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A Study of Salvage Radiotherapy With or Without Enzalutamide in Recurrent Prostate Cancer Following Surgery (STEEL)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03809000
Recruitment Status : Recruiting
First Posted : January 18, 2019
Last Update Posted : March 18, 2022
Sponsor:
Collaborators:
Pfizer
Astellas Pharma Inc
Information provided by (Responsible Party):
RTOG Foundation, Inc.

Study Description
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Brief Summary:
Patients with post-prostatectomy PSA (Prostate Specific Antigen) recurrences with aggressive disease features will receive salvage radiation therapy and standard androgen deprivation therapy (ADT) or enhanced ADT to determine if there is any improvement in progression-free survival when enhanced ADT is used compared to standard ADT.

Condition or disease Intervention/treatment Phase
Prostate Cancer Radiation: Radiation Therapy Drug: Enzalutamide Drug: Bicalutamide Drug: GnRH analog Phase 2

Detailed Description:

PRIMARY OBJECTIVE:

To determine whether, in men with post-prostatectomy PSA (prostate specific antigen) recurrences with aggressive disease features, salvage radiotherapy (SRT) with enhanced androgen deprivation therapy (ADT), consisting of enzalutamide (MDV3100) and a GnRH analog, will improve progression-free survival compared to SRT with standard GnRH analog -based ADT.

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 242 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: STEEL: A Randomized Phase II Trial of Salvage Radiotherapy With Standard vs Enhanced Androgen Deprivation Therapy (With Enzalutamide) in Patients With Post-Prostatectomy PSA Recurrences With Aggressive Disease Features
Actual Study Start Date : April 15, 2019
Estimated Primary Completion Date : September 15, 2024
Estimated Study Completion Date : September 15, 2029

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Active Comparator: Salvage Radiation Therapy + Standard ADT
Salvage RT will be given 66.0 - 70.2 Gy along with 24 months of a GnRH analog with or without 1-4 months of bicalutamide.
 Radiation: Radiation Therapy
Radiation Therapy
Other Names:
  • RT
  • Three-Dimensional Conformal Radiation Therapy (3D-CRT)
  • Intensity-Modulated Radiation Therapy (IMRT)
  • Image-Guided Radiation Therapy (IGRT)
  • Radiotherapy

Drug: Bicalutamide
Anti-androgen
Other Name: Casodex®

Drug: GnRH analog
Anti-androgen
Other Names:
  • Gonadotropin-releasing hormone analog
  • Lupron®
  • leuprolide acetate
  • goserelin acetate
  • Eligard™
  • Viadur™
  • Zoldaex®
  • Trelstar®
Experimental: Salvage Radiation Therapy + Enhanced ADT
Salvage RT will be given 66.0 - 70.2 Gy along with 24 months of a GnRH analog + 24 months of enzalutamide.
 Radiation: Radiation Therapy
Radiation Therapy
Other Names:
  • RT
  • Three-Dimensional Conformal Radiation Therapy (3D-CRT)
  • Intensity-Modulated Radiation Therapy (IMRT)
  • Image-Guided Radiation Therapy (IGRT)
  • Radiotherapy

Drug: Enzalutamide
Anti-androgen
Other Name: Xtandi®

Drug: GnRH analog
Anti-androgen
Other Names:
  • Gonadotropin-releasing hormone analog
  • Lupron®
  • leuprolide acetate
  • goserelin acetate
  • Eligard™
  • Viadur™
  • Zoldaex®
  • Trelstar®


Outcome Measures
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Primary Outcome Measures :
  1. Progression-Free Survival (PFS) [ Time Frame: From the date of randomization to the date of progression, death from any cause or last known follow-up date, assessed up to 5 years. ]
    The time from the date of randomization to the date of progression, death from any cause or last known follow-up date.


Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Pathologically (histologically) proven adenocarcinoma confirmed by prostatectomy performed within 10 years prior to registration and any type of radical prostatectomy is permitted, including retropubic, perineal, laparoscopic or robotically assisted.
  • PSA level (≥ 0.2 ng/mL) within 90 days prior to registration. GnRH analog may be started no more than 42 days prior study entry, but patients must have a PSA ≥ 0.2 ng/mL prior to starting ADT.
  • Hemoglobin ≥ 9.0 g/dL, independent of transfusion and/or growth factors within 90 days prior to registration.
  • Platelet count ≥ 75,000 x 10^9/µL independent of transfusion and/or growth factors within 90 days prior to registration.

  • At least 1 of the following aggressive features:

    • Gleason score of 8-10 (note any Gleason score is eligible)

    • Seminal vesicle invasion (SVI) (note any pT stage [AJCC v8.0] is eligible but a pT stage

      ≥ pT3b is considered aggressive)

    • Locoregional node involvement at radical prostatectomy (pN1)
    • Persistently elevated PSA post-RP nadir (PEPP) defined as PSA > 0.1 ng/mL after radical prostatectomy
  • Serum albumin ≥ 3.0 g/dL within 90 days prior to registration
  • GFR ≥35 mL/min estimated by Cockcroft-Gault or measured directly by 24 hour urine creatinine within 90 days prior to registration.
  • Serum total bilirubin ≤1.5 × ULN (Note: In subjects with Gilbert's syndrome, if total bilirubin is >1.5 × ULN, measure direct and indirect bilirubin and if direct bilirubin is ≤1.5 × ULN, subject is eligible) within 90 days prior to registration.
  • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) <2.5 × ULN within 90 days prior to registration.
  • Testosterone >50 ng/dL within 90 days prior to registration. Prior androgen deprivation (GnRH analog and/or non-steroidal antiandrogen) therapy is allowed provided that serum testosterone concentration must be ≥ 50 ng/dL prior to registration or starting ADT, whichever occurs first; 5-alpha reductase inhibitors will not impact eligibility, but must be discontinued prior to starting protocol treatment.
  • History and physical with ECOG Performance Status 0-1 or within 90 days prior to registration.

Exclusion Criteria:

  • Definitive clinical or radiologic evidence of metastatic disease with the exception of locoregional lymph nodes.
  • Prior invasive malignancy (except non-melanomatous skin cancer carcinoma in situ of the male breast, penis, oral cavity, or stage Ta of the bladder, or stage I completely resected melanoma) unless disease free for a minimum of 2 years).
  • Prior systemic chemotherapy for the study cancer. Note: prior chemotherapy for a different cancer is allowable.
  • Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields.

  • History of any of the following:

    • Documented inflammatory bowel disease
    • Transmural myocardial infarction within the last 4 months prior to registration.
    • New York Heart Association Functional Classification III/IV within 4 months prior to registration.
    • Unstable angina and/or congestive heart failure requiring hospitalization within the last 4 months prior to registration
    • History of loss of consciousness or transient ischemic attack within 12 months prior to randomization
    • History of seizure disorder or condition that may predispose to seizure (e.g. prior cortical stroke or significant brain trauma)
    • History of uncontrolled hypertension defined as a sustained systolic blood pressure in excess of 150 mmHg or a sustained diastolic blood pressure in excess of 90 mmHg despite optimized antihypertensive therapy.
    • History of repeated falls and fractures over the past 12 months that in the opinion of the treating investigator would put the patient at risk for poor bone outcomes from androgen receptor targeted therapy
  • Known gastrointestinal disorder affecting absorption of oral medications.
  • Active uncontrolled infection defined as an identified infectious condition that requires active therapy that has not yet been completed.
  • HIV positive patients with CD4 count < 200 cells/microliter within 30 days prior to registration OR HIV patients under treatment with highly active antiretroviral therapy (HAART) within 30 days prior to registration regardless of CD4 count. Note: HIV testing is not required for eligibility for this protocol as it is self-reported. This exclusion criterion is necessary because the treatments involved in this protocol may be immunosuppressive and/or interact with HAART.
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03809000


Contacts
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Contact: Edwin Posadas, MD 310-423-7600 edwin.posadas@csmc.edu

Locations
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Sponsors and Collaborators
RTOG Foundation, Inc.
Pfizer
Astellas Pharma Inc
Investigators
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Principal Investigator: Edwin Posadas, MD RTOG Foundation
Principal Investigator: Hiram Gay, MD RTOG Foundation
More Information
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Responsible Party: RTOG Foundation, Inc.
ClinicalTrials.gov Identifier: NCT03809000    
Other Study ID Numbers: RTOG 3506
STEEL ( Other Identifier: RTOG Foundation )
First Posted: January 18, 2019    Key Record Dates
Last Update Posted: March 18, 2022
Last Verified: March 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Keywords provided by RTOG Foundation, Inc.:
Post-prostatectomy
Enzalutamide
STEEL
Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Prostatic Diseases
Leuprolide
Goserelin
Bicalutamide
 Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Fertility Agents, Female
Fertility Agents
Reproductive Control Agents
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Androgen Antagonists
Hormone Antagonists