Prostate SBRT for Locally Recurrent Prostate Cancer After Prior Radiotherapy

Sponsor

National Cancer Institute (NCI) (NIH)

Overall Status

Recruiting

CT.gov ID

NCT03253744

Collaborator

(none)

Enrollment

Location

Arms

125.5

Anticipated Duration (Months)

0.4

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Background:

Prostate cancer is the second leading cause of cancer death in U.S. men. Radiation is an effective treatment for most patients with localized prostate cancer, but sometimes the tumor returns. Researchers want to see if a highly focused type of radiation can help. It is given in only 5 treatments. It is called stereotactic body radiation therapy (SBRT).

Objective:

To study the maximum tolerated dose and side effects of stereotactic body radiation therapy in people with a local recurrence of prostate cancer after radiation.

Eligibility:

Men at least 18 years old who have recurrent prostate cancer after radiation therapy and no evidence of distant metastatic disease

Design:

Participants will be screened with blood tests, physical exam, and medical history. They may also have:

Magnetic resonance imaging (MRI) scan of the prostate..

PET/CT scan. Participants will get an injection of 18F-DCFPyL for the PET scan. They will lie very still on their back on the scanner table.

Small samples of prostate tumor tissue will be taken by a needle through the skin or rectum to see if the cancer is in the prostate. Small metal seeds will be placed into the prostate at the same time to help guide the radiation.

About 2 weeks later, participants will have a radiation treatment planning CT scan.

Participants will answer questions about their urine function, bowel function, erectile function, and mood.

Participants will receive SBRT. They will have 5 radiation treatments over 2 weeks.

Participants will have follow-up visits. They will have a physical exam, blood tests, and questionnaires.

Six months after ending SBRT, the 18F-DCFPyL PET/CT will be repeated.

Participantes will continue to have routine visits until two years after treatment is completed....

Condition or Disease	Intervention/Treatment	Phase
Prostate Cancer Prosatatic Neoplasm	Drug: 18F-DCFPyL Radiation: Tumor Irradiation Radiation: Prostate + tumor irradiation	Phase 1

Detailed Description

Background:

Prostate cancer that recurs after prior radiation treatment can be challenging to cure due to the side effects of available treatments such as surgery and cryoablation.
Re-irradiation with brachytherapy or stereotactic approaches has shown excellent rates of prostate cancer disease control with tolerable side effects.
Using image guidance to allow highly conformal focal re-irradiation may potentially increase the efficacy of re-irradiation.

Objectives:

-Define the maximum tolerated dose (MTD) of image guided, focally dose escalated prostate radiation with stereotactic body radiation therapy (SBRT) in patients with a local recurrence of prostate cancer after prior radiotherapy.

Eligibility:

Histological confirmation of recurrent prostate cancer after prior irradiation (external beam or brachytherapy)
No evidence of distant metastases of prostate cancer
No prior prostatectomy
Subject is greater than or equal to18 years old
ECOG performance status less than or equal to 2 (Karnofsky greater than or equal to 60%).

Design:

This is a Phase I trial of focal dose escalation with SBRT using image and pathologic guidance.
Areas in the prostate shown to have tumor on biopsy or with advanced imaging studies will be treated with highly conformal SBRT over a period of two to three weeks. Treatment will be guided and gated by fiducials implanted in the prostate.
Patients will be treated to escalating doses based on tolerability of the treatment.
Quality of life and functional outcomes such as urine, bowel, and erectile function will be assessed with questionnaires.
Up to 52 patients will be enrolled.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

46 participants

Allocation:

Non-Randomized

Intervention Model:

Sequential Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Phase I Trial of Image Guided Focally Dose Escalated Prostate SBRT for Locally Recurrent Prostate Cancer After Prior Radiotherapy

Actual Study Start Date :

Jul 5, 2018

Anticipated Primary Completion Date :

Jun 20, 2028

Anticipated Study Completion Date :

Dec 20, 2028

Arms and Interventions

Arm	Intervention/Treatment
Experimental: 1/Tumor Irradiation SBRT will be delivered to areas of recurrent prostate cancer identified on imaging and biopsy	Drug: 18F-DCFPyL Subjects will receive 18F-DCFPyL at baseline and 6 months after radiation. The maximum amount of injected active drug will be less than 4.02 micrograms. The target administered activity will be 6-6.5 mCi. Radiation: Tumor Irradiation SBRT will be delivered to areas of recurrent prostate cancer identified on imaging and biopsy
Experimental: 2/Prostate and Tumor Irradiation SBRT will be delivered to areas of recurrent prostate cancer identified on imaging and biopsy; and a reduced dose will be delivered to the entire prostate	Drug: 18F-DCFPyL Subjects will receive 18F-DCFPyL at baseline and 6 months after radiation. The maximum amount of injected active drug will be less than 4.02 micrograms. The target administered activity will be 6-6.5 mCi. Radiation: Prostate + tumor irradiation SBRT will be delivered to areas of recurrent prostate cancer identified on imaging and biopsy; and a reduced dose will be delivered to the entire prostate

Arm

Intervention/Treatment

Experimental: 1/Tumor Irradiation

SBRT will be delivered to areas of recurrent prostate cancer identified on imaging and biopsy

Drug: 18F-DCFPyL

Subjects will receive 18F-DCFPyL at baseline and 6 months after radiation. The maximum amount of injected active drug will be less than 4.02 micrograms. The target administered activity will be 6-6.5 mCi.

Radiation: Tumor Irradiation

SBRT will be delivered to areas of recurrent prostate cancer identified on imaging and biopsy

Experimental: 2/Prostate and Tumor Irradiation

SBRT will be delivered to areas of recurrent prostate cancer identified on imaging and biopsy; and a reduced dose will be delivered to the entire prostate

Drug: 18F-DCFPyL

Radiation: Prostate + tumor irradiation

SBRT will be delivered to areas of recurrent prostate cancer identified on imaging and biopsy; and a reduced dose will be delivered to the entire prostate

Outcome Measures

Primary Outcome Measures

Maximum tolerated dose [3 weeks post-treatment]
Define the MTD of image-guided, focally dose escalated prostate SBRT in patients with a local recurrence of prostate cancer after prior radiotherapy.

Secondary Outcome Measures

Sensitivity and specifity of 18F-DCFPyl imaging as compared to biopsy in detecting locally recurrent prostate cancer [6 months after radiation]
Evaluate 18F-DCFPyL imaging as a method to detect locally recurrent prostate cancer after radiation. The sensitivity and specificity of DCF-PyL for detecting locally recurrent prostate cancer (at baseline) will be reported using biopsy as the gold standard.
Changes of quality of life scores during and after treatment [2 years after treatment]
Describe the effects of focally dose escalated prostate SBRT on patient reported outcomes (SHIM, AUA Symptom Index, EPIC-26) in patients previously treated with radiotherapy. The quality of life scores will be summarized at baseline and for each visit. Linear mixed effects model will be used to model quality of life scores at baseline and during and after treatment in which random intercept and random slope are used to account for patient-specific trajectory of quality of life scores. Changes of quality of life scores during and after treatment will be calculated from the estimated linear mixed effect model.
biochemical progression free survival [1 and 2 years after treamtnet]
Describe the rate of PSA control (bPFS, PSA < 2 ng/dL above post SBRT nadir) at 1 and 2 years after treatment with focally dose escalated SBRT for locally recurrent prostate cancer after irradiation: bPFS will be estimated by the Kaplan-Meier survival analysis and effects of clinical variables on bPFS will be assessed by the Cox proportional hazards model.
Assessment of Dose limiting toxicities [3 weeks after end of treatment]
Define the dose-limiting toxicities and toxicity profile of image-guided, focally dose escalated prostate SBRT in patients previously treated with radiotherapy: DLTs will be reported descriptively.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

Male

Accepts Healthy Volunteers:

INCLUSION CRITERIA:
Patients must have histologically confirmed locally recurrent adenocarcinoma of the prostate after prior radiation (EBRT or brachytherapy).
PSA failure after definitive radiation as defined by the Phoenix criteria (PSA elevation at least 2 ng/dL above post-radiotherapy nadir)
Age greater than or equal to 18 years.
ECOG performance status less than or equal to 2 (Karnofsky greater than or equal to 60%).
Ability of subject to understand and the willingness to sign a written informed consent document.

EXCLUSION CRITERIA:

Patients who are receiving any other investigational agents.
PSA greater than or equal to 20 ng/dL if no prior DCFPyL scan obtained (If PSA > 20 and DCFPyL obtained within 3 months prior to enrollment shows no evidence of metastatic disease, subjects may be included in the study)
Biochemical recurrence within one year of completion of radiotherapy
Need for chronic anticoagulation therapy (chronic low dose aspirin is not an exclusion)
Pre-existing and ongoing radiation-related grade 3 bowel or bladder toxicity
Inflammatory bowel disease
Active Lupus or Active scleroderma
Patients with distant metastatic disease (prostate adjacent adenopathy is not an exclusion)
Prior prostatectomy
Subjects with any coexisting medical or psychiatric condition that is likely to interfere with study procedures and/or results.
Subjects with severe claustrophobia that is unresponsive to oral anxiolytics
Other medical conditions deemed by the Principal Investigator (or associates) to make the subject unsafe or ineligible for protocol procedures
Subjects weighing > 350 lbs. (weight limit for scanner table), or unable to fit within the imaging gantry
Serum creatinine > 2 times the upper limit of normal
Total bilirubin > 2 times the upper limit of normal OR in patients with Gilbert s syndrome, a total bilirubin > 3.0.
Liver transaminases (ALT, AST) greater than 3 times the upper limit of normal
Patients with positive Human Immunodeficiency Virus (HIV) status and currently requiring treatment with agents known to sensitize to irradiation, such as protease inhibitors.