A Phase 2 Randomized Trial in Patients With Metastatic Castration Resistant Prostate Cancer to Determine the Efficacy of a Flexible Dosing Schedule of Lu-PSMA Treatment up to 12 Cycles Including Potential Treatment Holiday Periods in Comparison to the Standard Fixed Dosing Schedule of Six Cycles Every Six Weeks (FLEX-MRT)
Jonsson Comprehensive Cancer Center
Summary
In advanced metastatic castration resistant prostate cancer (mCRPC) progressing after chemotherapy and androgen receptor (AR)-targeted therapy 177Lu-PSMA-617 is an effective treatment. 177Lu-PSMA-617 RLT is administered with a fixed schedule: 6 treatment cycles, administered every 6 weeks. However, the optimum number of cycles of 177Lu-PSMA in patients who show good response remains unknown. Some patients may benefit from more than 6 cycles of therapy. Additionally, some patients experience a complete or almost complete response before the last cycle. It is unclear whether these patients benefit from the subsequent remaining treatment cycle(s). A treatment holiday period would spare these patients some exposure to the therapy agent and avoid potentially unnecessary toxicity when treatment efficacy is already maximal and additional treatment effect cannot be expected. This randomized phase 2 study compares a group of patients treated with LuPSMA on a flexible and extended dosing schedule including "treatment holiday" periods (investigational arm, up to 12 cycles, as described below) to a control group treated with a fixed dosing schedule of 6 treatments cycles maximum administered every 6 weeks. The flexible dosing schedule in the investigational arm will be based on single photon emission computed tomography (SPECT)/computed tomography (CT) response assessments obtained 24h after injection of LuPSMA therapy cycle. The response assessment during treatment holiday period will be based on positron emission tomography/computed tomography (PET/CT) every 12 weeks. Single-time point SPECT/CT dosimetry protocol at every cycle will be performed and will allow to determine the number of cycles that subjects may receive under the study without exceeding the kidney dose threshold.
Description
PRIMARY OBJECTIVE: I. To assess a potential survival benefit (2-year survival rate) of patients treated with Lu 177 vipivotide tetraxetan (177Lu-PSMA-617) therapy on a flexible dosing schedule including up to 12 cycles and potential "treatment holiday" periods in comparison to patients treated with the standard fixed dosing schedule of maximum 6 treatment cycles every 6 weeks. SECONDARY OBJECTIVES: I. To determine the safety of the flexible/extended schedule of 177Lu-PSMA-617 therapy. II. To compare the overall survival (OS) of the flexible/extended schedule of 177Lu-PSMA-617 therapy to th…
Eligibility
- Age range
- 18+ years
- Sex
- Male
- Healthy volunteers
- No
Inclusion Criteria: * Patients must have prostate cancer proven by histopathology * Patients must have ≥ 1 metastatic lesion by any imaging (CT, magnetic resonance imaging \[MRI\], bone scan, PET) * Patients must have received at least one regimen of chemotherapy for mCRPC * Patients must have received at least one androgen-receptor signaling inhibitors (ARSI) * Patients must be eligible by PSMA PET VISION criteria. PSMA PET/CT must be performed within 8 weeks of planned first cycle of 177Lu-PSMA-617 * White blood cell (WBC) ≥ 2,500/ul * Platelets (PLT) ≥ 100,000/ul * Hemoglobin (Hb) ≥ 9.0 g/…
Interventions
- ProcedureComputed Tomography
Undergo PSMA PET/CT, SPECT/CT, PET/CT and CT
- OtherGallium Ga 68 Gozetotide
Given IV
- DrugLutetium Lu 177 Vipivotide Tetraxetan
Given IV
- ProcedurePositron Emission Tomography
Undergo PET/CT
- ProcedurePSMA PET Scan
Undergo PSMA PET/CT
- OtherQuestionnaire Administration
Ancillary studies
- ProcedureSingle Photon Emission Computed Tomography
Location
- UCLA / Jonsson Comprehensive Cancer CenterLos Angeles, California