PROSTEP-002: Detecting Metastases by PyL PET/CT in Subjects Starting Enzalutamide for Untreated Castration Resistant Prostate Cancer.
Study Details
Study Description
Brief Summary
This study aimed to evaluate the diagnostic performance of 18F-DCFPyL (PyL) PET/CT in subjects presenting not previously treated for castration resistant prostate cancer and showing negative or equivocal findings per institutional standard of care conventional imaging
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2 |
Detailed Description
Prostate cancer (PCa) is the most common solid organ cancer in North American men and is initially androgen sensitive. Therefore, castration and/or androgen receptor blockade remains the central palliative treatment once PCa has metastasized or failed to locoregional therapies. Because androgen deprivation therapy is not curative, all patients will eventually progress to the metastatic castration-resistant prostate cancer state. About 5% of prostate cancers will be metastatic by conventional imaging techniques at diagnosis while most patients achieving CRPC state will first be localized and then progress to metastatic state later in the disease course. Therefore, a significant proportion of patients will progress through an intermediary state of disease defined as the non-metastatic CRPC state (M0CRPC). Over the last year and a half, M0CRPC treatment landscape has completely changed with demonstrating the benefits of second-generation antiandrogens (darolutamide, enzalutamide and apalutamide) to prevent progression of M0CRPC patients. Enzalutamide have then been approved by the Federal Drug Administration and Health Canada for the treatment of M0CRPC.
On the other hand, conventional imaging techniques based on bone turnover (bone scan (BS)) or anatomical features (magnetic resonance imaging (MRI) or computed tomography (CT)) have important limitations and poor accuracy. Bone scans (BS) is the commonest imaging technique used to detect bone metastases in the clinics. BS does not image directly cancer cells, but the effect of cancer on the bone. Other pathologies such as fractures, degenerative arthritis and other benign bone lesions can also cause focal uptake on BS and lead to false-positive results. Another drawback of BS is its poor sensitivity to image small metastases confined to bone marrow. These limitations stress the importance to improve PCa imaging by using new imaging modalities.
Because novel agents targeting the androgen synthesis and receptor axis (e.g. enzalutamide), bone metastasis (radium-223) and microtubules assembly (docetaxel, cabazitaxel) have been shown to increase metastatic CRPC patients overall survival, a burning question is to determine if the non-metastatic CRPC status is real. There is growing evidence that newer imaging techniques using positron emission tomography can improve metastasis detection accuracy and may refine PCa patient prognostic stratification and treatment eligibility.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Untreated Castration Resistant Prostate Cancer and Negative Conventional Imaging Subjects Enrolled subjects will receive a single dose of 9 mCi (333 MBq) 18F-DCFPyL Injection followed by a single PET/CT scan acquired at 1-2 hours post-dosing. After initial 18F-DCFPyL PET/CT, the patients with positive 18F-DCFPyL PET/CT imaging will be treated with enzalutamide (160 mg po id) for M0CRPC disease within less than two weeks. 18F-DCFPyL PET/CT scan will then be repeated 90 days after the start of enzalutamide treatment. |
Drug: Enzalutamide capsule
160 mg po id
Other Names:
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Outcome Measures
Primary Outcome Measures
- Determine the metastasis detection rate by 18F -DCFPyL-PSMA PET/CT in patients presenting with non metastatic castration resistant prostate cancers defined by conventional imaging and a rising PSA>1ng/mL [At the end of study completion, an average of 2 years]
The number of metastasis per compartment (bone, visceral, lymph node) will be determined by 18F-DCFPyL-PET/CT.
Secondary Outcome Measures
- Determine the intrapatient and interpatient 18F-DCFPyL-PSMA response rates defined by a 50% decrease in intralesional 18F-DCFPyL-PSMA uptake or 50% decrease in sum metastasis 18F-DCFPyL-PSMA uptake after 3 months of enzalutamide. [At the end of study completion, an average of 2 years]
Determine the changes in 18F-DCFPyL-PSMA sum metastasis SUVmax for each patient and the changes of 18F-DCFPyL-PSMA SUVmax in each lesion after 3 months of enzalutamide.
Other Outcome Measures
- Number and sites of metastasis detected by 18F-DCFPyL-PSMA PET/CT at several PSA thresholds. [At the end of study completion, an average of 2 years]
Number of metastasis per compartment (bone, visceral, lymph node) determined by 18F-DCFPyL-PET/CT when PSA is <1 ng/mL, 1 to 5 ng/mL and > 5 ng/mL.
- Determine the percentage of patients showing metastatic lesions with enough 18F-DCFPyL uptake (above that of the liver) to justify radioligand therapy before and 3 months after enzalutamide treatment. [At the end of study completion, an average of 2 years]
Analyze if a patient shows one or several lesions with a 18F-DCFPyL uptake more than that of the liver.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Histologically confirmed adenocarcinoma of the prostate per original diagnosis, with undergoing androgen deprivation therapy such as prior bilateral orchiectomy or surgical castration or LHRH-agonists/LHRH-antagonists.
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Suspected recurrence of prostate cancer based on rising PSA under androgen deprivation therapy. Recurrent castration resistant prostate cancer patients is defined by a rising PSA >1 ng/mL under ADT or surgical castration and with testosterone castration levels < 1.7 nM (PCWG3 criteria).
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Negative or equivocal findings for prostate cancer on conventional imaging bone scan AND 2) abdomen-pelvis CT/MRI and chest CT or FDG-PET/CT) performed as standard of care workup within 42 days of Day 1(accrual).
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The subject is candidate for second line androgen axis targeted inhibitors such as enzalutamide and planned to receive it.
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Life expectancy ≥6 months as determined by the investigator
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Able and willing to provide signed informed consent and comply with protocol requirement
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PSA doubling time less or equal to 10 months
Exclusion Criteria:
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Subjects administered any high energy (>300 KeV) gamma-emitting radioisotope within 5 physical half-lives prior to study drug injection.
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Receipt of investigational drug therapy for prostate cancer within 60 days of Day 1.
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Subjects with any medical condition or other circumstances that, in the opinion of the investigator, compromise obtaining reliable data, achieving study objectives, or completing the study.
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Contraindication to enzalutamide
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Treatment with 5-α reductase inhibitors (finasteride, dutasteride) within 4 weeks of randomization.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | CHU de Québec-Université Laval | Québec | Canada |
Sponsors and Collaborators
- CHU de Quebec-Universite Laval
- Astellas Pharma Europe Ltd.
Investigators
- Principal Investigator: Frédéric Pouliot, MD, CHU de Québec-Université Laval
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- PROSTEP-002