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Universidad del Estado de OhioEffects of Relugolix vs Leuprolide on Cardiac Function in Patients With Prostate Cancer Fase II 70 Basado en biomarcadores Ejercicio
I. To quantify the physiologic alterations in cardiopulmonary function in men receiving 6-month relugolix verse (vs.) 6-month leuprolide with definitive radiation therapy (RT) for unfavorable intermediate risk (UIR) clinically localized prostate cancer (PCa).
II. Cardiopulmonary and cardiac measures obtained from: 1) exercise stress cardiac magnetic resonance imaging (MRI) perfusion, and 2) maxi...
Mostrar másA Comparison of Orgovyx (Relugolix) vs Eligard (Leuprolide) on Cardiovascular Function and Biomarkers During Standard of Care Combined ADT (Androgen Deprivation Therapy)-Radiation for Prostate Cancer
| Grupo de participantes | Intervención/Tratamiento |
|---|---|
ExperimentalArm 1 (leuprolide) Patients receive definitive therapy for prostate cancer with ADT (leuprolide via injection once every 3 months, for a total of 6 months) in the absence of disease progression or unacceptable toxicity and definitive radiotherapy within 90 days of starting ADT. Patients receive gadolinium-based contrast intravenously (IV) and undergo exercise-stress cardiac MRI perfusion and comprehensive exercise physiology testing be...Mostrar más | Recolección de biospecímenes Undergo blood and urine sample collection Agente de contraste Given IV Leuprolide Given injection Imagen por resonancia magnética Undergo MRI Pruebas de rendimiento físico Undergo functional fitness tests |
ExperimentalArm 2 (relugolix) Patients receive definitive therapy for prostate cancer with ADT (relugolix orally once daily for a total of 6 months) in the absence of disease progression or unacceptable toxicity and definitive radiotherapy within 90 days of starting ADT. Patients receive gadolinium-based contrast intravenously (IV) and undergo exercise-stress cardiac MRI perfusion and comprehensive exercise physiology testing before starting ADT ...Mostrar más | Recolección de biospecímenes Undergo blood and urine sample collection Agente de contraste Given IV Imagen por resonancia magnética Undergo MRI Pruebas de rendimiento físico Undergo functional fitness tests Relugolix Given PO |
| Medida de resultado | Descripción de la medida | Periodo de tiempo |
|---|---|---|
Physiologic alterations in cardiopulmonary function - Myocardial perfusion | We will measure the difference in myocardial perfusion with exercise stress-rest cardiac MRI before and after ADT (leuprolide vs. relugolix). | Up to 6 months |
Physiologic alterations in cardiopulmonary function - Maximal rate of oxygen consumption | We will measure the difference in VO2 Max before and after ADT (leuprolide vs. relugolix). | Up to 6 months |
| Medida de resultado | Descripción de la medida | Periodo de tiempo |
|---|---|---|
Quality of life using EPIC-26 | Response options for each EPIC item form a Likert scale, and multi-item scale scores are transformed linearly to a 0-100 scale. Overall, higher scores across the EPIC domains represent better QoL. | Up to 6 months |
Quality of life using EORTC QLQ-C30 | All of the scales range in score from 0 to 100. A high score for a functional scale represents a high/healthy level of functioning. | Up to 6 months |
Quality of life using European (Euro) Qol-5-Dimension 5-level (EQ-5D-5L) | This validated utility assessment instrument evaluates 5-dimensions (5D) of function, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, each graded on 5 levels (ranging from 1 \[no problem\] to 5 \[extreme problems\]). The 5D index score is transformed into a utility score between 0 and 1. The sixth item is a visual analogue scale for overall health perceived by the patient. A lower score represents better health. | Up to 6 months |
Quality of life using PROMIS | A 5-point Likert scale from 1 (never/not at all) to 5 (almost always/very much) with a recall period of last 7 days. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10. Therefore, a person with a T-score of 40 is one SD below the mean. | Up to 6 months |
Functional tests of strength and balance using Timed Up-and-Go | Participants will be instructed to stand up from an armchair (seat height of 45 cm), walk at a comfortable pace to a line on the floor 3 meters away, turn, return to the chair and sit down again. A stopwatch is used to time the performance (in seconds). | Up to 6 months |
Functional tests of strength and balance using 10-meter walk time | Gait speed will be measured using a standardized 10-m course. | Up to 6 months |
Functional tests of strength and balance using Grip strength | A validated biomarker of overall strength and muscle mass. Patients will perform 3 trials with each hand, alternating hands between trials, with the maximum score for each hand being recorded. | Up to 6 months |
Changes in body composition | Abdominal CT/MRI to quantitate abdominal/visceral fat and lean muscle mass with utilization of image analysis software. | Up to 6 months |
Pathologically proven diagnosis of adenocarcinoma of the prostate within 270 days prior to registration.
Unfavorable intermediate risk prostate cancer, defined as having ALL the following bulleted criteria:
Has at least one intermediate risk factor (IRF):
- Prostate-specific antigen (PSA) 10-20 ng/mL
- Clinical stage tumor (T)2b-c (digital rectal exam \[DRE\] and/or imaging) by American Joint Committee on Cancer (AJCC) 8th edition
- Gleason Score 7 (Gleason 3+4 or 4+3 \[International Society of Urological Pathology \[ISUP\] grade group 2-3])
Has one or more of the following "unfavorable" intermediate-risk designators:
> 1 IRF
Gleason 4+3=7 (ISUP grade group 3)
≥ 50% of biopsy cores positive
- Biopsies may include "sextant" sampling of right/left regions of the prostate, often labeled base, mid-gland and apex. All such "sextant" biopsy cores should be counted. Men may also undergo "targeted" sampling of prostate lesions (guided by MRI, ultrasound or other approaches). A targeted lesion that is biopsied more than once and demonstrates cancer (regardless of number of targeted cores involved) should count as a single additional positive core sampled and positive. In cases of uncertainty, count the biopsy sampling as sextant core(s).
Absence of high-risk features
Appropriate stage based on the following diagnostic workup:
- History/physical examination within 120 days prior to registration
- Negative bone imaging (M0) with Tc-99m bone scan or fluciclovine (18F) sodium fluoride (NaF) positron emission tomography (PET) within 120 days prior to registration
- Clinically negative lymph nodes (N0) as established by conventional imaging (pelvic +/- abdominal CT or MRI), within 120 days prior to registration (lymph nodes equivocal or questionable by imaging are eligible if the nodes are ≤ 1.0 cm in short axis and/or if biopsy is negative)
- Prostate specific membrane antigen (PSMA) or fluciclovine PET negative for nodal or distant metastatic disease is an acceptable substitute for the above bone and pelvic imaging
Age ≥ 18
Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-1 within 120 days prior to registration.
Non-castrate testosterone level (> 50 ng/dL) within 120 days prior to registration.
Absolute neutrophil ≥ 1,000 cells/mm^3 (within 120 days prior to registration)
Hemoglobin ≥ 10 g/dL (within 120 days prior to registration)
Platelet count ≥ 100,000 cells/mm^3 (within 120 days prior to registration)
Creatinine clearance (CrCl) ≥ 30 mL/min estimated by Cockcroft-Gault Equation (within 120 days prior to registration)
- For African American patients, CrCl ≥ 30 mL/min is estimated by the alternative formula that takes race into account
Total bilirubin: 1.5 ≤ institutional upper limit of normal (ULN) (within 120 days prior to registration)
Aspartate aminotransferase (AST)(serum glutamic-oxaloacetic transaminase \[SGOT\]) and alanine aminotransferase (ALT)(serum glutamic-pyruvic transaminase \[SGPT\]) ≤ 2.5 × institutional ULN (within 120 days prior to registration)
HIV-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial. Note: HIV testing is not required for eligibility for this protocol.
For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated.
Note: Known positive test for hepatitis B virus surface antigen (HBV sAg) indicating acute or chronic infection would make the patient ineligible unless the viral load becomes undetectable on suppressive therapy. Patients who are immune to hepatitis B (anti-Hepatitis B surface antibody positive) are eligible (e.g. patients immunized against hepatitis B).
For patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load.
- Note: Known positive test for hepatitis C virus ribonucleic acid (HCV RNA) indicating acute or chronic infection would make the patient ineligible unless the viral load becomes undetectable on suppressive therapy.
The patient or a legally authorized representative must provide study-specific informed consent prior to study entry and, for patients treated in the United States (U.S.), authorization permitting release of personal health information.
Previous radical surgery (prostatectomy) or any form of curative-intent ablation whether focal or whole-gland (e.g., cryosurgery, High-intensity focused ultrasound (HIFU), laser thermal ablation, etc.) for prostate cancer.
Definitive clinical or radiologic evidence of metastatic disease (M1).
Prior invasive malignancy (except non-melanomatous skin cancer) or hematologic malignancy unless disease free for a minimum of 3 years.
Prior radiotherapy to the prostate/pelvis region that would result in overlap of radiation therapy fields.
Previous bilateral orchiectomy.
Previous hormonal therapy, such as luteinizing hormone-releasing hormone (LHRH) agonists (e.g., leuprolide, goserelin, buserelin, triptorelin) or LHRH antagonist (e.g. degarelix), anti-androgens (e.g., flutamide, bicalutamide, cyproterone acetate). ADT started prior to study registration is not allowed.
Prior use of 5-alpha-reductase inhibitors is allowed; however, it must be stopped ≥ 30 days prior to the pre-registration PSA measure for determining enrollment eligibility.
Prior testosterone replacement therapy is allowed; however, any replacement therapy must be stopped for at least 1 year prior to registration.
Severe, active co-morbidity defined as follows:
- Current/uncontrolled angina or arrhythmias
- New York Heart Association Functional Classification II-IV (Note: Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification.)
- History of any condition that in the opinion of the investigator, would preclude participation in this study
Patients with significant obstructive urinary symptoms that are suspected to be secondary to prostate cancer and/or benign prostatic hypertrophy.
Disabilities that prevent performing moderate intensity exercise test with exercise (treadmill) stress test and muscle function tests (walking/gait assessments and grip strength).
Patients unable to tolerate MRI (e.g. claustrophobia), has contraindications to MRI (e.g. metals and implants incompatible with MRI), body habitus preventing MRI scanning, or allergy to gadolinium-based contrast.
Significant uncontrolled gastrointestinal (e.g. Crohn's disease, ulcerative colitis) or metabolic disease (e.g. diabetes, hyperlipidemia).
Active inflammatory or immune-related disease treated with steroids or immunosuppressive agents.
Inability to swallow oral pills.
High risk features, which includes any of the following:
- Gleason 8-10 \[ISUP grade group 4-5\]
- PSA>20
- cT3-4 by digital exam OR gross extra-prostatic extension on imaging \[indeterminate MRI evidence will not count and the patient will be eligible\]
Universidad del Estado de Ohio- Sumitomo Pharma0 estudios activos para explorar
Ohio