MDRT in Prostate Cancer Treated With Long-term Androgen Deprivation Therapy in the STAMPEDE Trial (METANOVA)

NCT ID: NCT06150417

Last Updated: 2025-11-12

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: PHASE2
• Total Enrollment: 200 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-07-01
• Study Completion Date: 2028-04-01

Brief Summary

The purpose of this study is to find out if giving radiation therapy (RT) to areas of metastatic prostate cancer at the time a participant is diagnosed will help control disease better than the usual treatment. This treatment is called metastasis-directed radiotherapy (MDRT).

The usual treatment for prostate cancer that has spread to other parts of the body is to give lifelong treatment with hormone therapy (also known as androgen deprivation therapy or ADT). Participants may also be given prostate RT even if the disease is metastatic. Participants will receive hormone therapy (the standard treatment for prostate cancer) for 12 months. The hormone therapy agents may be taken by mouth or given as an injection. Participants will also have prostate RT. Up to 50 participants will have surgery to remove the prostate instead of having prostate RT. A portion of the participants will be randomized to receive MDRT to areas where the cancer has spread. For participants who have surgery to remove their prostate, they will be asked to allow tissue samples collected during the surgery to be sent to an outside lab for research tests and extra blood samples drawn for research tests before starting the study, and at the time the cancer becomes worse if applicable. Participation in the study will last approximately 12 months, and will be followed by their doctor for up to five years per standard of care.

The main goal is to compare the efficacy of the standard of care (standard systemic therapy + definitive prostate-directed local therapy) versus the standard of care with metastasis-directed radiotherapy (MDRT) for consolidation of metastatic disease.

Detailed Description

Prostate cancer (PCa) is the most common cancer in men worldwide, with 10% diagnosed with metastatic disease at the time of presentation. The metastatic capacity of cancers behaves along a spectrum of disease progression, such that some solid tumors have spread widely before clinical detectability and others never metastasize. While metastatic disease has historically been treated with palliative intent, an oligometastatic state where metastases are limited in number and location has emerged in which participants with oligometastatic disease may benefit from effective local therapy in addition to systemic therapy. Systemic standard-of-care therapies often include androgen deprivation therapy (ADT) and Androgen receptor signaling inhibitor (ARSI). Studies have shown that administering local radiotherapy (RT) to the prostate in addition to standard of care may improve radiographic profession-free survival. It may be even more efficacious to add metastasis-directed radiotherapy (MDRT) to the treatment of oligometastatic prostate cancer cases. More research is necessary to investigate the application of MDRT to improve disease control.

Conditions

Prostate Cancer; Malignant Neoplasm of Prostate; Secondary Malignant Neoplasm of Prostate

Keywords

Metastasis-directed Radiotherapy

Study Design

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

Study Groups

Standard of Care (SOC)

• Participants will receive the standard of care. Standard systemic therapy (SST) and definitive local therapy (radiotherapy [RT] or radical prostatectomy [RP]) are the standard of care for de novo oligometastatic prostate cancer. This arm will be used to compare to the experimental arm.
• SST will begin 6 weeks of randomization and occur for 12 months. The definitive local therapy will be RT, with a small portion undergoing RP. Local therapy should be completed by the end of Week 20.

Group Type: ACTIVE_COMPARATOR

Androgen deprivation therapy (ADT)

Intervention Type: DRUG

Standard androgen deprivation therapy (ADT) will be administered at the discretion of treating physician.

Androgen receptor signaling inhibitor (ARSI)

Intervention Type: DRUG

Standard androgen receptor signaling inhibitors (ARSI) will be administered at the discretion of the treating physician.

Local Therapy: Radical Prostatectomy (RP) or Radiotherapy (RT)

Intervention Type: OTHER

Local therapy will either be radiotherapy (RT) or radical prostatectomy (RP).

• Prostate +/- pelvic nodal radiation
• Radical prostatectomy + pelvic lymph node dissection

SOC + MDRT

• Participants will receive the standard of care. Standard systemic therapy (SST) and definitive local therapy (radiotherapy [RT] or radical prostatectomy [RP]) are the standard of care for de novo oligometastatic prostate cancer. This arm will be used to compare to the experimental arm.
• SST will begin 6 weeks of randomization and occur for 12 months. The definitive local therapy will be RT, with a small portion undergoing RP. Local therapy should be completed by the end of Week 20.
• MDRT should be completed by the end of Week 24. Depending on the participant, there are different approaches to MDRT dosing and fraction size.

Group Type: EXPERIMENTAL

Androgen deprivation therapy (ADT)

Intervention Type: DRUG

Standard androgen deprivation therapy (ADT) will be administered at the discretion of treating physician.

Androgen receptor signaling inhibitor (ARSI)

Intervention Type: DRUG

Standard androgen receptor signaling inhibitors (ARSI) will be administered at the discretion of the treating physician.

Local Therapy: Radical Prostatectomy (RP) or Radiotherapy (RT)

Intervention Type: OTHER

Local therapy will either be radiotherapy (RT) or radical prostatectomy (RP).

• Prostate +/- pelvic nodal radiation
• Radical prostatectomy + pelvic lymph node dissection

Metastasis directed radiotherapy (MDRT)

Intervention Type: RADIATION

In participants randomized to the MDRT arm, MDRT to all lesions will be performed by the end of Week 24. Selection of a particular regimen (the dose and fractionation) will based on the size and location of the participant's metastatic site and the surrounding normal tissue constraints.

Interventions

Androgen deprivation therapy (ADT)

Standard androgen deprivation therapy (ADT) will be administered at the discretion of treating physician.

Intervention Type: DRUG

Androgen receptor signaling inhibitor (ARSI)

Standard androgen receptor signaling inhibitors (ARSI) will be administered at the discretion of the treating physician.

Intervention Type: DRUG

Local Therapy: Radical Prostatectomy (RP) or Radiotherapy (RT)

Local therapy will either be radiotherapy (RT) or radical prostatectomy (RP).

• Prostate +/- pelvic nodal radiation
• Radical prostatectomy + pelvic lymph node dissection

Intervention Type: OTHER

Metastasis directed radiotherapy (MDRT)

In participants randomized to the MDRT arm, MDRT to all lesions will be performed by the end of Week 24. Selection of a particular regimen (the dose and fractionation) will based on the size and location of the participant's metastatic site and the surrounding normal tissue constraints.

Intervention Type: RADIATION

Eligibility Criteria

Inclusion Criteria

• Participant must be ≥ 18 years of age.
• Participant must have an ECOG performance status ≤ 1.
• Histologic confirmation of prostate adenocarcinoma of the prostate gland, with evidence of metastasis on imaging by conventional imaging (MRI, CT, or 99mTc bone scan) or PSMA PET/CT. Biopsy of sites of metastasis is strongly encouraged, but not required.

• There must be at least 10-15 unstained slides from 2 cores of the highest tumor cellularity available.
• Newly diagnosed disease with no prior treatment(surgery, radiation or systemic treatment, ie hormone therapy or chemotherapy) to the primary disease.

• Participants may have started LHRH agonist or antagonist therapy, and/or androgen receptor signaling inhibitor (ARSI) as long as it was not started more than 30 days before the participant is enrolled on this study.
• In participants who undergo only conventional imaging, oligometastatic disease is defined as 1-5 discrete metastatic sites in the bone and/or extra-pelvic lymph node (LN) stations.

• Extra-pelvic LN stations are superior to the regional/pelvic LN stations. Pelvic LN stations commence at the bifurcation of the aorta and bifurcation of the proximal inferior vena cava to the common iliac veins.

• Radiographic criteria for a LN to be considered a metastatic focus is defined as short-axis diameter in the axial plane of ≥ 1.0 cm, with irregular border and/or heterogeneous morphology
• In participants who undergo PSMA PET/CT (in the presence or absence of conventional imaging), oligometastatic disease is defined as 1-10 PSMA avid bone lesions and/or extra-pelvic LN stations. The MI-RADS reporting system will be followed to guide PSMA PET interpretation

• In participants extra-pelvic nodal (M1a) disease only by PSMA PET/CT and M0 by conventional imaging (i.e. extra-pelvic LN did not meet size criteria by CT), participant must meet 2 of 3 following criteria in order to be eligible:

• 1. PSA ≥ 40
• 2. Evidence of cN1 disease (pelvic LN)
• 3. Decipher score ≥ 0.89
• Adequate organ and marrow function to receive treatment per treating physician
• Medically fit for treatment and agreeable to follow-up.
• Ability to understand and the willingness to sign a written informed consent.

Exclusion Criteria

Participants with the presence of any of the following:

• Castration resistant prostate cancer (CRPC).
• Evidence of visceral or intracranial metastases.
• Participant receiving any other investigational agents for cancer.
• Participant is participating in a concurrent treatment protocol for cancer.
• Unable to lie flat during or tolerate PET/MRI, PET/CT or SBRT.
• Prior definitive treatment to the primary prostate cancer or pelvis.
• Participant with uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, uncontrolled diabetes (HgA1c > 10), active pituitary or adrenal dysfunction, or psychiatric illness/social situations that would limit compliance with study requirements
• History of another active malignancy within the previous 2 years, except for non-melanoma skin cancer, non-muscle invasive bladder cancer, or a malignancy that is considered cured with minimal risk of recurrence
• Active Crohn's disease or ulcerative colitis despite medical management.
• Refusal to sign informed consent.
• Any condition that in the opinion of the investigator would preclude participation in this study

• Minimum Eligible Age: 18 Years
• Eligible Sex: MALE
• Accepts Healthy Volunteers: No

Sponsors

National Institutes of Health (NIH)

NIH

Sponsor Role: collaborator

Case Comprehensive Cancer Center

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Angela Y Jia, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center

Daniel E Spratt, MD

Role: STUDY_CHAIR

University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center

Locations

University Hospitals Cleveland Medical Center Seidman Cancer Center

Cleveland, Ohio, United States

Site Status: RECRUITING

Carbone Cancer Center University of Wisconsin-Madison

Madison, Wisconsin, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Angela Y Jia, MD, PhD

Role: CONTACT

Phone: 216-844-3262

Email: Angela.Jia@UHhospitals.org

Facility Contacts

Angela Y Jia, MD, PhD

Role: primary

Christos Kyriakopoulos, MD

Role: primary

Other Identifiers

U01CA257638

Identifier Type: NIH

Identifier Source: secondary_id

View Link

CASE5823

Identifier Type: -

Identifier Source: org_study_id