Focal Therapy With Stereotactic Body Radiation Therapy (SBRT) for Patients With a Single Prostate Tumor

Sponsor
National Cancer Institute (NCI) (NIH)
Overall Status
Not yet recruiting
CT.gov ID
NCT05616650
Collaborator
(none)
42
1
1
69.8
0.6

Study Details

Study Description

Brief Summary

Background:

The current standard treatment of prostate cancer is either surgery or radiation. Typically, this includes either the removal or radiation of the whole prostate gland. Many people now seek out focal therapy options to decrease the side effects of treatment. Until now, several forms of physical destruction with heat (thermal ablation), cold (cryotherapy), sound waves (HIFU), laser (FLA), and electrical energy (IRE). A new type of radiation (SBRT) may be an effective way to cure men of early-stage prostate cancer with fewer side effects than standard treatments.

Objective:

To see how people with untreated localized prostate cancer will respond to focal therapy with SBRT.

Eligibility:

People aged 18 years and older with untreated localized prostate cancer (prostate cancer which has not spread outside of the prostate gland).

Design:
  • Participants will undergo screening including blood tests, an MRI, a PSMA PET/CT (18F-DCFPyL), and a biopsy.

  • Small, non-radioactive, gold seeds about the size of a grain of rice will be placed in and/or around the tumor to help target the radiation treatment.

  • Radiation (SBRT) will occur in 2 separate sessions about 1 week apart. No sedation is used, these sessions are painless. Each session will take about 1-2 hours. Participants can go home afterwards.

  • Follow-up will continue for 2 years with repeat scans (MRI and PSMA PET/CT) and blood (PSA) tests.

  • After two years, a biopsy will be done to understand the impact of this new treatment on prostate cancer.

Condition or Disease Intervention/Treatment Phase
Phase 2

Detailed Description

Background:
  • Prostate cancer is the most common cancer among American men.

  • The best current validated treatment options include whole gland radiotherapy and radical prostatectomy.

  • Based on recent advances in imaging, focal ablative therapies are under investigation in attempts to deliver comparable rates of tumor control with less side effects.

  • Thus far, focal therapies such as cryotherapy, high-intensity focused ultrasound, or focal laser ablation have resulted in poor local control with the exception of implanted radiation sources which have shown in-field control rates > 90%.

  • As such, the proposed trial is designed to investigate the efficacy of a novel form of focal stereotactic body radiation therapy (SBRT) for the treatment of localized, unifocal prostate cancer.

  • Prostate specific membrane antigen (PSMA) targeted PET imaging was recently FDA approved for imaging men with suspected prostate cancer metastases who are potentially curable by radiation or surgery. 18F-DCFPyL, a second generation PSMA PET agent that binds with high affinity to PSMA yet clears rapidly from the blood pool will be used in this study.

Objective:

-To determine whether localized, tumor-directed SBRT can produce biopsy-confirmed tumor response at 24 months in participants with unifocal prostatic adenocarcinoma.

Eligibility:
  • Histologically confirmed, low or intermediate risk prostatic adenocarcinoma verified by biopsy.

  • Unifocal prostate cancer defined as a single focus of prostate cancer on imaging which is correlated with a positive targeted biopsy.

  • Age >= 18.

  • No concurrent systemic Androgen Deprivation Therapy (ADT) is planned.

Design:
  • This is a single-arm phase II trial designed to measure the efficacy of a novel application of SBRT guided with advanced prostate-specific imaging techniques.

  • Participants will initially undergo a treatment planning CT, multiparametric MRI (mpMRI), 18F-DCFPyL PET/CT imaging, a biopsy, quality of life (QoL) questionnaires and laboratory evaluations. SBRT will be administered at 26Gy in two fractions on two separate days.

  • Following completion of treatment, participants will be followed for up to 2 years through clinical evaluation, laboratory evaluations (including a complete blood count (CBC), prostate specific antigen (PSA) and testosterone measurements), QoL assessments, mpMRI, 18FDCFPyL PET/CT imaging, and a biopsy.

  • The accrual ceiling is set to 42 participants with the goal of recruiting 30 evaluable participants.

Study Design

Study Type:
Interventional
Anticipated Enrollment :
42 participants
Allocation:
N/A
Intervention Model:
Single Group Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
A Phase II Trial of Focal Ultrahypofractionated Stereotactic Radiation Therapy for the Treatment of Unifocal Prostate Cancer
Anticipated Study Start Date :
Feb 6, 2023
Anticipated Primary Completion Date :
Dec 1, 2027
Anticipated Study Completion Date :
Dec 1, 2028

Arms and Interventions

Arm Intervention/Treatment
Experimental: 1/Focal SBRT

Focal SBRT to the tumor focus within the prostate, with response assessed by biopsy and imaging, including 18F-DCFPyL PET/CT.

Drug: 18F-DCFPyL
Each participant will receive a single IV dose of 18F-DCFPyL by bolus injection. The target administered activity will be 6.5 mCi with a lower limit of 6 mCi; dose variations will be in accordance with the Nuclear Regulatory Commission (NRC) standard dose variation (i.e., 20%) permitted for diagnostic clinical studies.

Radiation: Stereotactic Body Radiation Therapy
Intensity modulated radiotherapy will be delivered to a dose of 26Gy in two fractions with the second fraction performed within 8 days of the first session.

Outcome Measures

Primary Outcome Measures

  1. Pathologic complete response rate [2 years]

    The primary objective of this trial is to determine the pathologic complete response rate on biopsy at two years in patients undergoing focal SBRT for prostate cancer. This will be defined by a negative biopsy at 2 years post-treatment.

Secondary Outcome Measures

  1. Longitudinal quality of life (QoL) [baseline and 1, 3, 6, 9, 12, 15, 18, 21, and 24 months after focal SBRT]

    The QoL 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, during and after treatment. Changes of QoL scores from baseline at each timepoint treatment will be calculated from the estimated linear mixed effect model.

  2. PSA kinetics [1 week and 1, 3, 6, 9, 12, 15, 18, 21, 24 months after focal SBRT]

    The PSA kinetics scores will be summarized at baseline and for each visit. Linear mixed effects model will be used to model PSA kinetics at baseline, during and after treatment. Changes of PSA kinetics during and after treatment will be calculated from the estimated linear mixed effect model. In the rare case where PSA test is done on outside laboratory assay, a sensitivity analysis will be conducted to analyze PSA kinetics with and without outside values to determine whether outside laboratory measurement influenced results.

  3. Nadir PSA [1 week and 1, 3, 6, 9, 12, 15, 18, 21, 24 months after focal SBRT]

    The nadir PSA (time to nadir PSA and value of nadir PSA) will be described for this cohort (median, mean, standard deviation, and range).

  4. Absolute and relative fraction of free PSA to bound PSA [1 week and 1, 3, 6, 9, 12, 15, 18, 21, 24 months after focal SBRT]

    Descriptive statistics for the absolute amount and relative fraction of free PSA and bound PSA at the various timepoints detailed in 10.1 will be reported will be compared with baseline by paired Wilcoxon test.

  5. Toxicity profile [During the focal SBRT period and 1, 3, 6, 9, 12, 18, 24 months after focal SBRT]

    Descriptive statistics will be used to summarize the toxicity profile of focal SBRT of prostate cancer.

  6. Rate of biochemical failure [24 months after focal SBRT]

    The rate of biochemical failure as defined by nadir PSA + 2.0 ng/mL at 24 months will be described.

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years and Older
Sexes Eligible for Study:
Male
Accepts Healthy Volunteers:
No
  • INCLUSION CRITERIA:

  • Participants must have histologically confirmed, low or intermediate risk prostatic adenocarcinoma verified by biopsy (NIH Laboratory of Pathology confirmation is required).

  • Unifocal prostate cancer defined as a single focus of prostate cancer on MRI and PSMA PET/CT imaging which is correlated with a positive targeted biopsy.

  • Age >=18 years.

  • ECOG performance status <=2 (Karnofsky >60%).

  • Men must agree to use highly effective contraception with their partner (barrier method of birth control; abstinence) for the duration of study participation and up to 120 days after the last radiation treatment.

  • Ability of individual to understand and the willingness to sign a written informed consent document.

EXCLUSION CRITERIA:
  • Participants with NCCN high-risk prostate cancer features (Gleason score >=8, >cT2a, or PSA >= 20 ng/mL).

  • Participants with prostate biopsies which show >= grade group 2 adenocarcinoma determined to be outside of the radiographically visible lesion (systematic biopsies which map to a radiographically detected lesion are not an exclusion criterion).

  • Participants in whom concurrent systemic Androgen Deprivation Therapy (ADT) or chemotherapy is planned.

  • Participants who are receiving any other investigational agents.

  • Participants found to have pelvic or distant metastases on pre-treatment staging studies.

  • Participants with an AUA-SI/IPSS score > 18.

  • Participants who have previously received curative treatment for a prior or the current diagnosis of prostate cancer.

  • Active urinary tract infection assessed by urinalysis.

  • Human immunodeficiency virus (HIV)-infected individuals who are not on effective anti-retroviral therapy with undetectable viral load within the 6 months prior to registration are eligible for this trial.

  • Participants with hepatitis B virus (HBV) infection who have not been treated and cured.

  • Participants with chronic HBV at screening must have an undetectable HBV viral load on suppressive therapy.

  • Participants with hepatitis C virus (HCV) infection who have not been treated and cured.

  • Participants with HCV infection who are currently on treatment, are eligible if they have an undetectable HCV viral load at screening.

  • Anatomic relationship between the tumor and adjacent normal tissues judged to be unfeasible for the planned treatment by the PI.

  • Participants with connective tissue diseases.

  • Participants with radiation hypersensitivity syndromes.

  • Ongoing active irritable bowel disease within the radiation field.

  • Participants with prior medical comorbidity or surgical history involving the low pelvis which is expected to confer a high risk of toxicity to the experimental radiation regimen.

  • Ineligibility or unwillingness to undergo a contrast-enhanced MRI due to inadequate renal function (eGFR < 30), severe claustrophobia, a weight above tolerance of the scanner (> 350 lbs.), a body size unable to fit into the scanner, or implanted devices incompatible with an MRI (implanted cardiac devices, surgical hardware, retained shrapnel, cerebral aneurysm clips, or other incompatible objects.

  • Unwillingness to undergo an 18F-DCFPyL PET/CT or known allergy to the 18FDCFPyL tracer.

  • Contraindication or inability to undergo fiducial marker implantation.

  • History of prior radiotherapy overlapping with the intended radiation field.

  • Uncontrolled intercurrent illness, factors, or social situations that would limit compliance with study requirements.

Contacts and Locations

Locations

Site City State Country Postal Code
1 National Institutes of Health Clinical Center Bethesda Maryland United States 20892

Sponsors and Collaborators

  • National Cancer Institute (NCI)

Investigators

  • Principal Investigator: Krishnan R Patel, M.D., National Cancer Institute (NCI)

Study Documents (Full-Text)

None provided.

More Information

Additional Information:

Publications

None provided.
Responsible Party:
National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:
NCT05616650
Other Study ID Numbers:
  • 10000611
  • 000611-C
First Posted:
Nov 15, 2022
Last Update Posted:
Feb 1, 2023
Last Verified:
Jan 22, 2023
Individual Participant Data (IPD) Sharing Statement:
Yes
Plan to Share IPD:
Yes
Studies a U.S. FDA-regulated Drug Product:
Yes
Studies a U.S. FDA-regulated Device Product:
No
Keywords provided by National Cancer Institute (NCI)
Additional relevant MeSH terms:

Study Results

No Results Posted as of Feb 1, 2023