Stereotactic Ablative Radiation Therapy for Abiraterone-Resistant, Oligoprogressive Metastatic Prostate Cancer
Stereotactic Ablative Radiotherapy for Oligoprogressive Metastatic Castration-Resistant Prostate Cancer During Abiraterone Therapy
About This Trial
- This clinical trial is for men with advanced prostate cancer taking the drug abiraterone who have only a small number of tumor spots that are starting to grow.
- Researchers want to find out if using precise, high-dose radiation to target and destroy just these specific spots can help patients safely stay on their current medicine longer.
- The hope is to delay the need to switch to a different treatment or begin chemotherapy.
- To take part, patients must be generally active and feeling well, have five or fewer growing spots that radiation can safely treat, and not need strong opioid painkillers or urgent chemotherapy.
More Information
- There is increasing worldwide interest in exploring stereotactic ablative body radiotherapy (SABR) for treating metastases in men with prostate cancer, including for the treatment of oligoprogressive metastases.
- The latter applies to a situation whereby patients with widespread metastases undergoing systemic therapy present with a solitary or a few metastatic tumors that progress, while all other metastases are stable or responding.
- The usual practice would be to change systemic therapy at this point, but another approach is to locally ablate the "rogue" metastases and continue the same systemic therapy.
- SABR used in this scenario may delay the need to switch to another line of systemic therapy and improve progression-free survival while patients stay on the same systemic therapy.
Who Can Enroll
- Age Range: 18 years and older
- Gender: Male
- Who This Trial is For: This clinical trial is for men with advanced prostate cancer taking the drug abiraterone who have only a small number of tumor spots that are starting to grow.
Study Details
- Start Date: July 16, 2016
- Lead Sponsor: Sunnybrook Health Sciences Centre
Full Eligibility Criteria
Inclusion Criteria
- ECOG performance status 0-1.
- Histologic confirmation of prostate adenocarcinoma.
- Documentation of metastatic, castration-resistant prostate cancer.
- Patient being treated with abiraterone.
- Evidence of oligoprogression (according to RECIST [V1.1] and/or Prostate Cancer Working Group criteria [PCWG3], as applicable), applying any of the following: (i) ≤ 5 metastatic lesions progressing on conventional imaging (≤ 3 progressing metastases in any one organ system) while all other metastases are controlled or responding; (ii) PSA progression only, but in the setting of oligometastases (≤ 5 metastatic lesions seen on imaging, with ≤ 3 metastases in any one organ system); in this setting, all metastases will be irradiated.
- All metastases of interest amenable to SABR.
Exclusion Criteria
- Patients presenting with unequivocal clinical progression, defined as one of the following: (i) cancer pain requiring the initiation of opioid therapy; (ii) immediate need for cytotoxic chemotherapy as per treating physician's discretion; or (iii) deterioration of performance status to grade ≥ 3 according to ECOG.
- Evidence of spinal cord compression.
- Prior malignancy within the past 5 years, excluding non-melanoma skin cancer, and in-situ cancer.
Treatments
- Radiation: Stereotactic Body Radiation Therapy (SABR)