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Radium-223 in Biochemically Recurrent Prostate Cancer

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: NCT04206319
Recruitment Status : Recruiting
First Posted : December 20, 2019
Last Update Posted : September 25, 2020
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) )

Brief Summary:

Background:

Some men who have been treated for localized prostate cancer with surgery or radiation still show signs of the disease in their blood. This is called biochemically recurrent prostate cancer. Radium-223 is a small molecule. It uses radiation to kill cancer cells and improves survival in advanced prostate cancer. Researchers want to see if it can treat prostate cancer and induced immune changes earlier in the disease when the cancer is only detectable by prostate specific antigen (PSA) in the blood.

Objective:

To learn how Radium-223 affects men with rising PSA but no evidence of cancer on conventional CT or bone scan, but positive findings on PET or molecular imaging in the bones. The primary focus is impact on the immune system with secondary focus on impact on PSA and imaging.

Eligibility:

Men ages 18 and older with prostate cancer who have had surgery and/or radiation, but their PSA is rising even though no disease is visible on routine imaging scans (CT or bone scans). Patients are required to have PET or molecular imaging findings in bones, but not organs (lymph nodes are allowed).

Design:

Participants will be screened with a medical history and physical exam. Their ability to do normal tasks will be reviewed. They will give tissue samples or a report from their doctor about their cancer. They will have blood and urine tests. They will have an electrocardiogram to measure heart function. They will have a scan of their chest and abdomen using radiation or magnetic resonance imaging. They will have a bone scan with injection of Tc99. They will have a positron emission tomography scan with intravenous (IV) injection of 18F-NaF.

Participants will get Radium-223 by IV. For this, a small plastic tube is put into an arm vein. Radium-223 will be given on Day 1 of each cycle (1 cycle = 4 weeks) for up to 6 cycles. Participants will repeat the screening tests during the study. They will also complete Quality of Life Surveys and give stool samples.

After treatment, participants will have long-term follow-up every 6 weeks for the rest of their lives.


Condition or disease Intervention/treatment Phase
Biochemical Recurrent Prostate Cancer Drug: Radium-223 Drug: 18F Sodium Fluoride Phase 2

Detailed Description:

Background:

  • Androgen deprivation therapy (ADT) and surveillance are treatment options for prostate cancer patients with biochemical progression after localized therapy with either definitive radiation or surgery (biochemically recurrent prostate cancer). A primary goal in these patients is to prevent morbidity from their cancer that results from disease progression and metastatic disease on conventional imaging.
  • Radium-223 has demonstrated the ability to improve survival in men with symptomatic metastatic castration resistant prostate cancer (mCRPC) with a manageable toxicity profile, particularly in patients who have not yet received docetaxel.
  • Radiation, even at low doses can impact immune recognition and immune cell killing of cancer cells. Recent findings by the LTIB suggest that radium-223 potentiated T-cell killing of prostate cancer cells.
  • Radium-223 may present an alternative option for patients with BRPC that is not associated with substantial toxicity (as seen with ADT) and may have a lasting effect due to its potential effect on the immune system and/or the bone microenvironment.
  • Emerging PET imaging studies will likely find evidence of "micrometastatic" disease, often in the bones, in biochemically recurrent prostate cancer patients, although these patients will have no standard of care that can be supported by prospective data.
  • Radium-223 has demonstrated the ability to improve survival in men with symptomatic prostate cancer, but it remains unknown what the impact is in patients with "micrometastatic" or PET positive prostate cancer in their bones
  • Preclinical data has suggested that radium-223 can impact the immune system.
  • In addition, changes in PSA kinetics, changes on PET scan findings, and safety and tolerability of radium-223 in this population will also be evaluated.

Objective:

- To determine statistically significant changes in immune cell populations compared to baseline in patients with biochemically recurrent or 18F NaF PET scan positive prostate cancer treated with radium-223

Eligibility:

  • Histologically confirmed adenocarcinoma of the prostate
  • Patients with negative CT Scan and Tc-99m Bone Scan
  • Patients with positive findings NaF PET imaging.
  • Patients with a rise in PSA >= 0.8 ng/mL for patients following radical prostatectomy or for patients following definitive radiation therapy: a rise in PSA of >= 2 ng/mL above the nadir
  • Patients with a PSA doubling time of 5-15 months
  • ECOG 0-1

Design:

  • Single arm study
  • Patients will receive 6 injections of radium-223 with monthly assessments of PSA and periodic immune response. NaF PET scans will be completed at screening then at 4 and 7 months after the start of radium-223.
  • After completion of treatment patient will be followed every 6 (+/- 2 weeks).

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 26 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase II Trial of Radium-223 in Biochemically Recurrent Prostate Cancer
Actual Study Start Date : September 22, 2020
Estimated Primary Completion Date : November 15, 2021
Estimated Study Completion Date : November 15, 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Prostate Cancer

Arm Intervention/treatment
Experimental: 1
Patients will receive radium-223 treatment every 4 weeks for up to 6 cycles. 18F-NaF PET scans will be used to assess response in bone.
Drug: Radium-223
An alpha particle-emitting drug, dose consistent of 55 kBq /kg (1.49 microcurie /kg); administered every 4 weeks.

Drug: 18F Sodium Fluoride
18F-NaF (Sodium Flouride) is a radio- pharmaceutical used to image skeletal pathology with positron emission tomography (PET) imaging.




Primary Outcome Measures :
  1. Changes in immune cell populations [ Time Frame: 6 months ]
    to determine the statistically significant changes in immune cell populations compared to baseline in patients with biochemically recurrent prostate cancer


Secondary Outcome Measures :
  1. Changes in PSA kinetics [ Time Frame: 6 months ]
    rate of change in PSA per month

  2. Changes in PSA kinetics and the changes in immune cell populations relative to patients with similar disease undergoing a surveillance period on a similar protocol (NCT02649439) [ Time Frame: 6 months ]
    rate of change in PSA per month compared against those on the surveillance arm of 16-C-0035

  3. Safety and tolerability of radium-223 [ Time Frame: every 4 weeks ]
    type, number and frequency of adverse events



Information from the National Library of Medicine

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, Learn About Clinical Studies.


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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:
  • Histopathological confirmation of prostate adenocarcinoma confirmed in either the Laboratory of Pathology at the National Institutes of Health (NIH) Clinical Center, or Walter Reed National Military Medical Center prior to enrollment. If no pathologic specimen is available, patients may enroll with a pathologist s report showing a histologic diagnosis of prostate cancer and a clinical course consistent with the disease.
  • Biochemical progression after definitive surgery or radiation defined as follows:
  • For patients following definitive radiation therapy: a rise in PSA of >= 2 ng/mL above the nadir
  • For patients following radical prostatectomy: a rise in PSA >= 0.8 ng/mL
  • PSA <= 30 ng/mL
  • Rising PSA must be confirmed by 3 values a minimum of 1 week apart. All 3 values must be obtained over a period greater than 1 month.
  • PSA doubling time of 5-15 months.
  • Negative CT scan/MRI and Tc99 bone scan for metastatic prostate cancer.
  • Presence of findings on PET scan (i.e., NaF PET scan) suspicious for metastatic prostate cancer in bone. Note: while lymph node findings would be allowed and provide the opportunity for the assessment of any abscopal effects, PET scan findings suggesting visceral disease will be excluded.
  • Testosterone >= 100 ng/dL
  • ECOG performance status of 0 1
  • Recovery from acute toxicity related to prior therapy, including surgery and radiation, (defined as no toxicity >= grade 2).
  • Hematological eligibility parameters (within 16 days before treatment initiation):

    • Granulocyte count >= 3,000/mm^3
    • Absolute neutrophil count (ANC) >= 1,500/mm^3
    • Platelet count >= 100,000/mm^3
    • Hgb >= 10 g/dL
  • Hepatic function eligibility parameters (within 16 days before treatment initiation)
  • Bilirubin <=1.5 mg/dL (OR in patients with Gilbert s syndrome, a total bilirubin <= 3.0), AST and ALT <= 2.5 times upper limit of normal.
  • Adequate renal function defined by eGFR within normal as predicted by the CKD-EPI equation (>= 50 mL/min/1.73m^2) or by measure o f creatinine clearance from 24-hour urine collection.
  • No other active malignancies within 36 months of treatment initiation (with the exception of nonmelanoma skin cancers or carcinoma in situ of the bladder)
  • Patients must be >=18 years old. Currently, no dosing or adverse event data is available on the use of radium in patients < 18 years of age; therefore, only adults are included in this study.
  • Ability of subject to understand and the willingness to sign a written informed consent document.
  • The effects radium-223 on the developing human fetus are unknown but based on the mechanism of action, radium-223 has the potential to cause fetal harm. For this reason, men must agree to use condoms for the duration of study therapy and at least 6 months

after the last treatment administration. Female partners of reproductive potential must use a highly effective method of birth control during treatment and for 6 months after their partner s last treatment administration. Should a woman become pregnant or suspect she

is pregnant while her partner is participating in this study, she should inform her treating physician immediately.

EXCLUSION CRITERIA:

  • Patients with immunocompromised status due to Human Immunodeficiency Virus (HIV) infection or other immunodeficiency diseases because this is a trial with a primary endpoint looking at immune response, requiring functional immune systems.
  • Patients who test positive for HBV or HCV.
  • Chronic administration (defined as daily or every other day for continued use > 14 days) of systemic corticosteroids within 28 days of treatment initiation. Use of corticosteroids with minimal systemic absorption (e.g., inhaled steroids, nasal sprays, intraarticular, and topical agents) is allowed.
  • Receipt of any organ transplantation, including allogeneic stem-cell transplantation, but with the exception of transplants that do not require immunosuppression (e.g. corneal transplant, hair transplant).
  • Serious intercurrent medical illness that, in the judgement of the investigator, would interfere with patient s ability to carry out the treatment program.
  • Subjects required other medications known to alter PSA including 5-alpha reductase inhibitors (finasteride and dutasteride) and alternative therapies (e.g., phytoestrogens and saw palmetto).
  • History of prior chemotherapy.
  • History of prior systemic therapy with radionuclides (e.g., strontium-89, samarium-153, rhenium-186, rhenium-188, or radium 223 dichloride).
  • Receipt of an investigational agent within 28 days (or 56 days for an antibody-based therapy) of treatment initiation.
  • Major surgery within 28 days prior to treatment initiation.
  • PET scan findings suggesting visceral disease.

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): NCT04206319


Contacts
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Contact: Amy R Hankin, P.A.-C (240) 858-3149 amy.hankin@nih.gov

Locations
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United States, Maryland
National Institutes of Health Clinical Center Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact National Cancer Institute Referral Office    888-624-1937      
Sponsors and Collaborators
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Ravi A Madan, M.D. National Cancer Institute (NCI)
Additional Information:
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Responsible Party: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT04206319    
Other Study ID Numbers: 200010
20-C-0010
First Posted: December 20, 2019    Key Record Dates
Last Update Posted: September 25, 2020
Last Verified: August 18, 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) ):
Immune Response
Isotope
PSA
Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Prostatic Diseases
Listerine
Fluorides
Sodium Fluoride
Cariostatic Agents
Protective Agents
Physiological Effects of Drugs
Anti-Infective Agents, Local
Anti-Infective Agents