Randomized prospective phase III trial of (68)Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT]

BACKGROUND: Salvage radiotherapy (SRT) for prostate cancer (PCa) recurrence after prostatectomy offers long-term biochemical control in about 50–60% of patients. SRT is commonly initiated in patients with serum PSA levels < 1 ng/mL, a threshold at which standard-of-care imaging is insensitive for...

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Autores principales: Calais, Jeremie, Czernin, Johannes, Fendler, Wolfgang P., Elashoff, David, Nickols, Nicholas Nicholas G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322287/
https://www.ncbi.nlm.nih.gov/pubmed/30616601
http://dx.doi.org/10.1186/s12885-018-5200-1
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author Calais, Jeremie
Czernin, Johannes
Fendler, Wolfgang P.
Elashoff, David
Nickols, Nicholas Nicholas G.
author_facet Calais, Jeremie
Czernin, Johannes
Fendler, Wolfgang P.
Elashoff, David
Nickols, Nicholas Nicholas G.
author_sort Calais, Jeremie
collection PubMed
description BACKGROUND: Salvage radiotherapy (SRT) for prostate cancer (PCa) recurrence after prostatectomy offers long-term biochemical control in about 50–60% of patients. SRT is commonly initiated in patients with serum PSA levels < 1 ng/mL, a threshold at which standard-of-care imaging is insensitive for detecting recurrence. As such, SRT target volumes are usually drawn in the absence of radiographically visible disease. (68)Ga-PSMA-11 (PSMA) PET/CT molecular imaging is highly sensitive and may offer anatomic localization of PCa biochemical recurrence. However, it is unclear if incorporation of PSMA PET/CT imaging into the planning of SRT could improve its likelihood of success. The purpose of this trial is to evaluate the success rate of SRT for recurrence of PCa after prostatectomy with and without planning based on PSMA PET/CT. METHODS: We will randomize 193 patients to proceed with standard SRT (control arm 1, n = 90) or undergo a PSMA PET/CT scan (free of charge for patients) prior to SRT planning (investigational arm 2, n = 103). The primary endpoint is the success rate of SRT measured as biochemical progression-free survival (BPFS) after initiation of SRT. Biochemical progression is defined by PSA ≥ 0.2 ng/mL and rising. The randomization ratio of 1:1.13 is based on the assumption that approximately 13% of subjects randomized to Arm 2 will not be treated with SRT because of PSMA-positive extra-pelvic metastases. These patients will not be included in the primary endpoint analysis but will still be followed. The choice of treating the prostate bed alone vs prostate bed and pelvic lymph nodes, with or without androgen deprivation therapy (ADT), is selected by the treating radiation oncologist. The radiation oncologist may change the radiation plan depending on the findings of the PSMA PET/CT scan. Any other imaging is allowed for SRT planning in both arms if done per routine care. Patients will be followed until either one of the following conditions occur: 5 years after the date of initiation of randomization, biochemical progression, diagnosis of metastatic disease, initiation of any additional salvage therapy, death. DISCUSSION: This is the first randomized phase 3 prospective trial designed to determine whether PSMA PET/CT molecular imaging can improve outcomes in patients with PCa early BCR following radical prostatectomy. ACRONYM: PSMA-SRT Phase 3 trial. CLINICAL TRIAL REGISTRATION: ■ IND#130649: ◦ Submission: 04.26.2016; ◦ Safe-to-proceed letter issued by FDA: 05.25.2016; ■ UCLA IRB #18–000484, ■ First submission: 3.27.2018; ■ Date of approval: 5.31.2018; ■ UCLA JCCC Short Title NUC MED 18–000484; ■ NCI Trial Identifier NCI-2018-01518; ■ ClinicalTrials.gov Identifier NCT03582774: ■ First Submitted: 06.19.2018; ■ First Submitted that Met QC Criteria: 06.27.2018; ■ First Posted: 07.11.2018; ■ Last Update Submitted that Met QC Criteria: 07.17.2018; ■ Last Update Posted: 07.19.2018. TRIAL STATUS: Current Trial Status Active as of 08/13/2018 Trial Start Date 09/01/2018-Actual Primary Completion Date 09/01/2023-Anticipated Trial Completion Date 09/01/2024-Anticipated
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spelling pubmed-63222872019-01-09 Randomized prospective phase III trial of (68)Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT] Calais, Jeremie Czernin, Johannes Fendler, Wolfgang P. Elashoff, David Nickols, Nicholas Nicholas G. BMC Cancer Study Protocol BACKGROUND: Salvage radiotherapy (SRT) for prostate cancer (PCa) recurrence after prostatectomy offers long-term biochemical control in about 50–60% of patients. SRT is commonly initiated in patients with serum PSA levels < 1 ng/mL, a threshold at which standard-of-care imaging is insensitive for detecting recurrence. As such, SRT target volumes are usually drawn in the absence of radiographically visible disease. (68)Ga-PSMA-11 (PSMA) PET/CT molecular imaging is highly sensitive and may offer anatomic localization of PCa biochemical recurrence. However, it is unclear if incorporation of PSMA PET/CT imaging into the planning of SRT could improve its likelihood of success. The purpose of this trial is to evaluate the success rate of SRT for recurrence of PCa after prostatectomy with and without planning based on PSMA PET/CT. METHODS: We will randomize 193 patients to proceed with standard SRT (control arm 1, n = 90) or undergo a PSMA PET/CT scan (free of charge for patients) prior to SRT planning (investigational arm 2, n = 103). The primary endpoint is the success rate of SRT measured as biochemical progression-free survival (BPFS) after initiation of SRT. Biochemical progression is defined by PSA ≥ 0.2 ng/mL and rising. The randomization ratio of 1:1.13 is based on the assumption that approximately 13% of subjects randomized to Arm 2 will not be treated with SRT because of PSMA-positive extra-pelvic metastases. These patients will not be included in the primary endpoint analysis but will still be followed. The choice of treating the prostate bed alone vs prostate bed and pelvic lymph nodes, with or without androgen deprivation therapy (ADT), is selected by the treating radiation oncologist. The radiation oncologist may change the radiation plan depending on the findings of the PSMA PET/CT scan. Any other imaging is allowed for SRT planning in both arms if done per routine care. Patients will be followed until either one of the following conditions occur: 5 years after the date of initiation of randomization, biochemical progression, diagnosis of metastatic disease, initiation of any additional salvage therapy, death. DISCUSSION: This is the first randomized phase 3 prospective trial designed to determine whether PSMA PET/CT molecular imaging can improve outcomes in patients with PCa early BCR following radical prostatectomy. ACRONYM: PSMA-SRT Phase 3 trial. CLINICAL TRIAL REGISTRATION: ■ IND#130649: ◦ Submission: 04.26.2016; ◦ Safe-to-proceed letter issued by FDA: 05.25.2016; ■ UCLA IRB #18–000484, ■ First submission: 3.27.2018; ■ Date of approval: 5.31.2018; ■ UCLA JCCC Short Title NUC MED 18–000484; ■ NCI Trial Identifier NCI-2018-01518; ■ ClinicalTrials.gov Identifier NCT03582774: ■ First Submitted: 06.19.2018; ■ First Submitted that Met QC Criteria: 06.27.2018; ■ First Posted: 07.11.2018; ■ Last Update Submitted that Met QC Criteria: 07.17.2018; ■ Last Update Posted: 07.19.2018. TRIAL STATUS: Current Trial Status Active as of 08/13/2018 Trial Start Date 09/01/2018-Actual Primary Completion Date 09/01/2023-Anticipated Trial Completion Date 09/01/2024-Anticipated BioMed Central 2019-01-07 /pmc/articles/PMC6322287/ /pubmed/30616601 http://dx.doi.org/10.1186/s12885-018-5200-1 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Study Protocol
Calais, Jeremie
Czernin, Johannes
Fendler, Wolfgang P.
Elashoff, David
Nickols, Nicholas Nicholas G.
Randomized prospective phase III trial of (68)Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT]
title Randomized prospective phase III trial of (68)Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT]
title_full Randomized prospective phase III trial of (68)Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT]
title_fullStr Randomized prospective phase III trial of (68)Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT]
title_full_unstemmed Randomized prospective phase III trial of (68)Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT]
title_short Randomized prospective phase III trial of (68)Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT]
title_sort randomized prospective phase iii trial of (68)ga-psma-11 pet/ct molecular imaging for prostate cancer salvage radiotherapy planning [psma-srt]
topic Study Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322287/
https://www.ncbi.nlm.nih.gov/pubmed/30616601
http://dx.doi.org/10.1186/s12885-018-5200-1
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