Androgen Deprivation Therapy Prior to Prostatectomy for Patients With Intermediate and High Risk Prostate Cancer

This study is currently recruiting participants.
Verified February 2014 by Memorial Sloan-Kettering Cancer Center
Sponsor:
Collaborator:
Ferring Pharmaceuticals
Information provided by (Responsible Party):
Memorial Sloan-Kettering Cancer Center
ClinicalTrials.gov Identifier:
NCT01542021
First received: February 24, 2012
Last updated: February 14, 2014
Last verified: February 2014
  Purpose

Degarelix is used to treat prostate cancer by lowering testosterone levels in the body.

Degarelix is commonly given with radiation for prostate cancer, but less frequently with surgery since there has been no proven benefit with this approach.

The investigators do not expect the patient to benefit directly from treatment with degarelix since their prostate will be removed shortly after the drug is given. Instead, the investigators hope to learn about how degarelix and other treatment that lowers your testosterone effects prostate cancer cells and use this information to develop better treatments in the future.


Condition Intervention
Prostate Cancer
Prostatic Adenocarcinoma
Drug: degarelix injection
Drug: androgen deprivation therapy

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Establishing a Neo-Adjuvant Platform for Developing Targeted Agents: Androgen Deprivation Therapy Prior to Prostatectomy for Patients With Intermediate and High Risk Prostate Cancer

Resource links provided by NLM:


Further study details as provided by Memorial Sloan-Kettering Cancer Center:

Primary Outcome Measures:
  • To assess between the time to determine the time of the maximal change in prostate cancer cell proliferation (Ki-67) and apoptosis rates (cleaved caspase-3) [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    The primary endpoint is the change in the rate of proliferation (Ki-67) and the rate of apoptosis (cleaved caspase-3), as evaluated by IHC in anatomically matched tumor foci from the pre-treatment diagnostic biopsy and the RP specimen. The levels in pre-treatment biopsy serve as the baseline. Ki-67 is a widely accepted nuclear marker for cell proliferation. Cleaved caspase-3 has been shown to be a reliable marker of apoptosis and correlate with results from other apoptosis markers such as cleaved PARP-1 and TUNEL assay.


Secondary Outcome Measures:
  • To explore the association between PTEN status and maximal changes in prostate cancer proliferation and apoptosis rates in patients treated with androgen deprivation therapy [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    The secondary endpoint is PTEN status by IHC in the diagnostic biopsy and RP specimens. PTEN status will be determined by an IHC method that has been validated using control prostate cell lines and tissues at MSKCC. The PTEN status will be reported in binary fashion as "retained" (diffuse moderate immunoreactivity retained in benign glands as well as adenocarcinoma on 100X magnification) or "null" (complete loss of nuclear and cytoplasmic immunoreactivity in tumor cells while expression is retained in surrounding stroma.

  • To explore the association between PI3K pathway (pAKT and pS6) and prostate cancer proliferation and apoptosis rates after treatment with androgen deprivation therapy in relation to other markers of prostate cancer (ERG, AR and NCOA2). [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    Additional exploratory endpoints include IHC staining for markers of PI3K pathway (pAKT and pS6) as well as other markers of prostate cancer (ERG, AR and NCOA2) in the diagnostic biopsy and RP specimens. Some of these markers have been validated at MSKCC (pS6, ERG), while others (AR, pAKT, NCOA2) are currently being validated and standardized for the study using appropriate cell line and tissue controls. A general semiquantitative scoring method will be used for these markers.

  • To discover novel biomarkers and correlates of response [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    through expression profiling of prostate cancer after three time intervals of androgen deprivation therapy and correlate with PTEN and ERG status, proliferation rate, apoptotic rate, and histologic response


Estimated Enrollment: 45
Study Start Date: February 2012
Estimated Study Completion Date: February 2015
Estimated Primary Completion Date: February 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Untreated patients degarelix injection occur at days 4± 1
This is a pilot study to assess androgen deprivation therapy and its duration prior to prostatectomy in men with a diagnosis of prostate cancer and at least 3 positive core biopsies, and who are planning to have a radical prostatectomy at MSKCC.
Drug: degarelix injection
Treatment will consist of a single 240 mg injection of degarelix 4 ± 1 day before radical prostatectomy, depending on treatment arm.
Experimental: Untreated patients degarelix injection occur at days and 7± 1.
This is a pilot study to assess androgen deprivation therapy and its duration prior to prostatectomy in men with a diagnosis of prostate cancer and at least 3 positive core biopsies, and who are planning to have a radical prostatectomy at MSKCC.
Drug: degarelix injection
Treatment will consist of a single 240 mg injection of degarelix 7 ± 1 day before radical prostatectomy, depending on treatment arm.
Experimental: treated patients with androgen deprivation
Patients already treated with androgen deprivation are assigned to Cohort 3 and maintained on current androgen deprivation therapy until they undergo RP at MSKCC.
Drug: androgen deprivation therapy

  Eligibility

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

Inclusion Criteria:

  • Histologic confirmation of prostatic adenocarcinoma by MSKCC inclusive of the following:
  • 3 or more positive biopsy cores or equivalent tumor specimen as confirmed by pathologist
  • At least 2 cores containing ≥3 mm of tissue with carcinoma or equivalent tumor specimen as confirmed by pathologist
  • A primary tumor Gleason score ≥ 7
  • Adequate primary biopsy tissue or equivalent tumor specimen as confirmed by pathologist available for protocol required analysis (i.e. bladder or TURP specimen)
  • Planning to have a radical prostatectomy (RP) at MSKCC
  • Candidates may have a history of deep vein thrombosis, pulmonary embolism, and/or cerebrovascular accident, or require concomitant systemic anticoagulation, if otherwise deemed to be suitable for RP
  • Karnofsky performance status >70% (Appendix A)
  • Sexually active fertile subjects, and their partners, must agree to use medically accepted methods of contraception (eg, barrier methods, including male condom, female condom, or diaphragm with spermicidal gel) during the course of the study and for 3 months after the dose of study drug(s) for Cohorts 1 and 2 and for 3 months after the surgery for Cohort 3
  • For cohorts 1 and 2 only:, non-castrate testosterone level (>100 ng/dL)
  • For cohort 3 only:, 1-6 months of androgen deprivation therapy (gonadotropin hormone releasing analogs with or without an anti-androgen) prior to prostatectomy with a castrate testosterone level of <50 ng/dL within 1 month prior to prostatectomy.

Exclusion Criteria:

  • Histologic variants in the primary tumor (histologic variants other than adenocarcinoma)
  • Current or prior chemotherapy
  • The use of the 5-alpha-reductase inhibitor dutasteride must be discontinued within 4 weeks of degarelix injection for Cohort 1 and 2 and within 4 weeks of surgery for Cohort 3.
  • Saw palmetto administered with the intent to treat the patient's malignancy within 1 week of degarelix injection for Cohorts 1 and 2 and for within 1 week of surgery for Cohort 3
  • Current or prior radiation therapy to the prostate
  • Active infection or intercurrent illness
  • Concomitant therapy with any other experimental drug
  • For cohorts 1 and 2 only:, current or prior hormonal therapy (e.g., gonadotropin hormone releasing analogs, megestrol acetate, or antiandrogens) are exclusionary
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01542021

Contacts
Contact: Dana Rathkopf, MD 646-422-4379
Contact: Karim Touijer, MD 646-422-4486

Locations
United States, New York
Memorial Sloan Kettering Cancer Center Recruiting
New York, New York, United States, 10065
Contact: Dana Rathkopf, MD    646-422-4379      
Contact: Karim Touijer, MD    646-422-4486      
Principal Investigator: Dana Rathkopf, MD         
Sponsors and Collaborators
Memorial Sloan-Kettering Cancer Center
Ferring Pharmaceuticals
Investigators
Principal Investigator: Dana Rathkopf, MD Memorial Sloan-Kettering Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: Memorial Sloan-Kettering Cancer Center
ClinicalTrials.gov Identifier: NCT01542021     History of Changes
Other Study ID Numbers: 11-182
Study First Received: February 24, 2012
Last Updated: February 14, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Memorial Sloan-Kettering Cancer Center:
prostate
Degarelix
injections
radical prostatectomy
11-182

Additional relevant MeSH terms:
Adenocarcinoma
Prostatic Neoplasms
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Genital Diseases, Male
Prostatic Diseases
Androgens
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Pharmacologic Actions

ClinicalTrials.gov processed this record on April 17, 2014