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Prostate CancerPhase 2NCT00551525

Samarium Sm 153 Lexidronam Pentasodium and 3-Dimensional Conformal Radiation Therapy or Intensity-Modulated Radiation Therapy in Treating Patients With Rising Prostate-Specific Antigen Levels After Radical Prostatectomy for Prostate Cancer

A Phase 2 study testing Radiotherapy and Samarium 153 in people with Prostate Cancer, run by Radiation Therapy Oncology Group at 29 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

RATIONALE: Giving samarium Sm 153 lexidronam pentasodium and 3-dimensional (3-D) conformal radiation therapy or intensity-modulated radiation therapy may keep prostate cancer from growing in patients with rising prostate-specific antigen (PSA) levels after radical prostatectomy for prostate cancer. Read more about this study

Who is it for?
Ages 18 to 120 years, men only
Conditions the study is for
Prostate Cancer
What is being tested?
Radiotherapy and Samarium 153
Could I receive a placebo?
No, everyone receives an active treatment
How many people
67 participants
Where
29 sitesUnited States
Study dates
Apr 2008to Dec 2016
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 120 years
  • Men only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Histologically proven diagnosis of prostate cancer progressing after prior radical prostatectomy as indicated by one of the following:
  • Postoperative prostate-specific antigen (PSA) rising above 1.0 ng/mL
  • Postoperative PSA rising above 0.2 ng/mL with a surgical tumor Gleason score of 9 or 10
  • Postoperative PSA rising above 0.2 ng/ml with nodal disease
  • Stage II-IV disease (T2 -T4, N0-N1)
  • No distant metastases based on the following minimum diagnostic work up:
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  • History or physical examination within the past 8 weeks
  • Bone scan negative for bone metastases within the past 4 months
  • Abdominal imaging negative for metastases within the past 6 months
  • Zubrod Performance Status 0-1
  • Absolute neutrophil count (ANC) ≥ 1,800 cells/mm³
  • Platelet count ≥ 100,000 cells/mm³
  • Hemoglobin ≥ 8.0 g/dL (transfusion or other intervention to achieve Hgb ≥ 8.0 g/dl is permitted)

Who cannot join

  • Biopsy evidence of M1 disease
  • Presence of neuroendocrine features in any prostate cancer specimen
  • PATIENT CHARACTERISTICS:
  • Prior invasive malignancy (except nonmelanoma skin cancer) unless disease free for a minimum of 3 years
  • Severe, active comorbidity, defined as follows:
  • Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months
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  • Transmural myocardial infarction within the last 6 months
  • Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
  • Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects (laboratory tests for liver function and coagulation parameters, however, are not required for entry into this protocol)
  • Renal failure (laboratory tests for renal function, however, are not required for entry into this protocol)
  • AIDS based upon current Centers for Disease Control (CDC) definition (HIV testing is not required)
  • PRIOR CONCURRENT THERAPY:
  • No prior systemic chemotherapy for the study cancer
  • Prior chemotherapy for a different cancer is permitted
  • No hormonal therapy initiated within the last 3 months
  • No prior radiotherapy to the pelvic region that would result in overlap of radiotherapy fields

Trial locations and contacts

29 sites in 1 country.

29 sites in 1 country

United States29 sites
  • McDowell Cancer Center at Akron General Medical Center

    Akron, Ohio, 44307

  • Summa Center for Cancer Care at Akron City Hospital

    Akron, Ohio, 44309-2090

  • Tulane Cancer Center Office of Clinical Research

    Alexandria, Louisiana, 71315-3198

  • Auburn Radiation Oncology

    Auburn, California, 95603

  • Barberton Citizens Hospital

    Barberton, Ohio, 44203

  • Billings Clinic - Downtown

    Billings, Montana, 59107-7000

  • Radiation Oncology Centers - Cameron Park

    Cameron Park, California, 95682

  • Mercy Cancer Center at Mercy San Juan Medical Center

    Carmichael, California, 95608

  • John B. Amos Cancer Center

    Columbus, Georgia, 31904

  • Hudner Oncology Center at Saint Anne's Hospital - Fall River

    Fall River, Massachusetts, 02721

  • University of Florida Shands Cancer Center

    Gainesville, Florida, 32610-0232

  • West Michigan Cancer Center

    Kalamazoo, Michigan, 49007-3731

  • Kaiser Permanente Medical Center - Los Angeles

    Los Angeles, California, 90027

  • CCOP - Christiana Care Health Services

    Newark, Delaware, 19713

  • Sentara Cancer Institute at Sentara Norfolk General Hospital

    Norfolk, Virginia, 23507

  • Oklahoma University Cancer Institute

    Oklahoma City, Oklahoma, 73104

  • Regional Cancer Center at Singing River Hospital

    Pascagoula, Mississippi, 39581

  • Kimmel Cancer Center at Thomas Jefferson University - Philadelphia

    Philadelphia, Pennsylvania, 19107-5541

  • Arizona Oncology Services Foundation

    Phoenix, Arizona, 85013

  • Robinson Radiation Oncology

    Ravenna, Ohio, 44266

  • Radiation Oncology Center - Roseville

    Roseville, California, 95661

  • Radiological Associates of Sacramento Medical Group, Incorporated

    Sacramento, California, 95815

  • University of California Davis Cancer Center

    Sacramento, California, 95817

  • Mercy General Hospital

    Sacramento, California, 95819

  • Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis

    St Louis, Missouri, 63110

  • David C. Pratt Cancer Center at St. John's Mercy

    St Louis, Missouri, 63141

  • Stony Brook University Cancer Center

    Stony Brook, New York, 11794-9446

  • Solano Radiation Oncology Center

    Vacaville, California, 95687

  • Coastal Cancer Center at Sentara Virginia Beach General Hospital

    Virginia Beach, Virginia, 23454

Other trials in United States

About this study

Official title: A Phase II Trial of Samarium 153 Followed by Salvage Prostatic Fossa 3D-CRT or IMRT Irradiation in High-Risk, Clinically Non-Metastatic Prostate Cancer After Radical Prostatectomy

RATIONALE: Giving samarium Sm 153 lexidronam pentasodium and 3-dimensional (3-D) conformal radiation therapy or intensity-modulated radiation therapy may keep prostate cancer from growing in patients with rising prostate-specific antigen (PSA) levels after radical prostatectomy for prostate cancer.

PURPOSE: This phase II trial is studying how well samarium Sm 153 lexidronam pentasodium and 3-D conformal radiation therapy or intensity-modulated radiation therapy work in treating patients with rising PSA levels after radical prostatectomy for prostate cancer.

Read the detailed description

OBJECTIVES:

Primary

  • To assess the effectiveness of samarium Sm 153 lexidronam pentasodium (as determined by a 30% decline in the PSA level within 12 weeks) followed by either three-dimensional conformal radiation therapy or intensity-modulated radiation therapy in patients with rising prostate-specific antigen levels (PSA) after radical prostatectomy prostate cancer.

Secondary

  • To assess the proportion of patients completing protocol treatment.
  • To evaluate hematological toxicity at 12 weeks.
  • To evaluate samarium Sm 153 lexidronam pentasodium-related adverse events at 12 weeks.
  • To evaluate the "acute" and "late" radiation therapy-related events having occurred up to 24 weeks from the end of radiation therapy.
  • To compare the freedom from progression rate at 2 years to that predicted by the Kattan Nomograms.

OUTLINE: Patients receive samarium Sm 153 lexidronam pentasodium (SM) IV on day 1. Patients are closely monitored for prostate-specific antigen (PSA) level and SM-associated toxicity for 12 weeks. After the 12 weeks, patients undergo either intensity-modulated radiation therapy or 3-dimensional conformal radiation therapy 5 days a week for 7-8 weeks. Patients may receive hormonal therapy (after radiation therapy) at the discretion of their physician.

Treatment continues in the absence of disease progression (defined as a PSA doubling time less than 3 months), severe thrombocytopenia (defined as a platelet count of 25,000 cells/mm³ or less), or unacceptable toxicity.

After completion of study treatment, patients are followed up at 3 months, 6 months, and 12 months, every 6 months for 2 years, and then annually thereafter.

Conditions
Prostate Cancer
Being tested
Radiotherapy, Samarium 153
Keywords
stage IIB prostate cancer, stage IIA prostate cancer, stage III prostate cancer, stage IV prostate cancer
Medical subject headings
Prostatic Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • RadiotherapyRadiation

    Also called 3D-CRT, IMRT, Intensity-modulated radiation therapy

    3D-CRT or IMRT 64.8-70.2 Gy to the prostatic fossa begins 12 weeks (+/- 1 week) after Samarium 153 administration. Daily tumor doses of 1.8 - 2.0 Gy per day, 5 days per week x 7-8 weeks.

  • Samarium 153Drug

    Also called Samarium sm 153 lexidronam pentasodium, Quadramet

    Samarium 153 lexidronam dose 2.0 mCi/kg by IV injection one time within 2 weeks (+/- 3days) after registration.

Study groups in NCT00551525
Study groupRoleWhat they receive
Radiotherapy + Samarium 153ExperimentalSamarium 153 infusion followed by radiotherapy 12 weeks later
Receives: Radiation: Radiotherapy; Drug: Samarium 153

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of Patients With PSA Response (pt) Within 12 Weeks of Samarium 153 Administration

    A PSA response for each patient is calculated by (baseline PSA-current PSA)/baseline PSA. A decline of at least 30% is considered a response. Null hypothesis (H0): Samarium 153 is not effective (pt ≤ 0.1) vs alternative hypothesis (HA): Samarium 153 is effective (pt ≥ 0.25). The sample size of 69 analyzable patients (eligible patients receiving any protocol treatment with ≥ 12 weeks follow-up from the Samarium 153 injection) was calculated based on Fleming's Multiple Testing Procedure at a significance level of 0.019 and 91% statistical power requiring 69 patients to conclude either the null or alternative hypotheses. With only 52 analyzable patients this study had only 78% power and needed at least 11 patients with a PSA response to reject H0.

    Measured: Twelve weeks from the date of Samarium 153 infusion.

Secondary outcomes (5)
  1. Completion of Therapy

    The completion of protocol treatment is defined as receiving at least 64.8 Gy radiation after the Samarium 153 injection. The null hypothesis that the proportion of the number of patients who complete the protocol treatment (the Samarium 153 and the radiation therapy) is less than or equal to 0.5 was tested using an exact test for a binomial proportion. If the true treatment completion proportion is 0.8, then the statistical power of a one-sided 0.378 level exact binomial test of proportion would be 94.1% with the sample size of 26. Therefore any number of analyzable patients greater than 26 patients provides enough power for this endpoint.

    Measured: 90 days from the end of radiation therapy.

  2. Number of Patients With Hematologic Toxicity at 12 Weeks

    Adverse events are graded using CTCAE v3.0. Grade refers to the severity of the AE. The CTCAE v3.0 assigns Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild AE, Grade 2 Moderate AE, Grade 3 Severe AE, Grade 4 Life-threatening or disabling AE, Grade 5 Death related to AE. Hematological toxicities consist of platelet grade 3-5, white blood cell grade 3-5, hemoglobin grade 3-5, and any secondary leukemia's.

    Measured: Twelve weeks from the date of Samarium 153 infusion.

  3. Samarium 153-related Adverse Events at 12 Weeks (Percentage of Patients)

    Adverse events are evaluated by the NCI Common Terminology Criteria for Adverse Event (CTCAE) version 3.0. The treatment-related attribution includes definitely, probably or possibly related to treatment. The treatment-related adverse events are:

    • HEMATOLOGIC Platelet grade 3-5 White blood cell count (WBC) grade 3-5 Hemoglobin grade 3-5 Any secondary leukemia's
    • HEMORRHAGE/BLEEDING Hemorrhage, gastrointestinal - anus, rectum grade 3-5 Hemorrhage, genitourinary - bladder, prostate, urethra grade 3-5
    • SAMARIUM 153-RELATED GRADE 5 ADVERSE EVENT PRIOR TO TREATMENT OF RADIATION.

    Measured: Twelve weeks from the date of Samarium 153 infusion

  4. Acute and Late Radiotherapy-Related Adverse Events

    The number of patients who experienced a grade 1-5 radiation-related adverse events within 90 days of the start of radiotherapy (acute) and after 90 days (late). Adverse events are evaluated by the NCI Common Terminology Criteria for Adverse Event (CTCAE) version 3.0. Multivariate logistic regression was used to model the association of clinical T-stage (pT2 vs. pT3 [reference level]), baseline PSA, Gleason score (<8 vs. 8-10[reference level]), and age with the occurrence of any acute radiotherapy-related adverse event. Odds ratios and the respective 95% confidence intervals were computed for each factor. Per the protocol, late adverse events were not analyzed.

    Measured: 90 days from start of radiotherapy

  5. Freedom From Progression (FFP) Rate at 2 Years

    Progression is defined as biochemical (PSA) failure at any time for 2 years after prostatic fossa radiation therapy (RT), initiation of systemic therapy, or clinical failure. Biochemical failure is defined as a rise of 0.2 ng/ml or more above the nadir PSA after completion of RT followed by another higher value, or a continued rise in the serum PSA despite RT. FFP rate at 2 years was to be compared to that predicted by the Kattan Nomograms. See "Limitations and Caveats" section.

    Measured: From randomization to 2 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 Oct 2007 (estimated)
  2. Study startApr 2008
  3. Primary completionJul 2014
  4. Study completionDec 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
67 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00551525
Sponsor's protocol ID
RTOG-0622
Other IDs
CDR0000570622, NCI-2009-01094
Status last verified
Jun 2017
First submitted
30 Oct 2007
Last updated
25 Jul 2017
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Radiotherapy and Samarium 153 in people with Prostate Cancer, run by Radiation Therapy Oncology Group at 29 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 13 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Jul 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 29 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 25 Jul 2017). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of Patients With PSA Response (pt) Within 12 Weeks of Samarium 153 Administration (time frame: Twelve weeks from the date of Samarium 153 infusion.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Jul 2017.

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Clinical Trial NCT00551525 | AzTrials