imPlementing ROutine Molecular Characterization in Patients With Metastatic Castration Resistant ProstaTe Cancer by NGS (PROMPT)
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ClinicalTrials.gov Identifier: NCT04746300 |
Recruitment Status :
Recruiting
First Posted : February 9, 2021
Last Update Posted : February 9, 2021
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Condition or disease | Intervention/treatment |
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Metastatic Prostate Cancer | Procedure: Biopsy Procedure: Blood sample |
Prostate cancer is a major health problem leading to significant morbidity and mortality in men worldwide. Approved therapies for metastatic castration-resistant prostate cancer (mCRPC) include abiraterone and enzalutamide (targeting the androgen signaling pathway), radium-223 (bone targeting radionuclide therapy), and taxane chemotherapy. Controversy remains on optimal sequencing of available therapeutic agents, and these drugs are still commonly prescribed in a trial-and-error manner. Only a minority of patients receives the full benefit of the anticancer armamentarium, but all experience unnecessary side-effects, quality of life deterioration, and delay in onset to adequate life-prolonging treatment. In addition, the prescription of ineffective drugs and avoidable hospital admissions contribute to the financial burden of health care systems.
In recent years, distinct molecular subsets of prostate cancer have been identified in mCRPC. These molecular defects may guide physicians in proper sequencing of medication and in predicting the individual response more accurately. In previous studies using next-generation sequencing (NGS) mCRPC patients could be grouped into clearly distinct molecular subtypes. Moreover, in these subtypes biomarkers associated with resistance to certain therapies, or biomarkers actually predictive for enhanced response were identified.
In this study the investigators will introduce routine molecular characterization in participants with mCRPC as early as possible in their disease state. Participants will be screened before initiation of second-line treatment, since early identification will maximize clinical and financial benefit. Following screening, participants will be discussed in molecular tumor board and clinical meetings, and stratified to the agent they are most likely to respond to. Translational research is included to identify and validate additional predictive molecular biomarkers.
Study Type : | Observational [Patient Registry] |
Estimated Enrollment : | 400 participants |
Observational Model: | Cohort |
Time Perspective: | Prospective |
Target Follow-Up Duration: | 3 Years |
Official Title: | imPlementing ROutine Molecular Characterization in Patients With Metastatic Castration-resistant ProsTate Cancer by Next Generation DNA Sequencing (PROMPT-study) |
Actual Study Start Date : | February 4, 2020 |
Estimated Primary Completion Date : | February 2024 |
Estimated Study Completion Date : | February 2025 |
Group/Cohort | Intervention/treatment |
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Group 1: no sequencing
Participants in this group, for which DNA sequencing could not be reported due to a variety of (quality/technical) reasons, will be treated with standard of care therapy. This group is therefore comparable to patients treated outside the Radboudumc.
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Procedure: Biopsy
A biopsy will be taken from metastatic tissue, which will be used for DNA sequencing Procedure: Blood sample Blood samples will be taken for additional translational research |
Group 2: no druggable aberration
Participants in this group received a DNA sequencing report identifying no biomarkers to which a logical treatment option can be connected. These participants will also receive standard of care therapy.
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Procedure: Biopsy
A biopsy will be taken from metastatic tissue, which will be used for DNA sequencing Procedure: Blood sample Blood samples will be taken for additional translational research |
Group 3: allocated to personalized treatment
Participants in this group received a DNA sequencing report which identified presence of a biomarker allowing the participant to be treated with a personalized therapy. This therapy could range from immunotherapy, or PARP inhibitors, to other medication.
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Procedure: Biopsy
A biopsy will be taken from metastatic tissue, which will be used for DNA sequencing Procedure: Blood sample Blood samples will be taken for additional translational research |
- Responsiveness ratio [ Time Frame: Throughout completion of study (estimated 5 years from start) ]Ratio of radiographic progression-free survival of personalized treatment or standard of care to the standard last line therapy (PFS-MPT-ratio vs PFS-SOC-ratio)
- Efficacy endpoint: ORR [ Time Frame: Throughout completion of study (estimated 5 years from start) ]Best objective response rate (ORR) per RECIST1.1 criteria
- Efficacy endpoint: rPFS [ Time Frame: Throughout completion of study (estimated 5 years from start) ]Radiographic progresssion free survival (per RECIST1.1)
- Efficacy endpoint: PSA response [ Time Frame: Throughout completion of study (estimated 5 years from start) ]PSA decline >50% at 12 weeks or later
- Efficacy endpoint: PSA-PFS [ Time Frame: Throughout completion of study (estimated 5 years from start) ]Time to PSA progression (per PCWG3 criteria)
- Efficacy endpoint: OS [ Time Frame: Throughout completion of study (estimated 5 years from start) ]Overall survival capped at 1 year
- Quality of life endpoint: EORTC-QLQ-30 [ Time Frame: Throughout completion of study (estimated 5 years from start) ]Score of EORTC-QLQ-30 questionnaire
- Quality of life endpoint: EPIC-26 [ Time Frame: Throughout completion of study (estimated 5 years from start) ]Score of EPIC-26 questionnaire
- Quality of life endpoint: EQ-5D-5L [ Time Frame: Throughout completion of study (estimated 5 years from start) ]Score of EQ-5D-5L questionnaire
- Quality of life endpoint: BIP-SF [ Time Frame: Throughout completion of study (estimated 5 years from start) ]Score of BIP-SF questionnaire
- Medical Resource Utilization (MRU); nr of lines [ Time Frame: At the end of year 1, year 2, year 3, and at completion of the study (estimated end of year 5) ]Averaged number of lines of standard care per year
- Medical Resource Utilization (MRU); costs [ Time Frame: At the end of year 1, year 2, year 3, and at completion of the study (estimated end of year 5) ]Averaged costs of standard care per year
- Medical Resource Utilization (MRU); treatment-related costs [ Time Frame: At the end of year 1, year 2, year 3, and at completion of the study (estimated end of year 5) ]Averaged costs of treatment-related resource utilization (e.g. admissions in ward or ICU) per admission and/or per duration
Biospecimen Retention: Samples With DNA
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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | Male |
Accepts Healthy Volunteers: | No |
Sampling Method: | Probability Sample |
Inclusion Criteria:
- Male aged 18 or older with adenocarcinoma of the prostate defined by: Documented histopathology at diagnosis of prostate adenocarcinoma without evidence of predominant or primary neuroendocrine histology.
- Patients with a metastatic tumor site accessible for image-guided biopsy and allowing research analyses for this trial (e.g. biomarker testing by genomic, proteomic or transcriptomic assessment). A waiver can be made for patients presenting with metastatic hormone-sensitive prostate cancer (mHSPC), and no easily accessible tumour for biopsy and suitable primary tissue available for NGS.
- Castration-resistant state (defined as disease progressing despite [chemical] castration per PCWG3 criteria)
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Progressive disease as either
- A rising PSA on minimum 2 serial consecutive measurements
- Radiographic soft tissue progression per RECIST1.1 or bone progression per PCWG3 criteria
- Clinical progression
- At least one metastatic lesion present at baseline CT, MRI, 68Ga/18F-PSMA PET or bone scan
- ECOG Performance status 0 to 2
- Serum testosterone on castration level
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Adequate renal function:
• MDRD-GFR ≥ 30 ml/min/1.73m2
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Adequate bone marrow function:
- Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
- Platelet count ≥ 100 x109/L
- Hemoglobin (Hb) ≥ 5.6 mmol/L
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Adequate liver function:
- Total bilirubin level ≤ 2 institutional upper limit of the normal (ULN)
- Aspartate aminotransferase (ASAT) ≤ 3 x ULN (or ≤ 5x ULN in case of known liver metastases)
- Alanine aminotransferase (ALAT) ≤ 3 x ULN (or ≤ 5x ULN in case of known liver metastases)
- Estimated life expectancy > 12 months
- Willing and able to comply to the research protocol
- Signed, written informed consent
Exclusion Criteria:
- Prior chemotherapy and androgen receptor inhibition therapy related to castration resistant prostate cancer (one line of chemotherapy or androgen receptor inhibition may be given in the hormone-sensitive setting)
- Active malignancy other than prostate cancer, except for patients with basal or squamous skin cancer. A waiver may be obtained from the PI in cases where the active malignancy is indolent and believed not to reduce mortality.
- Imminent spinal cord compression based on clinical findings and/or magnetic resonance imaging (MRI).
- Concurrent illness, including severe infection that may jeopardize the ability of the participant to undergo the procedures outlined in this protocol with reasonable safety
- Presence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule, including alcohol dependence or drug abuse
- Any condition which, in the opinion of the investigator, would preclude participation in this observational study.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04746300
Contact: Niven Mehra, MD, PhD | +312410354 | niven.mehra@radboudumc.nl | |
Contact: Iris Kloots, MD | iris.kloots@radboudumc.nl |
Netherlands | |
Radboud UMC | Recruiting |
Nijmegen, Gelderland, Netherlands, 6500HB | |
Contact: Niven Mehra, MD, PhD niven.mehra@radboudumc.nl | |
Contact: Iris Kloots, MD iris.kloots@radboudumc.nl |
Responsible Party: | Radboud University Medical Center |
ClinicalTrials.gov Identifier: | NCT04746300 |
Other Study ID Numbers: |
MOURO41 - PROMPT NL68315.091.19 ( Registry Identifier: ABR registry ) |
First Posted: | February 9, 2021 Key Record Dates |
Last Update Posted: | February 9, 2021 |
Last Verified: | January 2021 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | Undecided |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
mCRPC |
Prostatic Neoplasms Genital Neoplasms, Male Urogenital Neoplasms Neoplasms by Site Neoplasms |
Genital Diseases, Male Genital Diseases Urogenital Diseases Prostatic Diseases Male Urogenital Diseases |