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Prostate CancerPhase 3CARLHA-2NCT04181203

Combined Apalutamide, Radiotherapy, and LHRH Agonist in Prostate Cancer Patients After Prostatectomy

A Phase 3 study testing Apalutamide, Salvage radiotherapy (SRT) and Luteinising Hormone Releasing Hormone agonist (LHRHa) in people with Prostate Cancer, run by UNICANCER at 15 sites in France.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

This is a multicenter, randomized, open label, phase III study comparing the efficacy and safety of apatulamide combined with concomitant prostate-bed salvage radiotherapy (SRT) and androgen deprivation therapy (ADT) versus concomitant prostate-bed SRT and ADT in high-risk postprostatectomy biochemically relapsed… Read more about this study

Who is it for?
Ages 18 to 80 years, men only
Conditions the study is for
Prostate Cancer
What is being tested?
Apalutamide, Salvage radiotherapy (SRT) and Luteinising Hormone Releasing Hormone agonist (LHRHa)
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
490 participants
Where
15 sitesFrance
Study dates
9 Jan 2020to 28 Dec 2033
Phase
Phase 3
Are there results?
Not yet: the study is under way

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

  • Patients must have signed a written informed consent form prior to any trial specific procedures
  • Age ≥18 years old and ≤80 years old
  • Histologically confirmed diagnosis of prostate adenocarcinoma treated primarily with radical prostatectomy
  • Tumor stage pT2, pT3 or pT4* (*only in case of bladder neck involvement)
  • Patients should have no clinical and radiological signs (18FCH-PET CT-scan or 68Ga-PSMA-PET CT-scan) of metastatic disease. Patients with a local relapse or pelvic nodal relapse (N1) detected on PET CT-scan can be randomized
  • Eastern Cooperative Oncology Group (ECOG) performance status ≤1
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  • PSA ≥0.2 ng/mL at the time of randomization with an elevation of PSA over three consecutive assays. PSA increases over a 1-month interval minimum
  • At least 3 months between radical prostatectomy and randomization.
  • High-risk features as defined by at least one of these characteristics: PSA at relapse >0.5 ng/mL or Gleason score >7 or tumor stage pT3b or resection margins R0 or PSA doubling time ≤6 months or pelvic lymph node relapse (N1, ≤5 lymph nodes)
  • Adequate renal function: serum creatinine <1.5 x upper limit of normal (ULN) or a calculated corrected creatinine clearance ≥60 mL/min according to the Cockcroft-Gault formula, creatinemia <2 ULN
  • Adequate hepatic function: total bilirubin ≤1.5 x ULN (unless documented Gilbert's syndrome), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5 x ULN
  • Patients with QTc prolongation <500 ms, inclusion should considered after close benefit/risk assessment and cardiologist advice
  • Patients must be willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations
  • Patients must be affiliated to the Social Security System

Who cannot join

  • Previous treatment with hormone therapy for prostate cancer
  • Histology other than adenocarcinoma
  • Surgical or chemical castration
  • Other malignancy except adequately treated basal cell carcinoma of the skin or other malignancy from which the patient has been cured for at least 5 years
  • Previous pelvic radiotherapy
  • More than 5 (>5) pelvic lymph node relapses
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  • Paraaortic, thoracic or supaclavicular nodal relapse (M1a)
  • History of Inflammatory bowel disease or any malabsorption syndrome or conditions that would interfere with enteral absorption
  • Uncontrolled hypertension (defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg). Patients with a history of hypertension are allowed provided blood pressure is controlled by anti-hypertensive treatment
  • Clinically significant history of liver disease consistent with Child-Pugh class B or C
  • History of seizure or condition that may pre-dispose to seizure (including, but not limited to prior stroke, transient ischemic attack or loss of consciousness ≤1 year prior to randomization; brain arteriovenous malformation or intracranial masses such as schwannomas and meningiomas that are causing edema or mass effect)
  • Medications known to lower the seizure threshold must be discontinued or substituted at least 4 weeks prior to study entry
  • Severe or 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
  • Certain risk factors for abnormal heart rhythms/QT prolongation: torsade de pointes ventricular arrhythmias (e.g, heart failure, hypokalemia, or a family history of a long QT syndrome), a QT or corrected QT (QTc) interval >500 ms at baseline
  • Medications known to prolong QTc
  • Known hypersensitivity to apalutamide or to any of its components
  • Galactosemia, Glucose-galactose malabsorption or lactase deficiency
  • Inability or willingness to swallow oral medication
  • Individual deprived of liberty or placed under the authority of a tutor
  • Patients already included in another therapeutic trial with an experimental drug or having been given an experimental drug within the 30 days before inclusion

Trial locations and contacts

15 sites in 1 country.

15 sites in 1 country

France15 sites
  • Clinique Claude Bernard

    Albi

  • Institut de Cancérologie de l'Ouest

    Angers

  • Institut Bergonié

    Bordeau

  • Centre Georges François LECLERC

    Dijon

  • Centre Hospitalier Emile ROUX

    Le Puy-en-Velay

  • Centre Oscar Lambret

    Lille

  • Institut de Cancérologie de Montpellier

    Montpellier

  • Centre Antoine Lacassagne

    Nice

  • Institut Jean Godinot

    Reims

  • Centre Henri Becquerel

    Rouen

  • Institut de Cancérologie de l'Ouest

    Saint-Herblain

  • Institut de Cancérologie de la Loire Lucien Neuwirth

    Saint-Priest-en-Jarez

  • Institut de Cancérologie Paris Nord

    Sarcelles

  • Centre Paul STRAUSS

    Strasbourg

  • Clinique Pasteur - ONCORAD

    Toulouse

Other trials in France

About this study

Official title: An Open Label, Randomized, Phase III Study, Evaluating the Efficacy of a Combination of Apalutamide With Radiotherapy and LHRH Agonist in High-risk Postprostatectomy Biochemically Relapsed Prostate Cancer Patients

This is a multicenter, randomized, open label, phase III study comparing the efficacy and safety of apatulamide combined with concomitant prostate-bed salvage radiotherapy (SRT) and androgen deprivation therapy (ADT) versus concomitant prostate-bed SRT and ADT in high-risk postprostatectomy biochemically relapsed prostate cancer patients.

Read the detailed description

The purpose of the CARLHA-2 study is to determine if the combination of apalutamide with 6 months of LHRH agonists and radiotherapy results in an improvement of progression-free survival (PFS) in comparison to the combination of 6 months of LHRH agonists with radiotherapy in high-risk postprostatectomy biochemically relapsed prostate cancer patients.

Radical prostatectomy must have been done at least 6 months before inclusion and is not part of this study.

Patients after radical prostatectomy and biochemical relapse will be randomized in a 1:1 ratio to receive either 6 months of LHRH agonists + SRT or 6 months of LHRH agonists + SRT + 6 months of apalutamide.

The stratification variables include Gleason score, prostate-specific antigen (PSA), negative resection margins, extension to seminal vesicle(s), and PSA doubling time.

Conditions
Prostate Cancer
Being tested
Apalutamide, Salvage radiotherapy (SRT), Luteinising Hormone Releasing Hormone agonist (LHRHa)
Keywords
Apalutamide, Salvage radiotherapy, Radical prostatectomy, PSA
Medical subject headings
Prostatic Neoplasms

What participants receive

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

  • ApalutamideDrug

    Also called ARN-509

    240 mg PO daily should start the same day as the first LHRHa administration for 6 months.

    months.

  • Salvage radiotherapy (SRT)Radiation

    The SRT treatment will be administered to a total dose of 66 Gy (in 33 fractions of 2 Gy) directed at the prostate bed with an additional 56.1 Gy (in 33 fractions of 1.7 Gy) directed at the pelvis region. The pelvis will be irradiated in all patients.

    An additional simultaneously integrated boost of 69.3 Gy (in 33 fractions of 2.1 Gy) can be delivered to a local relapse based on Positron Emission Tomography - Computed Tomography (PET/CT) and Magnetic Resonance Imaging (MRI) images.

  • Luteinising Hormone Releasing Hormone agonist (LHRHa)Drug

    Also called leuprolide, goserelin, triptorelin acetate

    Doses of LHRHa may vary due to availability of different brand names and pharmaceutical forms. It will be left to the discretion of the investigator.

Study groups in NCT04181203
Study groupRoleWhat they receive
SRT + 6 months of LHRHaActive comparator* Treatment with LHRHa will start 4 weeks before the first RT fraction (i.e Day 1 of Week 1 of treatment period.) The total duration of the LHRHa treatment is 6 months. * SRT will start 4 weeks after the first administration of LHRHa (i.e Day 1 of Week 5 of treatment period.). The total duration of SRT is 6.5 weeks.
Receives: Radiation: Salvage radiotherapy (SRT); Drug: Luteinising Hormone Releasing Hormone agonist (LHRHa)
SRT + 6 months of LHRHa + 6 months of ApalutamideExperimental* Treatment with LHRHa will start 4 weeks before the first RT fraction (i.e Day 1 of Week 1 of treatment period.) The total duration of the LHRHa treatment is 6 months. * Treatment with apalutamide (240 mg PO daily) should start the same day as the first LHRHa administration, for 6 months. * SRT will start 4 weeks after the first administration of LHRHa (i.e Day 1 of Week 5 of treatment period.). The total duration of SRT is 6.5 weeks.
Receives: Drug: Apalutamide; Radiation: Salvage radiotherapy (SRT); Drug: Luteinising Hormone Releasing Hormone agonist (LHRHa)

What is being measured

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

  1. Progression-free survival (PFS)

    PFS is defined as the time from the date of randomization to the date of first evidence of loco-regional recurrences, or distant metastases, or death from any cause whichever occurs first, or the date of last known follow-up alive without any such events.

    Measured: 5 years

Secondary outcomes (9)
  1. Cancer-specific overall survival

    Cancer-specific overall survival is defined as the time from the date of randomization to the date of death related to prostate cancer or the date of last known follow-up alive.

    Measured: 10 years

  2. Overall survival (OS)

    OS is defined as the time from the date of randomization to the date of death from any cause or the date of last known follow-up alive.

    Measured: 10 years

  3. Biochemical relapse-free survival

    Biochemical relapse-free survival will be retrospectively defined by the interval between the date of randomization and the date of the first PSA elevation following the 6-months treatment in both arms (PSA ≥0.5 ng/mL confirmed by two consecutive PSA increases over a 2-month interval).

    Measured: 10 years

  4. Time to castration resistance

    The time to castration resistance is defined as the time from the date of randomization to the date of appearance of castration resistance defined in the European Association of Urology (EAU) guidelines.

    Measured: 10 years

  5. Adverse events graded according to the NCI Common Terminology Criteria for Adverse Events version 5.0

    The NCI Common Terminology Criteria for Adverse Events is a descriptive terminology which can be utilized for Adverse Event (AE) reporting. A grading (severity) scale is provided for each AE term.

    Measured: Throughout study completion, up to 10 years

  6. Quality of life questionnaire - Core 30 (QLQ-C30)

    Developed by the EORTC, this self-reported questionnaire assesses the health-related quality of life of cancer patients in clinical trials.

    The questionnaire includes five functional scales (physical, everyday activity, cognitive, emotional, and social), three symptom scales (fatigue, pain, nausea and vomiting), a health/quality of life overall scale, and a number of additional elements assessing common symptoms (including dyspnea, loss of appetite, insomnia, constipation, and diarrhea), as well as, the perceived financial impact of the disease.

    All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level.

    Measured: At baseline, 3 months, 6 months, every 6 months up to 5 years then every 12 months up to 10 years

  7. Quality of Life Questionnaire - Prostate Cancer Module (QLQ-PR25)

    This EORTC prostate cancer specific questionnaire is intended to supplement the QLQ-C30.

    The prostate cancer module is a 25-item questionnaire designed for use among patients with localized and metastatic prostate cancer. It includes subscales assessing urinary symptoms (9 items), bowel symptoms (4 items), treatment-related symptoms (6 items) and sexual functioning (6 items). Using a 4-point Likert scale (1 = "not at all", 2 = "a little", 3 = "quite a bit", and 4 = "very much"), patients indicate the degree to which they have experienced symptoms.

    Measured: At baseline, 3 months, 6 months, every 6 months up to 5 years then every 12 months up to 10 years

  8. International Index of Erectile Function (IIEF-5)

    International Index of Erectile Function (IIEF-5) is multidimensional, self-administered questionnaire composed of 15 questions that examine the 4 main domains of male sexual function (erectile function [6 items], orgasmic function [2 items], sexual desire [2 items], and intercourse satisfaction [3 items]) and overall satisfaction (2 items). Using a 6-point Likert scale (questions 1 to 10) and 5-point Likert scale (questions 15 to 15), patients indicate the degree to which they have experienced symptoms. The total score for each domain can therefore classifies the severity of erectile dysfunction into five categories: no (score 26-30), mild (22-25), mild to moderate (17-21), moderate (11-16), and severe (1-10) erectile dysfunction.

    Measured: At baseline, 3 months, 6 months, every 6 months up to 5 years then every 12 months up to 10 years

  9. Lawton Instrumental Activities of Daily Living (IADL) Scale

    Lawton Instrumental Activities of Daily Living (IADL) Scale is a self-reported questionnaire to assess independent living skills for older adults. This questionnaire, composed of 31 questions organized into 8 domains (ability to use telephone, shopping, food preparation, housekeeping, laundering, mode of transportation, responsibility for own medications, and ability to handle finances), is designed to identify improvement or deterioration of a person functioning over time. Each domain is scored 0-1 for a summary score ranging from 0 (low function, dependent) to 8 (high function, independent).

    Measured: At baseline, 3 months, 6 months, every 6 months up to 5 years then every 12 months up to 10 years

Timeline

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

  1. First posted29 Nov 2019
  2. Study start9 Jan 2020
  3. Primary completion28 Sep 2028 (estimated)
  4. Study completion28 Dec 2033 (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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
490 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04181203
Sponsor's protocol ID
GETUG-AFU33 UC-0160/1702
Other IDs
2017-000155-21, 2017
Acronym
CARLHA-2
Status last verified
Jun 2025
First submitted
26 Nov 2019
Last updated
30 Jul 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Apalutamide, Salvage radiotherapy (SRT) and Luteinising Hormone Releasing Hormone agonist (LHRHa) in people with Prostate Cancer, run by UNICANCER at 15 sites in France.

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 20 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: under way, not looking for participants, as of the sponsor's last update on 30 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 15 sites in France. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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?

Progression-free survival (PFS) (time frame: 5 years). 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 30 Jul 2025.

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