START-MET HS Prostate Cancer. : SbrT & Androgen Receptor Therapy METastatic HSPC

NCT ID: NCT05209243

Last Updated: 2023-05-19

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 266 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-01-26
• Study Completion Date: 2027-01-31

Brief Summary

Phase III study of stereotactic body radiation therapy (SBRT) plus standard of care in castration sensitive oligometastatic prostate cancer patients, defined as androgen deprivation therapy plus radiotherapy to the primary tumor in previously not treated patients and second generation hormonal treatments (Apalutamide/Abiraterone+Prednisone/Enzalutamide) vs androgen deprivation therapy plus radiotherapy to the primary tumor in previously not treated patients plus second generation hormonal treatments, for the treatment of oligometastatic prostate cancer.

Detailed Description

A total of 266 patients with a histological diagnosis of metastatic hormone sensitive prostate cancer, with limited disease (≤ 3 lesions based on CT and Bone Scan and ≤ 5 lesions based on Choline or PSMA PET/TC) at the diagnosis or in an oligorrecurrent stage will be included in the study. Candidates will be first screened for metastatic sites through bone scintigraphy and computerised tomography (CT) scans. Those who meet the ≤3 metastatic sites criteria will be second screened for metastatic sites based on Choline or PSMA PET/TC, which will be used to define the treatment volume of metastatic disease with SBRT/HIGRT and to confirm the oligometastatic status before the inclusion in the study.

Once included in the study, patients will be randomize (1:1) to standard of care + SBRT vs standard of care.

• Interventional arm: STANDARD OF CARE + SBRT (all metastatic lesions). ADT+ RT to the primary tumor (previously not treated) + Second generation hormonal treatment
• Control arm: STANDARD OF CARE. ADT+ RT to the primary tumor (previously not treated) + Second generation hormonal treatment

Patients will be stratified according to prior local treatment (yes/no) or the new imaging technique used (Choline vs PSMA PET/TC).

Conditions

Prostate Cancer; Stereotactic Body Radiation Therapy

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Interventional arm

STANDARD OF CARE + SBRT (all metastatic lesions). ADT+ RT to the primary tumor (previously not treated) + Second generation hormonal treatment

Group Type: EXPERIMENTAL

SBRT

Intervention Type: RADIATION

SBRT (all metastatic lesions)

STANDARD OF CARE

Intervention Type: RADIATION

ADT+ RT to the primary tumor (previously not treated) + Second generation hormonal treatment

Control arm

STANDARD OF CARE. ADT+ RT to the primary tumor (previously not treated) + Second generation hormonal treatment

Group Type: ACTIVE_COMPARATOR

STANDARD OF CARE

Intervention Type: RADIATION

ADT+ RT to the primary tumor (previously not treated) + Second generation hormonal treatment

Interventions

SBRT

SBRT (all metastatic lesions)

Intervention Type: RADIATION

STANDARD OF CARE

ADT+ RT to the primary tumor (previously not treated) + Second generation hormonal treatment

Intervention Type: RADIATION

Eligibility Criteria

Inclusion Criteria

1. Patients with a histological diagnosis of prostate cancer.

2. Castration sensitive prostate cancer patients.

3. Oligometastatic disease defined as less than or equal 3 lesions based on CT and Bone Scan and less than or equal 5 lesions based on Choline or PSMA PET/TC. Bone metastases (including the spine) or/and lymph nodes metastases.

4. Informed consent is obtained from the patient.

5. Adequate bone-marrow, liver and renal function:

• Haemoglobin ≥10 g/dL, Leucocytes ≥ 2000/mm^3, Neutrophils ≥1500/mm^3, platelets ≥1000007mm^3
• GOT, GPT and Total Bilirrubin ≤1.5*ULN (Upper limit of normality)
• Creatinine ≤1.5*ULN or Creatinine Clearance ≥50 ml/min^-1

Exclusion Criteria

1. Lack of a histological diagnosis of prostate cancer.

2. Castration resistant prostate cancer patients according to PCWG3[30].

3. Metastatic disease defined as greater than or equal 3 lesions based on CT and Bone Scan and greater than or equal 5 lesions based on Choline or PSMA PET/TC.

4. Visceral metastases.

5. Tumor stage T4 according to AJCC 8th Edition Cancer staging form.

6. Prior treatment with docetaxel, second generation hormonal treatments (Apalutamide/Abiraterone+Prednisone/Enzalutamide) or bone antiresorptive therapy.

7. Presence of symptoms or signs that are indicative of urgent surgery/radiotherapy as the first treatment for the metastases disease.

8. Lesions that require SBRT treatment that exceed critical organ tolerance limits, or do not meet the criteria for the prescription of SBRT techniques used.

9. History of another neoplastic pathology which is not a currently controlled with the exception basal cell carcinomas.

10. Presence of a cardiopathy or metabolic disorder that does not recommend the treatment with second generation hormonal treatments, or the presence of inflammatory bowel disease or other pathology that does not recommend the treatment with radiotherapy.

11. Lack of informed consent or the patient's ability to give consent.

12. Participation in other clinical trials at the time of inclusion or in the 3 previous months.

• Eligible Sex: MALE
• Accepts Healthy Volunteers: No

Sponsors

Instituto de Investigación en Oncología Radioterápica - Fundación Española de Oncología Radioterápic

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Antonio J Conde Moreno, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Grupo de Investigación Clínica en Oncología Radioterápica

Fernando López Campos, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Grupo de Investigación Clínica en Oncología Radioterápica

Alfonso Gómez-Iturriaga, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Grupo de Investigación Clínica en Oncología Radioterápica

Locations

Hospital Universitario Ramón y Cajal

Madrid, , Spain

Site Status: RECRUITING

Hospital Universitari i Politècnic La Fe

Valencia, , Spain

Site Status: NOT_YET_RECRUITING

Countries

Spain

Central Contacts

Antonio J Conde Moreno, MD PhD

Role: CONTACT

antoniojconde@gmail.com

+34 649039866

Fernando López Campos, MD PhD

Role: CONTACT

fernando_lopez_campos@hotmail.com

+34 663158959

Facility Contacts

Fernando López Campos

Role: primary

flcampos@salud.madrid.org

Antonio J Conde

Role: primary

antoniojconde@gmail.com

0034649039866 ext. 0034649039866

Other Identifiers

GICOR-SEOR 2-21

Identifier Type: -

Identifier Source: org_study_id