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A Phase III Randomized Trial for Evaluating Second Line Hormonal Therapy (Ketoconazole/Hydrocortisone) Versus Paclitaxel/Estramustine Combination Chemotherapy on Progression Free Survival in Asymptomatic Patients With a Rising PSA After Hormonal Therapy for Prostate Cancer


Phase 3
18 Years
N/A
Not Enrolling
Male
Prostate Cancer

Thank you

Trial Information

A Phase III Randomized Trial for Evaluating Second Line Hormonal Therapy (Ketoconazole/Hydrocortisone) Versus Paclitaxel/Estramustine Combination Chemotherapy on Progression Free Survival in Asymptomatic Patients With a Rising PSA After Hormonal Therapy for Prostate Cancer


OBJECTIVES:

- Compare time to objective progression in patients with prostate cancer and a rising
prostate-specific antigen (PSA) after androgen suppression when treated with
second-line hormonal therapy (ketoconazole and hydrocortisone) vs combination
chemotherapy (docetaxel and estramustine).

- Compare time to PSA progression and correlate this with time to objective progression
in patients treated with these regimens.

- Compare the quality of life in patients treated with these regimens.

- Compare overall survival of patients treated with these regimens.

- Compare the natural history of progression in patients treated with these regimens.

- Identify prognostic indicators of clinical outcome by immunohistochemical evaluation of
apoptopic biomarkers in patients treated with these regimens.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to prior
treatment with bisphosphonates (yes vs no). Patients are randomized to 1 of 2 treatment
arms.

- Arm I: Patients receive oral ketoconazole three times daily and oral hydrocortisone
twice daily. Treatment continues in the absence of disease progression or unacceptable
toxicity.

- Arm II: Patients receive oral estramustine three times daily on days 1-5 and docetaxel
IV over 1 hour on day 2. Treatment repeats every 3 weeks for up to 6 courses in the
absence of disease progression or unacceptable toxicity.

Quality of life is assessed at baseline, on day 1 of week 9, at 6 months and 1 year, and
then annually for up to 10 years or until beginning of first non-protocol therapy.

Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then
annually for 5 years.

PROJECTED ACCRUAL: A total of 590 patients (295 per treatment arm) will be accrued for this
study within 4 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed adenocarcinoma of the prostate that was continuously treated
with androgen suppression

- Rising prostate-specific antigen (PSA), defined as PSA > 5 ng/mL, rising on 2
consecutive measurements at least 4 weeks apart

- Gleason score 7 or higher and/or seminal vesicle involvement at diagnosis

- Patients previously treated with antiandrogen or glucocorticoid therapy must meet the
following criteria:

- Must show a continued rise in PSA after stopping antiandrogen (flutamide,
bicalutamide, or nilutamide) or glucocorticoid (dexamethasone or prednisone)

- At least 4 weeks continued rise in PSA after flutamide or nilutamide (6
weeks for bicalutamide)

- Testosterone less than 50 ng/dL

- Patients who have not undergone surgical castration must continue primary
androgen suppression to maintain castrate levels of testosterone

- No progressive or measurable local or metastatic disease (including bone metastases)

PATIENT CHARACTERISTICS:

Age:

- 18 and over

Performance status:

- ECOG 0-1

Life expectancy:

- Not specified

Hematopoietic:

- Granulocyte count at least 2,000/mm^3

- Platelet count at least 100,000/mm^3

Hepatic:

- SGOT no greater than 2 times upper limit of normal

- Bilirubin no greater than 1.5 mg/dL

Renal:

- Creatinine no greater than 1.7 mg/dL

Cardiovascular:

- No American Heart Association class III or IV heart disease

- No uncontrolled congestive heart failure

- No life-threatening cardiac arrhythmias

Other:

- Fertile patients must use effective contraception

- No other prior malignancy unless curatively treated and disease-free for appropriate
time period for specific cancer

- No preexisting peripheral neuropathy greater than grade 1

- No known hypersensitivity to polysorbate 80

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- Not specified

Chemotherapy:

- At least 5 years since prior systemic chemotherapy

Endocrine therapy:

- See Disease Characteristics

- At least 4 weeks since prior hydrocortisone

- No prior ketoconazole

Radiotherapy:

- At least 28 days since prior radiotherapy to primary site

- No prior palliative radiotherapy

- No concurrent radiotherapy

Surgery:

- See Disease Characteristics

Other:

- Recovered form prior therapy

- At least 7 days since prior parenteral antibiotics for active infection

- No concurrent digitalis

- No concurrent H_2 blockers or proton pump inhibitors (arm I only)

- Concurrent bisphosphonates allowed provided they were initiated prior to study
therapy

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Primary Purpose: Treatment

Principal Investigator

Michael A. Carducci, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Sidney Kimmel Comprehensive Cancer Center

Authority:

United States: Food and Drug Administration

Study ID:

CDR0000069088

NCT ID:

NCT00027859

Start Date:

May 2003

Completion Date:

Related Keywords:

  • Prostate Cancer
  • adenocarcinoma of the prostate
  • stage III prostate cancer
  • Prostatic Neoplasms

Name

Location

Roswell Park Cancer Institute Buffalo, New York  14263
Memorial Sloan-Kettering Cancer Center New York, New York  10021
Mayo Clinic Cancer Center Rochester, Minnesota  55905
Walter Reed Army Medical Center Washington, District of Columbia  20307-5000
MBCCOP - Hawaii Honolulu, Hawaii  96813
University of Chicago Cancer Research Center Chicago, Illinois  60637
Indiana University Cancer Center Indianapolis, Indiana  46202-5265
Fox Chase Cancer Center Philadelphia, Pennsylvania  19111
CCOP - Kansas City Kansas City, Missouri  64131
CCOP - Southern Nevada Cancer Research Foundation Las Vegas, Nevada  89106
CCOP - Southeast Cancer Control Consortium Winston-Salem, North Carolina  27104-4241
Veterans Affairs Medical Center - Atlanta (Decatur) Decatur, Georgia  30033
CCOP - Illinois Oncology Research Association Peoria, Illinois  61602
CCOP - Carle Cancer Center Urbana, Illinois  61801
Veterans Affairs Medical Center - Indianapolis (Roudebush) Indianapolis, Indiana  46202
CCOP - Kalamazoo Kalamazoo, Michigan  49007-3731
Boulder Community Hospital Boulder, Colorado  80301-9019
Penrose Cancer Center at Penrose Hospital Colorado Springs, Colorado  80933
Porter Adventist Hospital Denver, Colorado  80210
Presbyterian - St. Luke's Medical Center Denver, Colorado  80218
St. Joseph Hospital Denver, Colorado  80218
Swedish Medical Center Englewood, Colorado  80110
Sky Ridge Medical Center Lone Tree, Colorado  80124
Hope Cancer Care Center at Longmont United Hospital Longmont, Colorado  80502
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Medical College of Wisconsin Cancer Center Milwaukee, Wisconsin  53226
CCOP - Cedar Rapids Oncology Project Cedar Rapids, Iowa  52403-1206
CCOP - Ochsner New Orleans, Louisiana  70121
CCOP - Sioux Community Cancer Consortium Sioux Falls, South Dakota  57105-1080
NYU School of Medicine's Kaplan Comprehensive Cancer Center New York, New York  10016
Veterans Affairs Outpatient Clinic - Martinez Martinez, California  94553
CCOP - Central Illinois Springfield, Illinois  62526
Veterans Affairs Medical Center - Lexington Lexington, Kentucky  40511-1093
CCOP - Columbus Columbus, Ohio  43206
Veterans Affairs Medical Center - Dayton Dayton, Ohio  45428
Western Pennsylvania Hospital Pittsburgh, Pennsylvania  15224
Harrington Cancer Center Amarillo, Texas  79106
Martha Jefferson Hospital Charlottesville, Virginia  22901
University of Wisconsin Comprehensive Cancer Center Madison, Wisconsin  53792
Ellis Fischel Cancer Center at University of Missouri - Columbia Columbia, Missouri  65203
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire  03756-0002
MBCCOP - University of New Mexico HSC Albuquerque, New Mexico  87131
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Columbus, Ohio  43210-1240
CCOP - Geisinger Clinic and Medical Center Danville, Pennsylvania  17822-2001
Abramson Cancer Center at the University of Pennsylvania Philadelphia, Pennsylvania  19104
Vanderbilt-Ingram Cancer Center at Vanderbilt Medical Center Nashville, Tennessee  37232-2516
CCOP - Scott and White Hospital Temple, Texas  76508
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore, Maryland  21231-2410
CCOP - St. Vincent Hospital Cancer Center, Green Bay Green Bay, Wisconsin  54301
Cleveland Clinic Taussig Cancer Center Cleveland, Ohio  44195
Veterans Affairs Medical Center - Tucson Tucson, Arizona  85723
Veterans Affairs Medical Center - Denver Denver, Colorado  80220
Veterans Affairs Medical Center - Wichita Wichita, Kansas  67218
MBCCOP - LSU Health Sciences Center New Orleans, Louisiana  70112
Veterans Affairs Medical Center - Shreveport Shreveport, Louisiana  71130
Veterans Affairs Medical Center - Detroit Detroit, Michigan  48201-1932
Veterans Affairs Medical Center - Jackson Jackson, Mississippi  39216
Veterans Affairs Medical Center - Albuquerque Albuquerque, New Mexico  87108-5138
Veterans Affairs Medical Center - Cincinnati Cincinnati, Ohio  45220-2288
Veterans Affairs Medical Center - Portland Portland, Oregon  97207
Veterans Affairs Medical Center - Charleston Charleston, South Carolina  29401-5799
Veterans Affairs Medical Center - San Antonio (Murphy) San Antonio, Texas  78284
Veterans Affairs Medical Center - Temple Temple, Texas  76504
Veterans Affairs Medical Center - Salt Lake City Salt Lake City, Utah  84148
Veterans Affairs Medical Center - Seattle Seattle, Washington  98108
Veterans Affairs Medical Center - New Orleans New Orleans, Louisiana  70112
Naval Medical Center - San Diego San Diego, California  92134-3202
Veterans Affairs Medical Center - Syracuse Syracuse, New York  13210
Rebecca and John Moores UCSD Cancer Center La Jolla, California  92093-0658
City of Hope Comprehensive Cancer Center Duarte, California  91010
UCSF Comprehensive Cancer Center San Francisco, California  94115
West Suburban Center for Cancer Care River Forest, Illinois  60305
Cape Fear Valley Health System Fayetteville, North Carolina  28302-2000
Veterans Affairs Medical Center - Amarillo Amarillo, Texas  79106
St. Mary's Medical Center Huntington, West Virginia  25701
CCOP - Colorado Cancer Research Program, Incorporated Denver, Colorado  80224
Veterans Affairs Medical Center - Tampa (Haley) Tampa, Florida  33612
Oklahoma University Medical Center Oklahoma City, Oklahoma  73104
CCOP - Toledo Community Hospital Toledo, Ohio  43623-3456
Mount Sinai Medical Center New York, New York  10029
Comprehensive Cancer Institute Huntsville, Alabama  35801
Veterans Affairs Medical Center - Little Rock Little Rock, Arkansas  72205
Veterans Affairs Medical Center - Hines Hines, Illinois  60141
Greenebaum Cancer Center at University of Maryland Medical Center Baltimore, Maryland  21201
New Hampshire Oncology-Hematology, PA - Hooksett Hooksett, New Hampshire  03106
Oncology and Hematology Associates of Southwest Virginia, Incorporated - Roanoke Roanoke, Virginia  24014
Lakeland Cancer Care Center at Lakeland Hospital - St. Joseph Saint Joseph, Michigan  49085
Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School New Brunswick, New Jersey  08903
Cedars-Sinai Comprehensive Cancer Center at Cedars-Sinai Medical Center Los Angeles, California  90048
Decatur Memorial Hospital Cancer Care Institute Decatur, Illinois  62526
Memorial Regional Cancer Center at Memorial Regional Hospital Hollywood, Florida  33021
St. Mary-Corwin Regional Medical Center Pueblo, Colorado  81004
CCOP - Mayo Clinic Scottsdale Oncology Program Scottsdale, Arizona  85259
H. Lee Moffitt Cancer Center and Research Institute at University of South Florida Tampa, Florida  33612
Missouri Baptist Cancer Center St. Louis, Missouri  63131
Medical Center of Aurora - South Campus Aurora, Colorado  80012-0000
Rocky Mountain Cancer Centers - Denver Rose Denver, Colorado  80220
Rocky Mountain Cancer Centers - Thornton Thornton, Colorado  80229