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Docetaxel with or without Radium Ra 223 Dichloride in Treating Patients with Metastatic Castration-Resistant Prostate Cancer

Trial Status: Active

This phase III trial studies docetaxel and radium Ra 223 dichloride to see how well it works compared with docetaxel alone in treating patients with prostate cancer that has spread to other places in the body, despite the surgical removal of the testes or medical intervention to block androgen production. Drugs used in chemotherapy, such as docetaxel and radium Ra 223 dichloride, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not known whether docetaxel with or without radium Ra 223 dichloride works better at treating metastatic castration-resistant prostate cancer.

Inclusion Criteria

  • Willing and able to provide written informed consent (ICF) and Health Insurance Portability and Accountability Act (HIPAA) authorization for the release of personal health information. A signed informed consent must be obtained before screening procedures are performed * NOTE: HIPAA authorization may be either included in the informed consent or obtained separately
  • Histological or cytological proof of prostate cancer
  • Documented progressive metastatic castrate resistant prostate cancer (mCRPC) based on at least one of the following criteria: * PSA progression defined as a minimum of 2 rising PSA levels with a minimum of a 1 week interval between each determination. A minimum PSA of 1.0 ng/mL is required for study entry * Soft-tissue progression defined as an increase >= 20% in the sum of the longest diameter (LD) of all target lesions based on the smallest sum LD since treatment started or the appearance of one or more new lesions * Progression of bone disease (evaluable disease) or two or more new bone lesions by bone scan
  • Two or more bone lesions defined by nuclear bone scan
  • Eastern Cooperative Oncology Group (ECOG) 0- 1
  • Albumin > 30 g/L (within 14 days of randomization)
  • Absolute neutrophil count (ANC) >= 1.5 x 10^9/L (within 14 days of randomization)
  • Hemoglobin >= 10 g/dL (within 14 days of randomization)
  • Platelet count >= 100 x 10^9/L (within 14 days of randomization)
  • Creatinine =< 1.5 x the institutional upper limit of normal (ULN) (within 14 days of randomization)
  • Bilirubin =< ULN (unless documented Gilbert's disease) (within 14 days of randomization)
  • Serum glutamic-oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) =< 1.5 x ULN (within 14 days of randomization)
  • Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 1.5 x ULN (within 14 days of randomization)
  • White blood cell (WBC) count >= 3 x 10^9/L (within 14 days of randomization)
  • Subjects must agree to use a medically acceptable method of birth control (e.g., spermicide in conjunction with a barrier such as a condom) or sexual abstinence for the duration of the study, including 6 months after the last dose of study drug. Sperm donation is prohibited during the study and for 6 months after the last dose of study drug. Female partners must use hormonal or barrier contraception unless postmenopausal or abstinent
  • Serum testosterone < 50 ng/dL. Subjects must continue primary androgen deprivation with an LHRH analogue (agonist or antagonist) if they have not undergone orchiectomy
  • All acute toxic effects of any prior treatment have resolved to National Cancer Institute (NCI)-Common Terminology Criteria for Adverse Events (CTCAE) version (v)4.0 grade 1 or less
  • Willing and able to comply with the protocol, including follow-up visits and examinations

Exclusion Criteria

  • Received any other investigational therapeutic agents or other anticancer therapies within 2 weeks or 5 half-lives, whichever is shorter, prior to randomization
  • Received external beam radiotherapy within the 2 weeks prior to randomization
  • Has an immediate need for external beam radiotherapy
  • Has received any other systemic investigational or anti-cancer radiopharmaceutical in the past
  • Has received any prostate cancer directed chemotherapy in the castration resistant setting
  • Has received > 6 prior doses of docetaxel in the castration sensitive setting. Subjects who have received up to 6 prior doses of docetaxel in the castration sensitive setting are permitted if they have not experienced disease progression within 36 weeks of last treatment with docetaxel
  • Has received four or more systemic anticancer regimens for mCRPC. Treatment with docetaxel or abiraterone for non-castrate metastatic disease is permissible and does not count towards the lines of therapy for mCRPC. A ‘line’ is a regimen. Combinations of hormones and other types of therapies count as single lines
  • Has known grade >= 3 docetaxel-related toxicities or docetaxel toxicity related dose interruption or discontinuation
  • Has received blood transfusions or growth factors within the last 4 weeks prior to randomization
  • Symptomatic nodal disease (i.e., scrotal, penile, or leg edema)
  • Has visceral metastases with > 3 lung and/or liver metastases or individual lesion > 2 cm, as assessed by computed tomography (CT) scan or magnetic resonance imaging (MRI) of the chest/abdomen/pelvis within the last 8 weeks prior to randomization
  • Symptomatic loco-regional disease that causes ongoing grade 3 or grade 4 urinary or rectal symptoms
  • Subjects with a second malignancy with a risk of recurrence > 30% within the next 3 years. Non-melanoma skin cancers, non-invasive bladder cancers, and other in-situ or non-invasive malignancies are permitted while on study
  • Has imminent or established cord compression based on clinical findings and/or MRI
  • Known bone marrow dysplasia
  • Has received any of the following in the 4 weeks prior to randomization: 5-alpha-reductase inhibitors, natural hormonally active foods (e.g., phytoestrogens) or other food supplements known to alter PSA in humans
  • Is receiving ongoing treatment with herbal medications that are known in humans to alter PSA or the natural history of prostate cancer. Subjects must discontinue any such herbal medications prior to the first dose of study drug
  • Any other serious illness or medical condition that would, in the opinion of the investigator, make this protocol unreasonably hazardous, including but not limited to: * Uncontrolled infection * New York Heart Association (NYHA) III or IV heart failure * Crohn’s disease or those with ulcerative colitis who have not undergone a colectomy * Known active infection with human immunodeficiency virus (HIV), hepatitis B or hepatitis C

Connecticut

New Haven
Yale University
Status: ACTIVE
Contact: Michael E. Hurwitz
Phone: 877-925-3637

Delaware

Newark
Helen F Graham Cancer Center
Status: ACTIVE
Contact: Michael J. Guarino
Phone: 302-366-1200

Illinois

Chicago
Rush University Medical Center
Status: ACTIVE
Contact: Dian Wang
Phone: 312-942-5751

Indiana

Indianapolis
Indiana University / Melvin and Bren Simon Cancer Center
Status: ACTIVE
Contact: Nabil Adra
Phone: 317-944-5349
Email: nadra@iu.edu

Louisiana

New Orleans
Ochsner Medical Center Jefferson
Status: ACTIVE
Contact: Marc R. Matrana
Phone: 504-842-3910

Maryland

Baltimore
University of Maryland / Greenebaum Cancer Center
Status: ACTIVE
Contact: Arif Hussain
Phone: 410-328-7225

Massachusetts

Worcester
UMass Memorial Medical Center - University Campus
Status: ACTIVE
Contact: Kriti Mittal
Phone: 508-334-3550

Michigan

Ann Arbor
University of Michigan Comprehensive Cancer Center
Status: CLOSED_TO_ACCRUAL
Contact: Zachery Roger Reichert
Phone: 734-764-3066

Nebraska

Omaha
Urology Cancer Center PC
Status: ACTIVE
Contact: Tony Romero
Phone: 402-991-8468

Nevada

Las Vegas
Comprehensive Cancer Centers of Nevada - Northwest
Status: ACTIVE
Contact: Nicholas J. Vogelzang
Phone: 702-952-3400

New Jersey

Basking Ridge
Memorial Sloan Kettering Basking Ridge
Status: ACTIVE
Contact: Michael J. Morris
Phone: 646-422-4649
Middletown
Memorial Sloan Kettering Monmouth
Status: ACTIVE
Contact: Michael J. Morris
Phone: 646-422-4469
Montvale
Memorial Sloan Kettering Bergen
Status: ACTIVE
Contact: Michael J. Morris
Phone: 646-422-4469
Voorhees
MD Anderson Cancer Center at Cooper-Voorhees
Status: ACTIVE
Contact: David Jesse Mulvihill
Phone: 856-735-6396
Willingboro
MD Anderson Cancer Center at Cooper-Willingboro
Status: ACTIVE
Contact: Ashish Bharat Patel
Phone: 855-632-2667

New Mexico

Gallup
New Mexico Cancer Center-Gallup
Status: ACTIVE
Contact: Pranshu Bansal
Phone: 505-842-8171

New York

Buffalo
Roswell Park Cancer Institute
Status: ACTIVE
Contact: Gurkamal S. Chatta
Phone: 716-845-2300
Commack
Memorial Sloan Kettering Commack
Status: ACTIVE
Contact: Michael J. Morris
Phone: 646-422-4469
New York
Memorial Sloan Kettering Cancer Center
Status: ACTIVE
Contact: Michael J. Morris
Phone: 646-422-4469
NYP / Weill Cornell Medical Center
Status: ACTIVE
Contact: Scott Tadashi Tagawa
Phone: 646-962-2072
Rochester
University of Rochester
Status: ACTIVE
Contact: Chunkit Fung
Phone: 585-275-5823
Uniondale
Memorial Sloan Kettering Nassau
Status: ACTIVE
Contact: Michael J. Morris
Phone: 646-422-4469
West Harrison
Memorial Sloan Kettering Westchester
Status: ACTIVE
Contact: Michael J. Morris
Phone: 646-422-4469

North Carolina

Chapel Hill
UNC Lineberger Comprehensive Cancer Center
Status: ACTIVE
Contact: Young E. Whang
Phone: 984-974-0000

Ohio

Kettering
Dayton Physicians LLC - Hematology and Medical Oncology Division
Status: ACTIVE
Contact: Kelly Lynn Robbins Miller
Phone: 937-293-1622

Oklahoma

Oklahoma City
University of Oklahoma Health Sciences Center
Status: ACTIVE
Contact: Abhishek Tripathi
Phone: 405-271-4088

Pennsylvania

Bala Cynwyd
Midlantic Urology - Bala Cynwyd
Status: ACTIVE
Contact: Laurence Belkoff
Phone: 610-667-3020

South Carolina

Charleston
Medical University of South Carolina
Status: ACTIVE
Contact: Michael Brian Lilly
Phone: 843-792-9300

Texas

Atascocita
Millennium Physicians – Oncology
Status: ACTIVE
Contact: John R. Waldron
Phone: 877-870-2640
Houston
Houston Methodist Hospital
Status: ACTIVE
Contact: Jorge German Darcourt

Washington

Seattle
University of Washington Medical Center
Status: ACTIVE
Contact: Celestia Savoye Higano
Phone: 855-557-0555

Netherlands

Alkmaar
Noordwest Ziekenhisgroep
Status: ACTIVE
Contact: Mathijs P. Hendriks
Phone: 31 72 5482872
Almelo
Ziekenhuisgroep Twente
Status: ACTIVE
Contact: I. M. Oving
Breda
Amphia Hospital
Status: ACTIVE
Contact: Hans M Westgeest
Delfzijl
Delfzicht Ziekenhuis
Status: ACTIVE
Den Haag
Medisch Centrum Haaglanden-Westeinde
Status: ACTIVE
Contact: Helgi H Helgason
Phone: 31-20-512-9111
Deventer
Deventer Hospital
Status: ACTIVE
Contact: A L Imholz
Hilversum
Tergooi - Locatie Hilversum
Status: ACTIVE
Contact: Pieter Van den Berg
Nijmegen
Canisius-Wilhelmina Hospital
Status: ACTIVE
Contact: Diederik Somford
Rotterdam
Erasmus University Medical Center
Status: ACTIVE
Contact: Ronald DeWitt
Phone: 31-107040704
Maasstad Hospital
Status: APPROVED
Contact: B.C.M. Haberkorn
Ziekenhuis Saint Franciscus
Status: ACTIVE
Contact: Paul Hamburg
Phone: 31-104616295
Zwolle
Isala Klinieken
Status: ACTIVE
Contact: Metin Tascilar

PRIMARY OBJECTIVE:

I. Compare overall survival for subjects treated with docetaxel versus subjects treated with docetaxel plus radium-223.

SECONDARY OBJECTIVES:

I. To compare radiographic progression free survival as defined in Prostate Cancer Working Group 3 (PCWG3) criteria.

II. To compare symptomatic skeletal event free survival.

III. To compare time to total alkaline phosphatase (ALP) progression.

IV. To compare on-treatment alterations in quality of life (QOL) as assessed by Functional Assessment of Cancer Therapy-Prostate (FACT-P), Brief Pain Inventory (BPI), and Brief Fatigue Inventory (BFI) measures between subjects who receive docetaxel with those who receive docetaxel and radium-223.

V. To determine if there is excessive febrile neutropenia in subjects treated with docetaxel plus radium-223.

VI. To determine if there is excessive treatment discontinuation in subjects who are on their fourth line of therapy.

CORRELATIVE/EXPLORATORY/TERTIARY OBJECTIVES:

I. To evaluate on treatment alterations in prostate specific antigen (PSA).

II. To evaluate time to first symptomatic skeletal event (SSE).

III. To evaluate on-treatment alterations in bone biomarkers.

IV. To evaluate total ALP response.

V. To evaluate circulating tumor cell (CTC) characterization at baseline and on treatment.

VI. To evaluate CTC response.

VII. To evaluate on-treatment AR-V7 characterization.

VIII. To evaluate on-treatment alterations in circulating tumor deoxyribonucleic acid (ctDNA).

IX. To evaluate on-treatment changes in automated Bone Scan Index (aBSI).

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM A: Patients receive docetaxel intravenously (IV) on day 1 and prednisone orally (PO) twice daily (BID). Treatment repeats every 3 weeks for up to 10 cycles in the absence of disease progression or unacceptable toxicity.

ARM B: Patients receive docetaxel IV on day 1 and prednisone PO BID. Treatment repeats every 3 weeks for up to 10 cycles in the absence of disease progression or unacceptable toxicity. Patients also receive radium Ra 223 dichloride via injection on day 1. Treatment with radium Ra 223 dichloride repeats every 6 weeks for up to 6 cycles in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for 1 year, then every 6 months thereafter.

Trial Phase Phase III

Trial Type Treatment

Lead Organization
Memorial Sloan Kettering Cancer Center

Principal Investigator
Michael J. Morris

  • Primary ID 18-150
  • Secondary IDs NCI-2018-01438
  • Clinicaltrials.gov ID NCT03574571