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Brief Title: RADAR Trial - Randomised Androgen Deprivation and Radiotherapy
Official Title: A Randomised Trial Investigating the Effect on Biochemical (PSA) Control and Survival of Different Durations of Adjuvant Androgen Deprivation in Association With Definitive Radiation Treatment for Localised Carcinoma of the Prostate.
Study ID: NCT00193856
Brief Summary: The principal objectives of the RADAR trial is to address the hypotheses; 1) that 18 months androgen deprivation in conjunction with radiotherapy is superior to 6 months androgen deprivation prior to and during radiotherapy; 2) that 18 months Bisphosphonate therapy will prevent bone loss caused by androgen deprivation therapy and further reduce relapse risk by impeding the development of bony metastases.
Detailed Description: Traditionally androgen deprivation (by orchidectomy, or more recently by medication) has been reserved for the palliative treatment of men with advanced, incurable prostate cancer. However, evidence from large scale trials is beginning to suggest that androgen deprivation (AD) may be helpful in preventing relapse in patients with more localised disease who are treated surgically or by radiotherapy. Of the 8000 patients per annum who are treated with curative intent, one half (4000) have cancers where 'adjuvant' AD may be prescribed according to interpretation of the registered indications. There are, however, enormous variations in prescribing practices which reflect uncertainty as to the appropriate indications. An important issue is osteopenia. The increasing use of AD in men with earlier stages of cancer, whose life expectancies exceed 3 years, has exposed many unwanted metabolic sequelae of prolonged AD, the most important being osteopenia. In 1996, with the funding support of the NHMRC and the pharmaceutical industry, TROG therefore launched a large randomised three-arm trial. Two of the arms repeated the two arms of the US Radiation Therapy Oncology Group (RTOG) 86.01 trial which, at the time, was showing early indications of benefit for the addition of two months maximal androgen deprivation (MAD), using Goserelin (Zoladex) and Flutamide, before radiation therapy and one month during. Since work from Canada had indicated that continued AD for periods longer than three months produced additional shrinkage of the prostatic tumour, the TROG 96.01 trial incorporated a third arm: six months MAD prior to and during radiotherapy. The trial completed its recruitment target of 800 eligible patients in early 2000. Although in August 2001 the median follow up time was still very short, a preliminary analysis indicated that significant increases in time to biochemical relapse had been produced by AD. In fact, the benefits of AD were independent of stage, tumour grade and initial PSA value which were confirmed also to predict time to biochemical failure. The hazard of relapse reduced to 0.75 (0.55 - 0.97, 95% confidence intervals) with 3 months AD, and still further to 0.6 (0.45 - 0.82) with six months AD. Subsequent international developments in this area of research encouraged the design of a 'follow on' trial. A European Organisation for Research and Treatment of Cancer (EORTC) trial reported that 3 years of adjuvant ('post hoc') AD (using Goserelin alone), administered after radiotherapy, reduced relapse and improved survival in patients with locally advanced prostate cancer. The US Radiation Therapy Oncology Group (RTOG) 85.31 trial indicated that indefinite Goserelin administration after radiotherapy reduced treatment failure rates at all sites when compared with radiotherapy alone. The RTOG 92.02 trial showed that 24 months of adjuvant Goserelin also reduced failure rates in patients treated with 4 months of MAD prior to and during radiotherapy. Subset analyses of the RTOG trials, suggested that patients who gain most from prolonged AD in terms of survival are those with high grade cancers. It was therefore logical for TROG to propose a second trial with the intention of finding out whether an additional 12 months of AD administered after radiotherapy (aka 'intermediate term' AD \[ITAD\]) would reduce relapse and mortality in patients treated with six months of AD prior to and during radiotherapy (aka 'short term' AD \[STAD\]) as in the 'best' arm of its first (96.01) trial. The availability of the potent bisphosphonate, zoledronic acid, also made it possible to find out whether or not osteopenia induced in the two arms of the proposed second trial would be prevented by a second random assignment to 18 months' bisphosphonate therapy (BP). This is a randomised phase III multicentre clinical trial. After informed consent is given and eligibility is checked patients will be randomised to one of four trial arms: 1. 6 months of androgen blockade with an LH-RH analogue (5 months before start of radiotherapy) (STAD), 2. 18 months of androgen blockade with an LH-RH analogue (starting 5 months before start of radiotherapy) (ITAD), 3. 18 months of therapy with zoledronic acid 4 mg by intravenous infusion every 3 months for 18 months beginning concurrently with STAD 4. 18 months of therapy with zoledronic acid beginning concurrently with ITAD. Stratification will be according to the following criteria: T2 / T3, 4 Gleason score 2 - 6 / 7+ Presenting PSA \<10 / 10 - 20 / \>20 Treatment centre Radiation Treatment will be delivered using a conventional technique, unless the treatment centre of the participating clinician demonstrates an ability to deliver the treatment using a CRT, IMRT, or HDRB technique verified by the trial TACT. Drug Treatment: LH-RH analogue (LH-RHa) (Leuprorelin acetate 22.5 mg) will be delivered as a depot injection every 3 months. This will be administered as an Intramuscular injection (IMI). Zoledronic acid 4 mg will be delivered as an intravenous infusion over 15 minutes once every 3 months for 18 months, in patients randomised to this therapy. No placebo therapy will be given to patients randomised to 'no bisphosphonate therapy' treatment arm.
Minimum Age: 18 Years
Eligible Ages: ADULT, OLDER_ADULT
Sex: MALE
Healthy Volunteers: No
Campbelltown Hospital, Campbelltown, New South Wales, Australia
St George Hospital, Kogarah, New South Wales, Australia
Lismore Hospital, Lismore, New South Wales, Australia
Liverpool Hospital, Liverpool, New South Wales, Australia
Calvary Mater Newcastle, Newcastle, New South Wales, Australia
Nepean Cancer Care Centre, Penrith, New South Wales, Australia
Royal North Shore Hospital, Sydney, New South Wales, Australia
Riverina Cancer Care Centre, Wagga Wagga, New South Wales, Australia
Westmead Hospital, Wentworthville, New South Wales, Australia
Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
Royal Brisbane Hospital, Herston, Queensland, Australia
Mater QRI, South Brisbane, Queensland, Australia
John Flynn Private Hospital, Tugun, Queensland, Australia
Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
Launceston General Hospital, Launceston, Tasmania, Australia
Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
Andrew Love Cancer Care Centre, Geelong Hospital, Geelong, Victoria, Australia
Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
Auckland Hospital, Auckland, , New Zealand
Christchurch Hospital, Christchurch, , New Zealand
Dunedin Hospital, Dunedin, , New Zealand
Waikato Hospital, Hamilton, , New Zealand
Palmerston North Hospital, Palmerston North, , New Zealand
Wellington Hospital, Wellington, , New Zealand
Name: Jim Denham, FRANZCR
Affiliation: University of Newcastle, Australia
Role: STUDY_CHAIR