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Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/ct2/show/NCT05939414




Registration number
NCT05939414
Ethics application status
Date submitted
3/07/2023
Date registered
11/07/2023
Date last updated
3/05/2024

Titles & IDs
Public title
An Open-label Study Comparing Lutetium (177Lu) Vipivotide Tetraxetan Versus Observation in PSMA Positive OMPC.
Scientific title
An International, Prospective, Open-label, Multi-center, Randomized Phase III Study Comparing Lutetium (177Lu) Vipivotide Tetraxetan (AAA617) Versus Observation to Delay Castration or Disease Recurrence in Adult Male Patients With Prostate-specific Membrane Antigen (PSMA) Positive Oligometastatic Prostate Cancer (OMPC)
Secondary ID [1] 0 0
2022-502956-29-00
Secondary ID [2] 0 0
CAAA617D12302
Universal Trial Number (UTN)
Trial acronym
PSMA-DC
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Oligometastatic Prostate Cancer (OMPC) 0 0
Condition category
Condition code
Cancer 0 0 0 0
Prostate

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Treatment: Drugs - AAA617

Experimental: Investigational Arm: lutetium (177Lu) vipivotide tetraxetan (AAA617) - All participants will be treated with Stereotactic Body Radiation Therapy (SBRT) to all metastatic lesions followed by a dose of 7.4 GBq (200 mCi) +/- 10% of AAA617 which will be administered once every 6 weeks (1 cycle) for a planned 4 cycles.

No Intervention: Control arm: observation (watchful waiting) - All participants will be treated with Stereotactic Body Radiation Therapy (SBRT) to all metastatic lesions followed by observation only.


Treatment: Drugs: AAA617
Stereotactic Body Radiation Therapy (SBRT) followed by AAA617 will be administered once every 6 weeks (1 cycle) for a planned 4 cycles to participants randomized to the Investigational arm
Intervention code [1] 0 0
Treatment: Drugs
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
Blinded Independent Review Committee (BIRC) assessed Metastasis Free Survival (MFS)
Timepoint [1] 0 0
From date of randomization until first evidence of radiographically detectable bone or soft tissue distant metastasis or death due to any cause, whichever occurs first, assessed up to approximately 30 months
Secondary outcome [1] 0 0
Key secondary endpoint: Time to Hormonal Therapy (TTHT)
Timepoint [1] 0 0
From date of randomization until date of Androgen Deprivation Therapy (ADT), assessed up to approximately 74 months
Secondary outcome [2] 0 0
Investigator assessed Metastasis Free Survival (MFS)
Timepoint [2] 0 0
From date of randomization until first evidence of radiographically detectable bone or soft tissue distant metastasis or death from any cause, whichever occurs first, assessed up to approximately 74 months
Secondary outcome [3] 0 0
Time to prostate specific antigen (PSA) progression (TTPSAP)
Timepoint [3] 0 0
From date of randomization until date of first PSA progression, assessed up to approximately 74 months
Secondary outcome [4] 0 0
Radiographic Progression Free Survival (rPFS)
Timepoint [4] 0 0
From date of randomization until date of radiographic progression or date of death from any cause, whichever comes first, assessed up to approximately 74 months
Secondary outcome [5] 0 0
Time to next therapy (local or systemic)
Timepoint [5] 0 0
From date of randomization until initiation of the next line of therapy (local or systemic), assessed up to approximately 74 months
Secondary outcome [6] 0 0
24-month prostate-specific antigen (PSA) progression free survival (PFS)
Timepoint [6] 0 0
From date of randomization until date of first documented PSA progression 2 or death from any cause, whichever occurs first, assessed up to approximately 74 months
Secondary outcome [7] 0 0
Time to symptomatic progression
Timepoint [7] 0 0
From date of randomization until date of first documented symptomatic progression, assessed up to approximately 74 months
Secondary outcome [8] 0 0
Functional Assessment of Cancer Therapy - Prostate (FACT-P) Questionnaire
Timepoint [8] 0 0
From date of randomization up till 42 day safety Follow-up, assessed up to approximately 74 months
Secondary outcome [9] 0 0
Functional Assessment of Cancer Therapy - Radionuclide Therapy (FACT-RNT) Questionnaire
Timepoint [9] 0 0
From date of randomization up till 42 day safety Follow-up, assessed up to approximately 74 months
Secondary outcome [10] 0 0
Brief Pain Inventory - Short Form (BPI-SF) Questionnaire
Timepoint [10] 0 0
From date of randomization up till 42 day safety Follow-up, assessed up to approximately 74 months
Secondary outcome [11] 0 0
European Quality of Life (EuroQol) - 5 Domain 5 Level scale (EQ-5D- 5L)
Timepoint [11] 0 0
From date of randomization up till 42 day safety Follow-up, assessed up to approximately 74 months
Secondary outcome [12] 0 0
Time to First Symptomatic Skeletal Event (TTSE)
Timepoint [12] 0 0
From date of randomization till end of treatment (EOT) or death, whichever happens first, assessed up to approximately 74 months
Secondary outcome [13] 0 0
Incidence and severity of adverse events (AEs) and serious adverse events (SAEs)
Timepoint [13] 0 0
From date of randomization up till 42 day safety Follow-up, assessed up to approximately 74 months
Secondary outcome [14] 0 0
Dose modifications and intensity for AAA617
Timepoint [14] 0 0
From date of randomization until end of treatment (EOT), assessed up to approximately 30 months
Secondary outcome [15] 0 0
Overall survival (OS)
Timepoint [15] 0 0
From date of randomization until date of death from any cause, assessed up to approximately 74 months

Eligibility
Key inclusion criteria
Key Inclusion criteria:

1. Histologically confirmed prostate cancer prior to randomization

2. Participants must have biochemically recurrent disease after definitive treatment to
prostate by Radical Prostatectomy ((RP), (alone or with post-operative radiation to
prostate bed/pelvic nodes)) or External beam Radiation Therapy (XRT), (prostate alone
or prostate with seminal vesicle and/or pelvic nodes) and/or brachytherapy prior to
randomization. Biochemical recurrence is defined as: nadir PSA + 2 ng/mL post XRT (if
participant received-radiation therapy to intact prostate) and PSA > 0.2 ng/mL and
rising post RP (with or without post-operation Radiation Therapy (RT))

3. Participants must have OMPC with =< 5 PSMA-positive metastatic lesions on screening
PSMA PET/CT scan (with either gallium (68Ga) gozetotide or piflufolastat (18F)) as
visually assessed by BIRC based on the methodology proposed in the Prostate Cancer
Molecular Imaging Standardized Evaluation (PROMISE v2) (Seifert et al 2023); for
further details, please refer to Section 8.1 and the Imaging Manual. Metastatic
lesions may include regional/pelvic lymph nodes (N1), distant lymph nodes (M1a), bone
(M1b), lung and others visceral (M1c) except liver and brain classified using AJCC 8.
When counting the number of oligometastatic lesions, each lesion is counted as
distinct metastasis irrespective of its anatomical location (e.g., one pelvic and one
extra-pelvic lymph node will be counted as two metastatic lesions)

4. At least 1 PSMA-positive lesion should be a distant metastasis (M1) per AJCC8
classification at screening. For AJCC M staging, PSMA PET information should be used

5. Participants must have a negative conventional imaging for M1 disease at screening.

Note:

- For a participant not to be eligible, CI positive M1 lesions should be
unequivocal in CI scans, i.e., potentially not attributable to findings thought
to represent something other than tumor (e.g., degenerative, or post-traumatic
changes or Paget's disease in bone lesions). For conventional imaging
assessments, bone lesions must be assessed by bone scan only and soft tissue
lesions must be assessed by CT/MRI scans only at screening.

- Prior knowledge of PSMA PET positivity should not influence the radiologist
(reader) in determination of CI positivity. Two different readers will be
involved, one reader for PSMA PET scan and one reader for CI: Reader will be
blinded to PSMA PET scan results while reading CI scans. Reader should not modify
their assessment of CI scans (e.g. changing a lesion previously identified as
equivocal in CI to unequivocal) after reading the PSMA PET scan. Similarly,
biopsy positivity should not influence the reader in the assessment of CI
positivity. More details on the reading paradigm will be provided in the imaging
charter

- MRI for radiation treatment planning may show M1 disease but this will not
exclude the participant from the study if the lesion is deemed negative per
baseline CT or bone scans

- Participants with pelvic disease (N1) seen in conventional imaging are allowed if
the local spread is below common iliac bifurcation (per AJCC 8 definition of
local disease)

- Distant lymph node disease (M1a) that is visible per CI and less than 10mm in the
short axis is not exclusionary irrespective of PSMA PET positivity.

- If a previously surgically removed lesion was unequivocal for M1 by bone scan or
CT, the participant is not eligible.

6. All metastatic lesions detected at screening should be amenable to SBRT

7. Non-castration testosterone level >100 ng/dL at screening

Key
Minimum age
18 Years
Maximum age
No limit
Sex
Males
Can healthy volunteers participate?
No
Key exclusion criteria
Exclusion criteria:

1. Participants with de novo OMPC at screening

2. Unmanageable concurrent bladder outflow obstruction or urinary incontinence at
screening. Note: participants with bladder outflow obstruction or urinary
incontinence, which is manageable and controlled with best available standard of care
(incl. pads, drainage) are allowed

3. Prior therapy with:

1. ADT including bilateral orchiectomy

- Participants who had XRT or RP and completed adjuvant ADT (or ADT+ARPI)
prior to recurrence are eligible to participate if the last dose of ADT (or
ADT+ARPI) was before 12 months from randomization. Participants who had
prior SBRT with short term ADT (3-6 months) are also allowed if the ADT was
stopped at least 12 months before randomization.

- Participants who discontinued ADT due to disease progression are not allowed
(i.e., Castration-Resistant Prostate Cancer (CRPC) participants)

2. Other hormonal therapy. e.g.,

- Use of estrogens, 5-a reductase inhibitors (finasteride, dutasteride), other
steroidogenesis inhibitors (aminoglutethimide) if used in the context of
prostate cancer treatment. Same medications are allowed if used for other
indications: e.g., Benign Prostatic Hyperplasia (BPH), if stopped at least 5
half-lives before randomization.

- First-generation anti-androgens (bicalutamide, flutamide, nilutamide,
cyproterone)

- Second generation anti-androgens (e.g., enzalutamide, apalutamide and
darolutamide)

- CYP17 inhibitors (e.g., abiraterone acetate, orteronel, galeterone,
ketoconazole). Short term ketoconazole treatment (<28 days) is permitted

3. Radiopharmaceutical agents (e.g., Strontium-89, PSMA-targeted radioligand
therapy)

4. Immunotherapy (e.g., sipuleucel-T)

5. Chemotherapy, except if administered in the adjuvant/neoadjuvant setting
completed > 12 months before randomization

6. Any other investigational or systemic agents for metastatic disease

4. Radiation therapy external beam radiation therapy (EBRT) and brachytherapy within 28
days before randomization

5. Concurrent cytotoxic chemotherapy, immunotherapy, radioligand therapy, hormonal
therapy (see ADT initiation guidance in Section 6.8.2), Poly Adenosine
Diphosphate-Ribose Polymerase (PARP) inhibitor, biological therapy or investigational
therapy

6. Diagnosed at screening with other malignancies that are expected to alter life
expectancy or may interfere with disease assessment. However, participants with a
prior history of malignancy that has been adequately treated and who have been
disease/treatment free for more than 3 years are eligible, as are participants with
adequately treated non-melanoma skin cancer and superficial bladder cancer.

7. History or current diagnosis of ECG abnormalities indicating significant risk of
safety for participants participating in the study such as:

- Concomitant clinically significant cardiac arrhythmias, e.g. sustained
ventricular tachycardia, and clinically significant second or third degree
Atrioventricular (AV) block without a pacemaker

- History of familial long QT syndrome or known family history of Torsades de
Pointe

8. Participants in immediate need of ADT as assessed by the investigator.

Other protocol defined Inclusion/Exclusion may apply.

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Parallel
Other design features
Phase
Phase 3
Type of endpoint/s
Statistical methods / analysis

Recruitment
Recruitment status
Recruiting
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
12/03/2024
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
3/06/2030
Actual
Sample size
Target
450
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
NSW,SA
Recruitment hospital [1] 0 0
Novartis Investigative Site - Darlinghurst
Recruitment hospital [2] 0 0
Novartis Investigative Site - Adelaide
Recruitment postcode(s) [1] 0 0
2010 - Darlinghurst
Recruitment postcode(s) [2] 0 0
5000 - Adelaide
Recruitment outside Australia
Country [1] 0 0
United States of America
State/province [1] 0 0
Virginia
Country [2] 0 0
Canada
State/province [2] 0 0
Quebec
Country [3] 0 0
Israel
State/province [3] 0 0
Haifa
Country [4] 0 0
Israel
State/province [4] 0 0
Jerusalem
Country [5] 0 0
Israel
State/province [5] 0 0
Tel Aviv
Country [6] 0 0
Japan
State/province [6] 0 0
Hyogo
Country [7] 0 0
Singapore
State/province [7] 0 0
Singapore
Country [8] 0 0
Switzerland
State/province [8] 0 0
Geneve
Country [9] 0 0
Switzerland
State/province [9] 0 0
Luzern

Funding & Sponsors
Primary sponsor type
Commercial sector/Industry
Name
Novartis Pharmaceuticals
Address
Country

Ethics approval
Ethics application status

Summary
Brief summary
The purpose of this study is to evaluate the efficacy and safety of lutetium (177Lu)
vipivotide tetraxetan (AAA617) in participants with oligometastatic prostate cancer (OMPC)
progressing after definitive therapy to their primary tumor. The data generated from this
study will provide evidence for the treatment of AAA617 in early-stage prostate cancer
patients to control recurrent tumor from progressing to fatal metastatic disease while
preserving quality of life by delaying treatment with androgen deprivation therapy (ADT).
Trial website
https://clinicaltrials.gov/ct2/show/NCT05939414
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 0 0
Novartis Pharmaceuticals
Address 0 0
Novartis Pharmaceuticals
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
Novartis Pharmaceuticals
Address 0 0
Country 0 0
Phone 0 0
1-888-669-6682
Fax 0 0
Email 0 0
novartis.email@novartis.com
Contact person for scientific queries



Summary Results

For IPD and results data, please see https://clinicaltrials.gov/ct2/show/NCT05939414