A Study of Salvage Radiotherapy With or Without Enzalutamide in Recurrent Prostate Cancer Following Surgery (STEEL)
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|ClinicalTrials.gov Identifier: NCT03809000|
Recruitment Status : Recruiting
First Posted : January 18, 2019
Last Update Posted : March 18, 2022
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|Condition or disease||Intervention/treatment||Phase|
|Prostate Cancer||Radiation: Radiation Therapy Drug: Enzalutamide Drug: Bicalutamide Drug: GnRH analog||Phase 2|
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 Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||242 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|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|
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
Other Name: Casodex®
Drug: GnRH analog
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
Other Name: Xtandi®
Drug: GnRH analog
- 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.
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|Ages Eligible for Study:||18 Years and older (Adult, Older Adult)|
|Sexes Eligible for Study:||Male|
|Accepts Healthy Volunteers:||No|
- 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.
- 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.
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
|Contact: Edwin Posadas, MDfirstname.lastname@example.org|
|Principal Investigator:||Edwin Posadas, MD||RTOG Foundation|
|Principal Investigator:||Hiram Gay, MD||RTOG Foundation|
|Responsible Party:||RTOG Foundation, Inc.|
|Other Study ID Numbers:||
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|
|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|
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