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Prostate CancerPhase 2ARNEONCT03080116

Neoadjuvant Degarelix With or Without Apalutamide (ARN-509) Followed by Radical Prostatectomy

A Phase 2 study testing ARN-509 and Degarelix in people with Prostate Cancer and Neoadjuvant Therapy, run by Universitaire Ziekenhuizen KU Leuven at 1 site in Belgium.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

RATIONALE: Neoadjuvant hormonal therapy using luteinizing hormone releasing hormone (LHRH) agonists and/or anti-androgens has already demonstrated to downstage primary prostate cancer in patients treated by radical prostatectomy without a survival benefit. Read more about this study

Who is it for?
Ages 18 to 80 years, men only
What is being tested?
ARN-509 and Degarelix
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
90 participants
Where
1 siteBelgium
Study dates
28 Mar 2019to 1 Jul 2024
Phase
Phase 2
Are there results?
None posted in the registry

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 80 years
  • Men only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Absence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial
  • Before patient registration/randomization, written informed consent must be given according to ICH/GCP, and national/local regulations
  • Male aged 18 years or older (within 80 years)
  • Histologically confirmed adenocarcinoma of the prostate without neuroendocrine differentiation or small cell features
  • Diagnosis of intermediate (at least 2 of the following factors: cT2b, biopsy GS 7, PSA 10-20ng/ml) or high-risk prostatic adenocarcinoma (clinical stage≥T2c and/or biopsy GS≥8 and/or PSA>20ng/ml), cN0-cN1, cM0.
  • Patient amenable for open or robotic radical prostatectomy + pelvic lymph node dissection
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  • ECOG performance status: 0-1
  • Adequate organ function as defined by the following criteria:
  • White blood cells (WBC) ≥ 4.0 x109/L
  • Platelet count ≥ 100 x109/L
  • Hemoglobin ≥9 g/dl
  • Creatinine ≤ 2 x ULN
  • Serum aspartate transaminase (AST; serum glutamic oxaloacetic transaminase [SGOT]) and serum alanine transaminase (ALT; serum glutamic pyruvic transaminase [SGPT]) ≤ 2.5 x upper limit of normality (ULN)
  • Total serum bilirubin ≤1.5 x ULN.

Who cannot join

  • Previous surgical/endoscopic treatments for prostatic disease
  • Herbal and non-herbal products that in the opinion of the investigator may decrease PSA levels
  • cM1 disease
  • Any contraindication for PET or MR investigations
  • History of seizure or condition that may pre-dispose to seizure (e.g., prior stroke within 1 year prior to randomization, brain arteriovenous malformation, Schwannoma, meningioma, or other benign CNS or meningeal disease which may require treatment with surgery or radiation therapy)
  • Medications known to lower the seizure threshold
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  • History of:
  • Any prior malignancy (other than adequately treated basal cell or squamous cell skin cancer, superficial bladder cancer currently in complete remission) within 5 years prior to randomization
  • Severe/unstable angina, myocardial infarction, symptomatic congestive heart failure, arterial or venous thromboembolic events (e.g., pulmonary embolism, cerebrovascular accident including transient ischemic attacks), or clinically significant ventricular arrhythmias within 6 months prior to randomization
  • Uncontrolled hypertension (systolic blood pressure ≥160 mmHg or diastolic BP ≥100 mmHg). Patients with a history of uncontrolled hypertension are allowed provided blood pressure is controlled by anti-hypertensive treatment.
  • Gastrointestinal disorder affecting absorption
  • Any other condition that, in the opinion of the Investigator, would impair the patient's ability to comply with study procedures.

Trial locations and contacts

1 site in 1 country.

Belgium1 site
  • University Hospitals Leuven

    Leuven, Vlaams-brabant, 3000

Other trials in Belgium

About this study

Official title: Neoadjuvant Degarelix +/- Apalutamide (ARN-509) Followed by Radical Prostatectomy for Intermediate and High-risk Prostate Cancer: a Randomized, Placebo-controlled Trial

RATIONALE: Neoadjuvant hormonal therapy using luteinizing hormone releasing hormone (LHRH) agonists and/or anti-androgens has already demonstrated to downstage primary prostate cancer in patients treated by radical prostatectomy without a survival benefit. There is no evidence yet of a survival impact of LHRH antagonist (LHRHa) +/- new-generation anti-androgens in this setting. Thus novel studies are needed to assess this treatment combination.

PURPOSE: To assess the difference in treatment antitumor effect between arms by measuring pathological tumor volume with minimal residual disease (MRD) following radical prostatectomy + pelvic lymph-node dissection (RP + PLND) for intermediate or high-risk prostate cancer patients.

Read the detailed description

PRIMARY OBJECTIVE: To assess the difference in antitumor effect between the treatment arms by measuring MRD following radical prostatectomy.

SECONDARY OBJECTIVES: To measure differences between study arms in

  • Proportions of post neoadjuvant prostate specific antigen (PSA) ≤ 0.3 ng/ml as a predictor of prostate cancer mortality
  • T down-staging, complete pathological response, PSA kinetics, Testosterone kinetics, operation time, blood loss, grade of surgical difficulty
  • New generation hybrid imaging 68Ga PSMA (Prostate-Specific Membrane Antigen) PET/MR (Positron emission tomography/Magnetic Resonance) derived parameters
  • Early biochemical recurrence as prognostic factor of prostate cancer mortality
  • Transcriptome and genome
  • Tissue microarrays (TMA) protein expression (DNA repair, resistance etc.) by immunohistochemistry
  • Perioperative safety and tolerability
  • Quality of life, erection recovery, continence through validated preoperative and postoperative questionnaires pre and postop (IEEF5, ICIQ, EORTC QLQ-C30)

OUTLINE: interventional, single center, phase II, randomized, double blind, placebo controlled trial.

Being tested
ARN-509, Degarelix, Placebo
Keywords
Randomized, Placebo-controlled, Neoadjuvant, Androgen deprivation, Antiandrogen, Radical Prostatectomy
Medical subject headings
Prostatic Neoplasms

What participants receive

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

  • ARN-509Drug

    Also called apalutamide

    240mg/day (4x60mg tablets, Oral administration: OS)

  • DegarelixDrug

    1st injection: 120mg Subcutaneous administration (SC) x2, 2nd-3rd SC injection 80mg monthly

  • PlaceboOther

    4 tablets, per OS

Study groups in NCT03080116
Study groupRoleWhat they receive
ARN-509 + degarelixExperimentalTreatment period of 12 weeks before RP + PLND.
Receives: Drug: ARN-509; Drug: Degarelix
placebo + degarelixActive comparatorTreatment period of 12 weeks before RP + PLND.
Receives: Drug: Degarelix; Other: Placebo

What is being measured

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

  1. Minimal Residual Disease (MRD)

    Proportions of MRD between arms. MRD: tumor volume ≤ 0.25 cm3

    Measured: After 12 weeks of neoadjuvant therapy + RP + PLND

Secondary outcomes (26)
  1. Difference in proportions of pathological downstage

    Any decrease in T stage from clinical to pathological stage

    Measured: After 12 weeks of neoadjuvant therapy + RP + PLND

  2. Complete pathological response rates

    Difference in proportions of complete pathological response (no evidence of tumour in the postoperative specimen) between arms.

    Measured: After 12 weeks of neoadjuvant therapy + RP + PLND

  3. Difference in proportions of patients with pN1 disease.

    Difference in proportions of lymph node invasion between arms

    Measured: After 12 weeks of neoadjuvant therapy + RP + PLND

  4. Proteins expression in prostatic tumour TMA's (tissue microarrays)

    Intensity of immunoreactivity and percentage of immunoreactive cells for, selected markers between arms. The TMA's will be produced from the formalin-fixed paraffin-embedded (FFPE) specimen of the RP.

    Measured: After 12 weeks of neoadjuvant therapy + RP + PLND

  5. Transcriptome analysis by microarray expression platform

    To assess differences in the transcriptome in tumour tissue on formalin-fixed paraffin-embedded (FFPE) specimens: clinical-grade high-density oligonucleotide microarray expression platform and cloud-based informatics pipeline to interrogate 1.4M probe sets representing all known ~46K genes and non-coding RNAs.

    Measured: At baseline and after 12 weeks of neoadjuvant therapy + RP + PLND

  6. Pathway profiling and Gene Set Enrichment Analyses

    To assess differences in the transcriptome in tumour tissue on formalin-fixed paraffin-embedded (FFPE) specimens. Pathway profiling and Gene Set Enrichment Analyses will also be used to generate pathway scores for the 'androgen receptor signaling pathway'; determination of pathway scores for the DNA damage checkpoints and the different DNA repair pathways.

    Measured: At baseline and after 12 weeks of neoadjuvant therapy + RP + PLND

  7. Genomic subtyping by exome-sequencing

    Genomic subtyping (e.g., ERG, SPINK1, SPOP, FOXA1, PTEN, circulating nucleic acids (CNA) data...) will be performed based on exome-sequencing data. The exome and CNA data will be linked with the transcriptome data on androgen regulation and DNA repair pathways.

    Measured: At baseline and after 12 weeks of neoadjuvant therapy + RP + PLND

  8. PSA kinetics

    Changes of PSA during time and comparison of PSA values and changes between arms.

    Measured: Up to 40 months

  9. Testosterone kinetics

    Comparison of total and free serum testosterone and testosterone change between arms

    Measured: Up to 40 months

  10. PSA nadir </=0.3ng/ml after neoadjuvant treatment

    Differences in proportions of PSA nadir </=0.3ng/ml after neoadjuvant treatment.

    PSA nadir after neoadjuvant therapy and before external beam radiotherapy (EBRT) is an important biomarker of hormonal response and an independent prognostic factor of prostate cancer survival.

    Measured: After 12 weeks of neoadjuvant therapy before RP + PLND

  11. Peri-operative features

    Differences in peri-operative features (operative time, blood loss, grade of surgical difficulty...) will be collected to evaluate the possible effect of treatment on surgical intervention.

    Measured: up to (about) 5 hours

  12. Differences in proportions of surgical complications between arms

    Clavien-Dindo classification will be implemented to assess differences in surgical complications between the two arms.

    Measured: Up to 6 weeks post RP + PLND

  13. Continence

    Assessment of continence rates through validated preoperative and postoperative questionnaire (ICIQ)

    Measured: Up to 40 months

  14. Quality of life

    Assessment of Quality of life through validated preoperative and postoperative questionnaire (EORTC QLQ-C30)

    Measured: Up to 40 months

  15. Erection state

    Assessment of erection state through validated preoperative and postoperative questionnaire (IEEF5)

    Measured: Up to 40 months

  16. Survival

    Three years biochemical recurrence free survival

    Measured: Up to 36 months

  17. Standardized Uptake Value (SUV) on pelvic [68]Ga PSMA PET/MR per arm

    Standardized Uptake Value (SUV) change (delta) per arm comparing SUV values before and after treatment

    Measured: At baseline and after 12 weeks of neoadjuvant therapy + RP + PLND

  18. Standardized Uptake Value (SUV) on pelvic [68]Ga PSMA PET/MR between arms

    SUV delta between the two arms.

    Measured: After 12 weeks of neoadjuvant therapy + RP + PLND

  19. Standardized Uptake Value (SUV) on pelvic [68]Ga PSMA PET/MR and tumour volume

    Correlation between SUV values and the tumour volume (TV) in the RP correspondent volume of interest (VOI) at definitive pathology

    Measured: After 12 weeks of neoadjuvant therapy + RP + PLND

  20. Standardized Uptake Value (SUV) on prostate [68]Ga PSMA PET/MR and Immunohistochemistry

    Correlation between SUV values and PSMA expression at Immunohistochemistry

    Measured: After 12 weeks of neoadjuvant therapy + RP + PLND

  21. Magnetic resonance (MR) and tumor volume (TV) per arm

    Change of magnetic resonance (MR) tumor volume (TV): Tumor volume (TV) change (delta) per arm comparing TV values before and after treatment

    Measured: At baseline and after12 weeks of neoadjuvant therapy + RP + PLND

  22. Magnetic resonance (MR) and tumor volume (TV) between arms

    Change of magnetic resonance (MR) tumor volume (TV):TV deltas between the two arms.

    Measured: At baseline and after12 weeks of neoadjuvant therapy + RP + PLND

  23. PI-RADS between arms at MR

    Proportion of PI-RADS between arms

    Measured: After 12 weeks of neoadjuvant therapy + RP + PLND

  24. PI-RADS score and Gleason score

    Correlation between PI-RADS score and pathology Gleason score

    Measured: After 12 weeks of neoadjuvant therapy + RP + PLND

  25. Down-staging at imaging

    Proportion of down-staging

    Measured: At baseline and after 12 weeks of neoadjuvant therapy + RP + PLND

  26. Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]

    Frequencies of adverse events (AE), severe adverse events (SAE) and Suspected Unexpected Serious Adverse Reaction (SUSAR)

    Measured: From patient inclusion until RP + PLND

Timeline

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

  1. First posted15 Mar 2017
  2. Study start28 Mar 2019
  3. Primary completion1 Jul 2021
  4. Study completion1 Jul 2024 (estimated)

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
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
90 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03080116
Sponsor's protocol ID
S58827
Other IDs
2016-002854-19, 2016
Acronym
ARNEO
Status last verified
Jul 2024
First submitted
14 Feb 2017
Last updated
3 Jul 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Tosco L, Laenen A, Gevaert T, Salmon I, Decaestecker C, Davicioni E, Buerki C, Claessens F, Swinnen J, Goffin K, Oyen R, Everaerts W, Moris L, De Meerleer G, Haustermans K, Joniau S; P.E.A.R.L. (ProstatE cAncer Research Leuven). Neoadjuvant degarelix with or without apalutamide followed by radical prostatectomy for intermediate and high-risk prostate cancer: ARNEO, a randomized, double blind, placebo-controlled trial. BMC Cancer. 2018 Apr 2;18(1):354. doi: 10.1186/s12885-018-4275-z.

    PubMed 29606109

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing ARN-509 and Degarelix in people with Prostate Cancer and Neoadjuvant Therapy, run by Universitaire Ziekenhuizen KU Leuven at 1 site in Belgium.

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 14 inclusion and 12 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: status not confirmed, as of the sponsor's last update on 3 Jul 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Belgium. 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?

Results are not available in the source record.

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?

Minimal Residual Disease (MRD) (time frame: After 12 weeks of neoadjuvant therapy + RP + PLND). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03080116, which also lists 1 linked publication.

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 3 Jul 2024.

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