Hormone Therapy Plus Chemotherapy in Treating Patients With Prostate Cancer

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborators:
Eastern Cooperative Oncology Group
Cancer and Leukemia Group B
Southwest Oncology Group
Information provided by (Responsible Party):
Radiation Therapy Oncology Group
ClinicalTrials.gov Identifier:
NCT00030654
First received: February 14, 2002
Last updated: November 12, 2013
Last verified: November 2013
  Purpose

RATIONALE: Androgens can stimulate the growth of prostate cancer cells. Drugs such as luteinizing hormone-releasing hormone agonist, flutamide, and bicalutamide may stop the adrenal glands from producing androgens. Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Combining hormone therapy with chemotherapy may kill more tumor cells. It is not yet known whether chemotherapy given at the same time as hormone therapy is more effective than chemotherapy given after hormone therapy in treating prostate cancer.

PURPOSE: Randomized phase III trial to compare the effectiveness of chemotherapy given at the same time as hormone therapy with that of chemotherapy given after hormone therapy in treating patients who have prostate cancer.


Condition Intervention Phase
Prostate Cancer
Drug: bicalutamide
Drug: docetaxel
Drug: doxorubicin hydrochloride
Drug: estramustine phosphate sodium
Drug: flutamide
Drug: ketoconazole
Drug: paclitaxel
Drug: releasing hormone agonist therapy
Drug: vinblastine sulfate
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase III Randomized Study of Patients With High Risk, Hormone-Naive Prostate Cancer: Androgen Blockade With 4 Cycles of Immediate Chemotherapy Versus Androgen Blockade With Delayed Chemotherapy

Resource links provided by NLM:


Further study details as provided by Radiation Therapy Oncology Group:

Primary Outcome Measures:
  • Overall Survival [ Time Frame: From date of randomization to the date of death due to any cause ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Biochemical control [ Time Frame: From date of randomization to the date of first PSA failure defined as a PSA doubling time <= 32 weeks ] [ Designated as safety issue: No ]
  • Time to Clinical Failure [ Time Frame: Time from study entry to positive scan or positive disease evaluation of the pelvis or chest or a PSA doubling time ≤ 32 weeks ] [ Designated as safety issue: No ]
  • Frequency of non-hematologic (>= grade 3), hematologic (grade >=4) and fatal (grade 5) toxicities [ Time Frame: From the beginning of treatment to 90 days post treatment ] [ Designated as safety issue: Yes ]

Enrollment: 21
Study Start Date: October 2002
Primary Completion Date: February 2005 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Androgen blockade + immediate chemotherapy
Androgen blockade with immediate chemotherapy
Drug: bicalutamide Drug: docetaxel Drug: doxorubicin hydrochloride Drug: estramustine phosphate sodium Drug: flutamide Drug: ketoconazole Drug: paclitaxel Drug: releasing hormone agonist therapy Drug: vinblastine sulfate
Experimental: Androgen blockade + delayed chemotherapy
Androgen blockade with delayed chemotherapy
Drug: bicalutamide Drug: docetaxel Drug: doxorubicin hydrochloride Drug: estramustine phosphate sodium Drug: flutamide Drug: ketoconazole Drug: paclitaxel Drug: releasing hormone agonist therapy Drug: vinblastine sulfate

Detailed Description:

OBJECTIVES:

Primary

  • Compare the survival of patients with high-risk hormone-naive prostate cancer treated with androgen blockade with concurrent chemotherapy vs delayed chemotherapy.

Secondary

  • Compare biochemical control in patients treated with these regimens.
  • Determine the toxicity of these regimens in these patients.
  • Compare the time to clinical failure, as measured by progression on bone scan or CT scan or a prostate-specific antigen doubling time of ≤ 32 weeks, in patients treated with these regimens.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to prior therapy (surgery vs radiotherapy and/or brachytherapy vs both), original combined Gleason score (6 vs 7 vs 8-10), and prior vaccine therapy (yes vs no). Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive androgen blockade (AB) comprising a luteinizing-hormone releasing-hormone agonist continuously and oral flutamide or oral bicalutamide once daily for at least 1 month. Within 4 weeks of initiation of AB, patients begin chemotherapy. Patients receive 1, and only 1, of the following chemotherapy regimens:

    • Regimen A: Patients receive oral estramustine 3 times daily on days 1-5 and docetaxel IV on day 3. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.
    • Regimen B: Patients receive oral estramustine 3 times daily on days 1-5 and paclitaxel IV on days 3, 10, 17, 24, 31, and 38. Treatment repeats every 56 days for 4 courses in the absence of disease progression or unacceptable toxicity.
    • Regimen C: Patients receive oral ketoconazole 3 times daily on days 1-7, 15-21, and 29-35; doxorubicin IV on days 1, 15, and 29; vinblastine IV on days 8, 22, and 36; and oral estramustine 3 times daily on days 8-14, 22-28, and 36-42. Treatment repeats every 56 days for 4 courses in the absence of disease progression or unacceptable toxicity.
    • Regimen D: Patients receive oral estramustine 3 times daily on days 1-4 and docetaxel IV over 1 hour on days 3, 10, and 17. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity.
    • Regimen E: Patients receive docetaxel IV on day 1. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.
    • Regimen F: Patients receive docetaxel IV on days 1, 8, and 15. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity.
    • Regimen G: With approval from the protocol chair, patients may receive a regimen that has been demonstrated in a published phase II study to have at least a 50% response rate as measured by PSA decrease from baseline over 2 measurements 28 days apart or a decrease in measurable soft tissue disease by 50% in 2 dimensions.
  • Arm II: Patients receive AB as in arm I. Patients continue with AB until clinical failure, at which time patients receive chemotherapy as in arm I. Patients who have a response may continue to receive chemotherapy beyond 4 courses.

Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.

PROJECTED ACCRUAL: A total of 1,050 patients will be accrued for this study within 4-6 years.

  Eligibility

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

DISEASE CHARACTERISTICS:

  • Diagnosis of adenocarcinoma of the prostate

    • Failed local treatments (surgery and/or radiotherapy and/or brachytherapy) as defined by a rising prostate-specific antigen level of at least 2.0 ng/mL (confirmed by 2 measurements at least 2 weeks apart) and a doubling time of 32 weeks or less
    • No clinical or radiographic evidence of disease
    • Original Gleason score of at least 7 OR Gleason score of 6 with capsular penetration or positive seminal vesicles or lymph nodes
  • No metastases

PATIENT CHARACTERISTICS:

Age:

  • 18 and over

Performance status:

  • Zubrod 0-1

Life expectancy:

  • Not specified

Hematopoietic:

  • Absolute granulocyte count at least 1,500/mm^3
  • Platelet count at least 100,000/mm^3
  • Hemoglobin at least 10 g/dL
  • No history of bleeding disorders that would contraindicate warfarin, including clotting factor defects

Hepatic:

  • Bilirubin no greater than 1.5 mg/dL
  • AST/ALT no greater than 1.5 times upper limit of normal

Renal:

  • Creatinine no greater than 1.5 mg/dL
  • BUN no greater than 1.2 times normal

Cardiovascular:

  • No symptomatic heart disease
  • No history of myocardial infarction
  • No history of thromboembolic events (e.g., deep vein thrombosis, symptomatic cerebrovascular events, or pulmonary embolism)

Other:

  • No other major medical or psychiatric illness that would preclude study entry
  • No other prior or concurrent invasive malignancy within the past 5 years except superficial skin cancer
  • No history of esophageal varices
  • Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • At least 6 weeks since prior vaccine therapy

Chemotherapy:

  • At least 5 years since prior chemotherapy

Endocrine therapy:

  • Prior adjuvant or neoadjuvant hormonal therapy of less than 8 months duration allowed
  • At least 1 year since prior androgen therapy

Radiotherapy:

  • See Disease Characteristics
  • At least 5 years since prior radiotherapy to sites other than prostate

Surgery:

  • See Disease Characteristics

Other:

  • Concurrent warfarin allowed
  • Concurrent bisphosphonate therapy initiated prior to or after randomization allowed
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00030654

  Show 78 Study Locations
Sponsors and Collaborators
Radiation Therapy Oncology Group
Eastern Cooperative Oncology Group
Cancer and Leukemia Group B
Southwest Oncology Group
Investigators
Study Chair: Kenneth J. Pienta, MD, FACP University of Michigan Cancer Center
Study Chair: Naomi S. Balzer-Haas, MD Fox Chase Cancer Center
Study Chair: Arif Hussain, MD University of Maryland Greenebaum Cancer Center
Study Chair: Gregory P. Swanson, MD Deaconess Medical Center, Spokane, Washington
Study Chair: Primo N. Lara, MD University of California, Davis
  More Information

Additional Information:
Publications:
Responsible Party: Radiation Therapy Oncology Group
ClinicalTrials.gov Identifier: NCT00030654     History of Changes
Other Study ID Numbers: RTOG-P-0014, CDR0000069186, RTOG-DEV-1028, ECOG-RTOG-P-0014, CALGB-RTOG-P-0014, SWOG-RTOG-P-0014
Study First Received: February 14, 2002
Last Updated: November 12, 2013
Health Authority: United States: Federal Government

Keywords provided by Radiation Therapy Oncology Group:
adenocarcinoma of the prostate
stage IIB prostate cancer
stage IIA prostate cancer
stage III prostate cancer
stage IV prostate cancer
recurrent prostate cancer

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Androgens
Doxorubicin
Liposomal doxorubicin
Docetaxel
Bicalutamide
Estramustine
Flutamide
Vinblastine
Paclitaxel
Ketoconazole
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Pharmacologic Actions
Antibiotics, Antineoplastic
Antineoplastic Agents
Therapeutic Uses
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents, Alkylating
Alkylating Agents

ClinicalTrials.gov processed this record on September 14, 2014