Neoadjuvant Androgen Deprivation Therapy Plus Abiraterone With or Without Apalutamide for High-Risk Prostate Cancer

Instituto do Cancer do Estado de São Paulo

Status and phase: Completed; Phase 2

Conditions: Prostate Cancer

Treatments: Drug: Goserelin; Drug: Prednisone; Drug: Apalutamide; Drug: Abiraterone

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT02789878

NP 779/15

Details and patient eligibility

About

This is a randomized study to evaluate the efficacy and safety neoadjuvant androgen deprivation therapy with goserelin and abiraterone with or without apalutamide prior to radical prostatectomy for patients diagnosed with localized high-risk prostate cancer.

Full description

In the prostate specific antigen (PSA) era, about 15% to 20% of patients are diagnosed with high-risk localized disease and radical prostatectomy is a standard therapy for this subgroup of patients. However, despite best local therapy, about 30-60% of high-risk patients will eventually develop biochemical relapse and a significant proportion of these patients may progress with metastatic disease and die from prostate cancer. Currently, there is no data supporting the use of neoadjuvant therapy for patients with high-risk disease since studies failed to demonstrate clinically significant benefit with standard androgen deprivation therapy (ADT). Following improved outcomes in other malignancies with the use of neoadjuvant therapy with active drugs in the metastatic setting, there is a growing interest in evaluating new-generation androgen receptor (AR)-targeted therapy in earlier stages of prostate cancer. Therefore, the goal of this study is to evaluate the efficacy and safety of neoadjuvant therapy with ADT and abiraterone versus maximal androgen blockade using ADT, abiraterone and apalutamide for patients with high-risk localized prostate cancer.

Enrollment: 64 patients

Sex: Male

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Histologic confirmed prostatic adenocarcinoma

• Non-castrate levels of testosterone (> 150 ng/dL)

• High-risk localized prostate cancer, defined by either:

  • Tumor stage T3 by digital rectal examination, or
  • Primary tumor Gleason score ≥ 8, or
  • PSA ≥ 20 ng/mL

• Willing to undergo prostatectomy as primary treatment for localized prostate cancer

• Adequate hematologic, renal and hepatic function:

  • WBC > 3000/uL
  • Platelets > 150,000/uL
  • Creatinine < 2 mg/dL
  • Bilirubin < 1.5 x upper limit of normal (ULN)
  • AST/ALT < 2 x ULN

• Karnofsky Performance Status (KPS) ≥ 80%

• Able to swallow the study drugs whole as tablets

Exclusion criteria

• Pathological finding consistent with small cell, ductal or neuroendocrine carcinoma of the prostate
• Current or prior hormonal therapy, radiation therapy or chemotherapy for prostate cancer
• Evidence of metastatic disease (M1) on imaging studies
• Other prior malignancy less than or equal to 5 years prior to randomization with the exception of squamous or basal cell skin carcinoma
• Abnormal cardiac function as manifested by NYHA (New York Heart Association) class III or IV heart failure
• History of prior cardiac arrhythmia.
• Evidence of serious and/or unstable pre-existing medical, psychiatric or other condition (including laboratory abnormalities) that could interfere with patient safety or provision of informed consent to participate in this study.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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64 participants in 2 patient groups

ADT and Abiraterone

Experimental group

Description:

* Goserelin 10.8 mg, single dose, subcutaneously. * Abiraterone 1,000 mg, once daily, orally for 3 months. * Prednisone 5 mg, once daily, orally for 3 months.

Treatment:

Drug: Abiraterone

Drug: Prednisone

Drug: Goserelin

ADT, Abiraterone and Apalutamide

Experimental group

Description:

* Goserelin 10.8 mg, single dose, subcutaneously. * Abiraterone 1,000 mg, once daily, orally for 3 months. * Prednisone 5 mg, once daily, orally for 3 months. * Apalutamide 240 mg, once daily, orally for 3 months.

Treatment:

Drug: Apalutamide

Drug: Abiraterone

Drug: Prednisone

Drug: Goserelin