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Trial · Interventional

CompletedPhase 2Results postedRegistry data

A Salvage Trial of AR Inhibition With ADT and Apalutamide With Radiation Therapy Followed by Docetaxel in Men With PSA Recurrent Prostate Cancer After Radical Prostatectomy (STARTAR)

This trial does not test a peptide that PepBank tracks.

  • Names Degarelix, does not test it. It appears in the description.
  • Names Goserelin, does not test it. It appears in the description.
  • Names Leuprolide, does not test it. It appears in the description.
  • Names Triptorelin (Trelstar, Decapeptyl), does not test it. It appears in the description.

Overview

Status
Completed
Phase
Phase 2
Enrollment
39 participants (actual)
Sponsor
Andrew J. Armstrong, MD · Other
Design
Allocation not applicable · Open label (no masking)
Countries
1 country

United States

Start
28 Mar 2018
Primary completion
22 Dec 2022
Completion
22 Dec 2022
First posted
17 Oct 2017
Last update posted
19 Mar 2024
Conditions
Prostate Cancer

Timeline

1 trial · 1 completed · 1 with posted results

  • Completed
  • Ongoing
  • Not yet recruiting
  • Stopped
  • Estimated dates (est.)
  • Results posted
201820192020202120222023
  1. Ph 2

    A Salvage Trial of AR Inhibition With ADT and Apalutamide With Radiation Therapy Followed by Docetaxel in Men With PSA Recurrent Prostate Cancer After Radical Prostatectomy (STARTAR)

    NCT03311555

    28 Mar 2018 to 22 Dec 2022

Registry summary

Text and fields below are the sponsor's entries at ClinicalTrials.gov, shown as posted.

The purpose of this study is to describe the rate of 3-year progression free survival in men with recurrent PSA-only disease after prostatectomy, who receive combined apalutamide (ARN-509) and standard ADT with salvage radiation therapy followed by docetaxel, ADT, and apalutamide, AND who have had testosterone recovery to \>100 ng/dl at 36 months. The hypothesis is that AR inhibition with apalutamide added to standard salvage external beam radiation with androgen deprivation therapy, as well as the addition of 6 cycles of docetaxel, will further prolong progression free survival.

Interventions

  • ApalutamideDrug
  • Androgen deprivationDrug
  • Salvage radiation therapyRadiation
  • DocetaxelDrug

Arms1

  • Experimental

    Recurrent PSA-only non-metastatic prostate cancer

    Subjects with recurrent PSA-only prostate cancer within 4 years of prostatectomy, and a PSA of greater than 0.2 ng/mL and less than 4 ng/mL in the absence of metastatic disease on CT and bone scans.

Primary outcomes1

Outcomes the sponsor listed as primary.

  1. Progression-free Survival (PFS) at 36 Months (3 Years)

    Time frame · up to 36 months

    Registry description

    The percentage of subjects with testosterone \>100 ng/dl at 36 months post-Cycle 1 Day 1 without one or more of the following: Serum PSA value of 0.2 ng/mL or more above the post-radiotherapy PSA nadir and confirmed (at least) 4 weeks later by a second PSA measurement higher than the first by any amount; Continued rise in the PSA level following study treatment if no nadir is experienced, defined as 2 rising values greater than the baseline PSA and separated by at least 4 weeks; Evidence of clinical progression or initiation of systemic therapy for progressive disease; Death

Secondary outcomes(8)
  1. Number of Participants With a PSA of <0.1 ng/mL and Testosterone Recovery at 12 Months Post-Cycle 1 Day 1

    Time frame · 12 months

    Registry description

    Testosterone recovery defined as testosterone \>100 ng/dl

  2. Percentage of Participants With a PSA of <0.1 ng/mL and Testosterone Recovery at 24 Months Post-Cycle 1 Day 1

    Time frame · 24 months

    Registry description

    Testosterone recovery defined as testosterone \>100 ng/dl

  3. Percentage of Participants With a PSA of <0.1 ng/mL and Testosterone Recovery at 36 Months Post-Cycle 1 Day 1

    Time frame · 36 months

    Registry description

    Testosterone recovery defined as testosterone \>100 ng/dl

  4. Biochemical Progression-free Survival (PFS) at 36 Months (3 Years)

    Time frame · 36 months

    Registry description

    Percentage of participants still alive without disease progression based on PSA (prostate-specific antigen) only. Must have serum PSA value of 0.2 ng/mL or more above the post-radiotherapy PSA nadir and confirmed (at least) 4 weeks later by a second PSA measurement higher than the first by any amount.

  5. Median PSA Nadir Value

    Time frame · 36 months

    Registry description

    Median PSA nadir value

  6. Time to Testosterone Recovery

    Time frame · up to 36 months

    Registry description

    Testosterone recovery defined as testosterone \>100 ng/dl

  7. Percentage of Participants With Adverse Events as Assessed by CTCAE v4.0

    Time frame · up to 36 months

    Registry description

    To describe the safety, feasibility and tolerability profile of combination apalutamide, ADT, and radiation therapy followed by apalutamide, ADT, and docetaxel as assessed by NCI common toxicity scales

  8. Percentage of Participants Completing All Treatments

    Time frame · 36 months

    Registry description

    To describe the percentage of participants completing all treatments including salvage radiation therapy and 6 cycles of docetaxel

Posted results

Values are shown as posted at ClinicalTrials.gov, with their units. PepBank has not converted, pooled or compared them.

Primary outcome results

Primary outcomeNumber· up to 36 months

Progression-free Survival (PFS) at 36 Months (3 Years)

GroupValue (percentage of participants)
Recurrent PSA-only Non-metastatic Prostate Cancer69.2
Secondary and other outcome results(7)
Secondary outcomeCount of participants· 12 months

Number of Participants With a PSA of <0.1 ng/mL and Testosterone Recovery at 12 Months Post-Cycle 1 Day 1

GroupValue (Participants)
Recurrent PSA-only Non-metastatic Prostate Cancer38
Secondary outcomeNumber· 24 months

Percentage of Participants With a PSA of <0.1 ng/mL and Testosterone Recovery at 24 Months Post-Cycle 1 Day 1

GroupValue (percentage of participants)
Recurrent PSA-only Non-metastatic Prostate Cancer67
Secondary outcomeNumber· 36 months

Percentage of Participants With a PSA of <0.1 ng/mL and Testosterone Recovery at 36 Months Post-Cycle 1 Day 1

GroupValue (percentage of participants)
Recurrent PSA-only Non-metastatic Prostate Cancer69
Secondary outcomeNumber· 36 months

Biochemical Progression-free Survival (PFS) at 36 Months (3 Years)

GroupValue (percentage of participants)
Recurrent PSA-only Non-metastatic Prostate Cancer69.2
Secondary outcomeMedian· 36 months

Median PSA Nadir Value

GroupValue (ng/mL)Spread
Recurrent PSA-only Non-metastatic Prostate CancerNANA
Secondary outcomeMedian· up to 36 months

Time to Testosterone Recovery

GroupValue (months)
Recurrent PSA-only Non-metastatic Prostate Cancer15
Secondary outcomeNumber· up to 36 months

Percentage of Participants With Adverse Events as Assessed by CTCAE v4.0

GroupValue (percentage of participants)
Recurrent PSA-only Non-metastatic Prostate Cancer100

Adverse events, as posted

Adverse events as posted: participants affected out of participants at risk, by group
GroupDeathsSerious eventsOther events
Recurrent PSA-only Non-metastatic Prostate CancerSubjects with recurrent PSA-only prostate cancer within 4 years of prostatectomy, and a PSA of greater than 0.2 ng/mL and less than 4 ng/mL in the absence of metastatic disease on CT and bone scans. Apalutamide: 240mg tablet daily for 36 weeks Androgen deprivation: ADT will consist of treatment with a GnRH agonist or antagonist per physician and institutional preference. Either leuprolide acetate (Lupron Depot, 22.5 mg or 45 mg IM), triptorelin pamoate (Trelstar, 11.25 mg or 22.5 mg IM), goserelin acetate (Zoladex, 10.8mg SC) or degarelix (Firmagon 120 mg or 240 mg SC) will be administered monthly, every 3 months, or every 6 months, depending on institutional standards, for 36 weeks total. Salvage radiation therapy: On week 9 (+/- 28 days), subjects will begin salvage radiation therapy to the prostate bed. The total dose to the prostate bed must be 66-74 Gy in 1.8-2 Gy daily fractions over a total of 6-8 weeks Docetaxel: About 4 weeks (+/- 2 weeks, pending recovery of adverse events from radiation to Grade 2 or less) after completing radiation, patients will start docetaxel 75mg/m2 intravenously, every 3 weeks for 6 cycles.0 / 394 / 3939 / 39

Each cell reads participants affected / participants at risk, as the registry posted them.

Registry data comes from ClinicalTrials.gov. Study results come from studies, not from the registry. How PepBank works

Studies0

Studies that cite this trial.

No study cites this trial.

Eligibility

Who could join, as posted.

Sex
Male
Age
from 18 Years
Healthy volunteers
Not accepted
Inclusion and exclusion criteria, as posted
Inclusion Criteria: 1. Histologically-confirmed diagnosis of prostate adenocarcinoma. Variants of prostate cancer, including neuroendocrine features and small cell carcinoma of the prostate, are not permitted. 2. Gleason sum of 7 (with pT3 disease or positive margins or positive nodes \[4 or fewer\]), 8, 9, or 10 based on the radical prostatectomy specimen 3. PSA relapse within 4 years of prostatectomy defined by persistently detectable or rising PSA after surgery. 4. Evidence of disease recurrence or progression as evidenced by a PSA \> 0.20. This requires 2 consecutive rises in PSA, at least 1 week apart, over the post-prostatectomy nadir OR one PSA value above 0.20 ng/mL IF the patient failed to achieve a post-prostatectomy nadir of \< 0.2 ng/mL. 5. Age ≥ 18 years 6. Karnofsky performance status ≥ 80 7. Adequate laboratory parameters * Adequate bone marrow function: ANC ≥1.5 x 109/L, Platelets ≥100 x 109/L, Hb \>9g/dL * AST/SGOT and ALT/SGPT ≤ 2.5 x Institutional Upper Limit of Normal (ULN) * Serum bilirubin ≤ 1.5 x Institutional ULN (In subjects with Gilbert's syndrome, if total bilirubin is \> 1.5xULN, measure direct and indirect bilirubin and patient is eligible if direct bilirubin ≤ 1.5xULN). * Glomerular filtration rate (either estimated or calculated from 24-hour urine collection) ≥ 45 mL/min * Serum potassium ≥3.5 mmol/L 8. A minimum of 4 weeks from any major surgery prior to Cycle 1 Day 1. 9. Ability to swallow, retain, and absorb oral medication. 10. Ability to understand and the willingness to sign a written informed consent document. 11. Must use a condom if having sex with a pregnant woman. 12. Male patient and his female partner who is of childbearing potential must use 2 acceptable methods of birth control (one of which must include a condom as a barrier method of contraception) starting at screening and continuing throughout the study period and for 3 months after final study drug administration. Exclusion Criteria: 1. Radiographic evidence of metastatic disease. Patients with node-positive disease (≤4 positive nodes) at the time of radical prostatectomy are eligible. Patients with pelvic nodes less than 1.5 cm by short axis at the time of screening are eligible. Patients with any enlarged lymph nodes in the retroperitoneum or above the aortic bifurcation or with pelvic nodes ≥ 1.5 cm must be excluded. 2. PSA ≥ 4.0 ng/mL. 3. Testosterone level ≤ 100 ng/dL. 4. More than 1 month of prior hormone exposure or hormone exposure within 30 days of enrollment (up to 1 month of prior LHRH agonist and/or anti-androgen therapy as neoadjuvant therapy prior to prostatectomy is allowed). Prior enzalutamide, apalutamide, ketoconazole, abiraterone, or TAK700 for prostate cancer are prohibited. Prior antiandrogen therapy (including but not limited to bicalutamide, flutamide, nilutamide, enzalutamide, and apalutamide) and prior estrogen therapy (including estrogen patch) are not allowed. All investigational agents are prohibited within 30 days of enrollment. 5. The following medications are prohibited within 2 weeks of enrollment and while on study drug: * 5 α-reductase inhibitors (finasteride, dutasteride); * Biologic or other agents with anti-tumor activity against prostate cancer; * Systemic glucocorticoids greater than the equivalent of 10 mg per day of prednisone; oPremedication with systemic glucocorticoids greater than the equivalent of 10 mg per day of prednisone is permitted prior to docetaxel infusions. * Androgens (testosterone, dihydroepiandrosterone \[DHEA\], etc.) 6. Prior immunotherapy including sipuleucel-T. 7. Prior systemic chemotherapy (docetaxel, cabazitaxel, estramustine, other cytotoxic agents) 8. History of solid organ or stem cell transplantation. 9. History of seizure or any condition that may predispose to seizure (e.g., prior cortical stroke, prior head or traumatic brain injury with loss of consciousness, prior or current space-occupying lesion in the brain). Also, history of loss of consciousness or transient ischemic attack within 12 months of Day 1 visit. 10. Known or suspected brain metastasis or active leptomeningeal disease. 11. Other concurrent severe and/or uncontrolled concomitant medical conditions (e.g., active or uncontrolled infection) that could cause unacceptable safety risks or compromise compliance with the protocol. 12. Severe or unstable angina, myocardial infarction, symptomatic congestive heart failure, arterial or venous thromboembolic events (eg, pulmonary embolism, cerebrovascular accident including transient ischemic attacks), or clinically significant ventricular arrhythmias within 6 months prior to enrollment 13. Sustained uncontrolled hypertension (\>150/90 average over 1 week) despite optimal medical management 14. Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of apalutamide or increase the risk of radiation (e.g., uncontrolled nausea, vomiting, diarrhea, malabsorption syndromes, prior small bowel resection, or inflammatory bowel disease). 15. Patients who have received prior prostate or pelvic radiotherapy, including external beam or brachytherapy. 16. Patients who have not recovered from side effects of prior systemic therapy prior to Cycle 1 Day 1. 17. Use of medications known to lower the seizure threshold within 4 weeks prior to study entry. 18. Patients unable or unwilling to abide by the study protocol or cooperate fully with the investigator.

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