligible for this study. Candidates are screened with a medical history and physical examination, including blood tests, bone and CT scans or other imaging studies.

Study participants are randomly assigned to one of two treatment groups. One group receives leuprolide or goserelin followed by thalidomide; the other receives leuprolide or goserelin followed by placebo (a look-alike pill with no active ingredients). Patients in both groups receive an injection of leuprolide or goserelin once a month for 6 months. After that time they take four capsules of either thalidomide or placebo once a day and remain on the drug until their prostate-specific antigen (PSA) level returns to what it was before beginning leuprolide or goserelin or to 5 nanograms per liter, whichever is lower. (PSA is a protein secreted by the prostate gland. Monitoring changes in levels of this protein can help evaluate tumor progression.) At this point the entire procedure begins again, starting with leuprolide or goserelin treatment, but the experimental drug is switched; patients originally treated with thalidomide are crossed over to placebo, and patients originally treated with placebo are crossed over to thalidomide.

Patients are monitored periodically with the following tests and procedures:

  • Medical histories and physical examinations
  • Blood and urine tests to monitor thalidomide and PSA levels, the response to treatment, and routine laboratory values (e.g., cell counts and kidney and liver function)
  • CT and bone scans, and possibly other imaging tests to assess the tumor
  • Electromyography (EMG) and nerve conduction studies, as needed. For electromyography, a thin needle is inserted into a few muscles and the patient is asked to relax or to contract the muscles. ...

Condition Intervention Phase
Prostate Cancer
Drug: Thalidomide
Drug: leuprolide acetate
Drug: goserelin
Phase III

Study Type: Interventional
Study Design: Allocation: Randomized
Masking: Double-Blind
Primary Purpose: Treatment
Official Title: A Double Blinded Randomized Crossover Phase III Study of Oral Thalidomide Versus Placebo in Patients With Stage D0 Androgen Dependent Prostate Cancer Following Limited Hormonal Ablation

Resource links provided by NLM:


Further study details as provided by National Institutes of Health Clinical Center (CC):

Enrollment: 101
Study Start Date: February 2000
Study Completion Date: March 2010
Primary Completion Date: March 2010 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: Thalidomide
    N/A
    Drug: leuprolide acetate
    N/A
    Drug: goserelin
    N/A
Detailed Description:

This is a double-blind randomized phase III study designed to determine if thalidomide can improve the efficacy of the LHRH agonist (leuprolide or goserelin) in hormone-responsive patients with a rising PSA after primary definitive therapy for prostate cancer. Patients with only a rising PSA will be randomized to LHRH agonist for six months followed by oral thalidomide 200 mg per day or placebo (Phase A). At the time of PSA progression, an LHRH agonist will be restarted for six additional months. After six months, patients originally treated with thalidomide will be crossed over to placebo and patients originally treated with placebo will be crossed over to thalidomide and followed until PSA progression or the development of metastatic disease, whichever occurs first (Phase B). Additional information will be obtained on changes in the circulating levels of the following growth factors: bFGF, TNF, VEGF, and TGFbeta. Likewise we will monitor changes in testosterone and DHT throughout the study. Neurological complications are the primary dose-limiting toxicity anticipated with chronic thalidomide administration.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA

Patients must have PSA only androgen dependent adenocarcinoma of the prostate. All patients must have failed definitive therapy (radical prostatectomy, radiation therapy with external beam or brachytherapy, or cryosurgery).

Patients must have a negative CT scan and Bone Scan for metastatic prostate cancer.

Patients must have histopathological documentation of prostate cancer. Every attempt should be made to have slides and blocks reviewed at NCI Pathology laboratory. The review of pathology by the NCI will not delay enrollment.

Patients must have progressive prostate cancer. Two consecutively rising PSAs above the nadir post-definitive therapy and an absolute value greater than 1.0 ng/ml separated by at least 2 weeks.

Patients must have a life expectancy of more than 12 months.

Patients must have a performance status of 0 to 2 according to the ECOG criteria.

Hematological eligibility parameters (within 2 weeks of starting therapy): Granulocyte count greater than or equal to 1,000/mm(3). Platelet count greater than or equal to 75,000/mm(3).

Biochemical eligibility parameters (within 2 weeks of starting therapy): If the creatinine is greater than 2.0 mg/dL obtain a 24 hour urine collection. Creatinine clearance must be greater than 40 mL/min. Hepatic function: bilirubin (total) less than or equal to 1mg/dL upper limit of normal; ALT less than 2.5 times upper limit of normal.

Exception: Patients with Clinical Gilbert's Syndrome may have total bilirubin less than or equal to 2.5 mg/dL.

Patients must not have other concurrent malignancies (within the past 2 years, with the exception of nonmelanoma skin cancer and Rai Stage 0 chronic lymphoma leukemia), in situ carcinoma of any site, or life threatening illnesses, including untreated infection (must be at least 1 week off intravenous antibiotic therapy before beginning thalidomide).

Patients with a history of unstable or newly diagnosed angina pectoris, recent myocardial infarction (within 6 months of enrollment), New York class II-IV congestive heart failure, chronic obstructive lung disease requiring oxygen therapy, uncontrolled seizure activity or by medical judgment of the physician, are not eligible.

Patients must be able to understand and sign an informed consent document.

Patients must be willing to travel from their home to the NIH or the participating institution (LSU, Univ. of Washington, Columbia University, Wayne State, University of Minnesota, University of Pittsburg, Holy Cross) for follow-up visits (due to sedation associated with thalidomideit is preferred that patients not drive during the first 3 days of taking daily dosing, or if sedation appears to be a continuing complication).

Patients must be greater than or equal to18 years of age.

Male patients must be counseled about the possibility that thalidomide may be present in semen. Men must use a latex condom every time they have sexual intercourse with women during therapy and for 8 weeks after discontinuing thalidomide, even if they have had a successful vasectomy.

Patients may enroll as a late entry if the following criteria are met: Have received luprolide or goserelin within 3 months of starting study, have a PSA within two weeks of hormonal injection and have a bone scan and CT scan without metastasis within 8 weeks of enrollment.

Patients with Rai Stage 0 Chronic Lymphocytic Leukemia (lymphocytosis only) will be eligible.

EXCLUSION CRITERIA

Patients that have received leuprolide, DES, flutamide, bicalutamide, PC-SPES, goserelin, cytotoxic chemotherapy, finasteride and/or nilutamide within the past year (or currently) are not eligible. Patients that received these agents for adjuvant or neoadjuvant therapy at the time of definitive therapy are eligible. Exception: Patients enrolled under late entry criteria, who have received luprolide/goserelin within 3 months of starting study are eligible.

Patients with NCI/CTEP grade 2 or greater peripheral neuropathy of any cause that is clinically detectable, patients receiving anti-convulsive medications, and patients with a history of seizures within the past 10 years will not be eligible for this study.

Patients who are receiving sedative/hypnotic agents (i.e. benzodiazepines) which cannot be discontinued, will not be eligible for this study.

Patients who have had a surgical orchiectomy will not be eligible for this study.

Patients who received systemic chemotherapy therapy for prostate cancer will not be eligible.

Patients with a confirmed psychiatric history of a major depression consistent with American Psychiatric Association Diagnostic and Statistical Manual (DSM IIIR criteria), confirmed by a psychiatrist, will not be eligible.

  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00004635

Locations
United States, Florida
Holy Cross Hospital, Fort Lauderdale
Fort Lauderdale, Florida, United States, 33308
United States, Louisiana
Louisiana State University
New Orleans, Louisiana, United States, 70112-2282
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, United States, 20892
United States, Michigan
Wayne State University Hutzel Hospital
Detroit, Michigan, United States, 48201
United States, Minnesota
University of Minnesota
Minneapolis, Minnesota, United States, 55415
United States, New York
Columbia University
New York, New York, United States, 10032-3784
United States, Pennsylvania
University of Pittsburgh
Pittsburgh, Pennsylvania, United States, 15261
United States, Virginia
Naval Medical Center, Portsmouth
Portsmouth, Virginia, United States, 23708
United States, Washington
University of Washington
Seattle, Washington, United States, 98195
Sponsors and Collaborators
  More Information

Additional Information:
Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: William L. Dahut, M.D./National Cancer Institute, National Institutes of Health
ClinicalTrials.gov Identifier: NCT00004635     History of Changes
Obsolete Identifiers: NCT00020085
Other Study ID Numbers: 000080, 00-C-0080
Study First Received: February 19, 2000
Last Updated: January 20, 2011
Health Authority: United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):
Angiogenesis
Cancer
Hormonal Therapy
Prostate
Thalidomide
Prostate Cancer

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Thalidomide
Leuprolide
Goserelin
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Leprostatic Agents
Anti-Bacterial Agents
Anti-Infective Agents
Therapeutic Uses
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors
Antineoplastic Agents
Antineoplastic Agents, Hormonal
Fertility Agents, Female
Fertility Agents
Reproductive Control Agents

ClinicalTrials.gov processed this record on February 12, 2012