Androgen Receptor Antagonist ARN-509 With or Without Abiraterone Acetate, Gonadotropin-Releasing Hormone Analog, and Prednisone in Treating Patients With High-Risk Prostate Cancer Undergoing Surgery
Conditions
Stage II Prostate Adenocarcinoma, Stage III Prostate AdenocarcinomaDrugs
Abiraterone Acetate, Androgen Receptor Antagonist ARN-509, PrednisoneSummary
This randomized phase II trial studies how well androgen receptor antagonist ARN-509 works with or without abiraterone acetate, gonadotropin-releasing hormone agonist, and prednisone in treating patients with high-risk prostate cancer undergoing surgery. Androgen can cause the growth of prostate cancer cells. Hormone therapy using androgen receptor antagonist ARN-509, abiraterone acetate, and gonadotropin-releasing hormone analog (GnRH agonist) may fight prostate cancer by lowering the levels of androgen the body makes. Prednisone may either kill the tumor cells or stop them from dividing. Giving androgen receptor agonist ARN-509 with or without abiraterone acetate, GnRH agonist and prednisone may work better in treating patients with prostate cancer.
Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate the effect of neoadjuvant androgen receptor antagonist ARN-509 (apalutamide) with or without abiraterone acetate, GnRH agonist, and prednisone on the feasibility of performing nerve-sparing radical prostatectomy (RP) in men with high-risk prostate cancer (PCa).
OUTLINE: Patients are randomized to 1 of 3 treatment arms.
ARM I: Patients receive androgen receptor antagonist ARN-509 orally (PO) daily for 3 months. Patients then undergo radical prostatectomy.
ARM II: Patients receive GnRH agonist subcutaneously (SC) on day 1, androgen receptor antagonist ARN-509 PO daily PO for 4 times, abiraterone acetate PO daily for 4 times, and prednisone PO daily for 3 months. Patients then undergo radical prostatectomy.
ARM III: Patients undergo radical prostatectomy.
After completion of study treatment, patients are followed up for 2 years.
Locations
2 locations Found with status Recruiting
Status
- RECRUITING
Contact Person
- Isaac Kim, MD
- 203-785-6540
- [email protected]
Principal Investigator
- Saum Ghodoussipour, MD
Status
- RECRUITING
Contact Person
- Saum Ghodoussipour, MD
- 732-235-2043
- [email protected]
Principal Investigator
- Saum Ghodoussipour, MD
Eligibility Criteria
Inclusion Criteria:
* Histologically proven adenocarcinoma of the prostate and: Gleason > 8 OR prostatic specific antigen (PSA) > 20 and more than 1 positive core
* Patients with Eastern Cooperative Oncology Group performance scale (ECOG PS) 0 or 1
* Clinical stage T3 or less as demonstrated by abdominal/pelvic computed tomography (CT) or magnetic resonance imaging (MRI) will be selected as the prostate is resectable
* Hemoglobin >= 9.0 g/dL, independent of transfusion and/or growth factors within 3 months prior to randomization
* Platelet count >= 100,000 x 10^9/uL independent of transfusion and/or growth factors within 3 months prior to randomization
* Serum albumin >= 3.0 g/dL
* Glomerular filtration rate (GFR) >= 45 mL/min
* Serum potassium >= 3.5 mmol/L
* Serum total bilirubin =< 1.5 × upper limit of normal (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 may be eligible)
* Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 2.5 × ULN
* Medications known to lower the seizure threshold must be discontinued or substituted at least 4 weeks prior to study entry
* Agrees to use a condom (even men with vasectomies) and another effective method of birth control if he is having sex with a woman of childbearing potential or agrees to use a condom if he is having sex with a woman who is pregnant while on study drug and for 3 months following the last dose of study drug; must also agree not to donate sperm during the study and for 3 months after receiving the last dose of study drug
Exclusion Criteria:
* Clinical stage T4 (invasion into rectum or ureters) significantly increases the morbidity of the surgery
* Patients with rectal or ureteral invasion will be considered to have unresectable disease
* History of any of the following:
* Seizure or known condition that may pre-dispose to seizure (e.g. prior stroke within 1year to randomization, brain arteriovenous malformation, Schwannoma, meningioma, or other benign central nervous system [CNS] or meningeal disease which may require treatment with surgery or radiation therapy)
* Severe or unstable angina, myocardial infarction, symptomatic congestive heart failure, arterial within 6 months prior to randomization
* Venous thromboembolic events (e.g., pulmonary embolism, cerebrovascular accident including transient ischemic attacks) within 6 months prior to randomization
* Clinically significant ventricular arrhythmias within 6 months prior to randomization
* Metastatic prostate cancer
* Baseline moderate or severe hepatic impairment (Child-Pugh class B or C)
Study Plan
Arm I (androgen receptor ARN-509, radical prostatectomy)
EXPERIMENTAL
Patients receive androgen receptor antagonist ARN-509 PO daily for 3 months. Patients then undergo radical prostatectomy.
DRUG:
Androgen Receptor Antagonist ARN-509Description:
Given POOTHER:
Quality-of-Life AssessmentDescription:
Ancillary studiesOTHER:
Questionnaire AdministrationDescription:
Ancillary studiesPROCEDURE:
Radical ProstatectomyDescription:
Undergo radical prostatectomy
Arm II (ARN-509, abiraterone acetate, GnRH, prednisone, RP)
ACTIVE_COMPARATOR
Patients receive GnRH agonist SC on day 1, androgen receptor antagonist ARN-509 PO daily PO for 4 times, abiraterone acetate PO daily for 4 times, and prednisone PO daily for 3 months. Patients then undergo radical prostatectomy.
DRUG:
Abiraterone AcetateDescription:
Given PODRUG:
Androgen Receptor Antagonist ARN-509Description:
Given POBIOLOGICAL:
Gonadotropin-releasing Hormone AnalogDescription:
Given SCDRUG:
PrednisoneDescription:
Given POOTHER:
Quality-of-Life AssessmentDescription:
Ancillary studiesOTHER:
Questionnaire AdministrationDescription:
Ancillary studiesPROCEDURE:
Radical ProstatectomyDescription:
Undergo radical prostatectomy
Arm III (radical prostatectomy)
ACTIVE_COMPARATOR
Patients undergo radical prostatectomy.
OTHER:
Quality-of-Life AssessmentDescription:
Ancillary studiesOTHER:
Questionnaire AdministrationDescription:
Ancillary studiesPROCEDURE:
Radical ProstatectomyDescription:
Undergo radical prostatectomy
Outcome Measures
Primary Outcome Measures
Post-surgical potency rate defined as proportion of patients with International Index of Erectile Function score >= 17
Secondary Outcome Measures
Change in tumor volume on pelvic MRI after neoadjuvant therapy
Number of patients with biochemical recurrence defined using the Prostate Cancer Clinical Trials Working Group 2 definition
Number of patients with pathological T0
Number of patients with positive surgical margins
Postoperative continence rate as determined by the American Urological Association Symptom Score (AUAss)
Postoperative continence rate as determined by the Sexual Health Inventory for Men
Postoperative continence rate as determined by the Expanded Prostate Cancer Index Composite (EPIC)
Quality of life as assessed by the AUAss questionnaires
Quality of life as assessed by the EPIC questionnaires
Timeline
Last Updated
September 26, 2023Start Date
October 31, 2016Today
January 16, 2025Completion Date ( Estimated )
January 20, 2024
Sponsors of this trial
Lead Sponsor
Rutgers, The State University of New JerseyCollaborating Sponsors
National Cancer Institute (NCI)