Combining Lu-PSMA with Stereotactic Radiotherapy for Prostate Cancer Treatment

A Phase II Randomized Trial of Lu-PSMA and Stereotactic Radiotherapy Versus Radiotherapy Alone for Oligometastatic Prostate Cancer (LUST)

This study is testing if combining a targeted prostate cancer treatment with focused radiation can help men with a few small cancer spots feel better and live longer.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 70 (estimated)
• Ages: 18 Years and up
• Sex: Male
• Sponsor: Istituto Romagnolo per lo Studio dei Tumori Dino Amadori IRST S.r.l. IRCCS (Academic / other)
• Drugs / interventions: chemotherapy, radiation
• Locations: 2 sites (Cesena, FC and 1 other locations)
• Trial ID: NCT05893381 on ClinicalTrials.gov

What this trial studies

This phase II clinical trial investigates the effectiveness of combining Lutetium-177 PSMA therapy with Stereotactic Radiotherapy in patients with oligometastatic prostate cancer, characterized by 1-3 asymptomatic metastatic lesions. Participants will be randomly assigned to receive either the combination treatment or Stereotactic Radiotherapy alone. The study aims to assess the safety and efficacy of this combined approach in improving patient outcomes. The trial will utilize advanced imaging techniques to ensure precise targeting of metastatic lesions.

Who should consider this trial

Good fit: Ideal candidates include men with oligometastatic prostate cancer who have 1-3 asymptomatic metastatic lesions and meet specific eligibility criteria regarding PSA levels and prior treatments.

Not a fit: Patients with extensive metastatic disease or those who are symptomatic may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could significantly improve local control of prostate cancer metastases and enhance overall patient survival.

How similar studies have performed: Previous studies have shown promising results with similar approaches, indicating potential for success in this trial.

Eligibility criteria

Inclusion Criteria:

1. Patients with prostate cancer must have 1-3 asymptomatic metastatic lesions that are ≤ 5.0 cm or \< 250 cm3 documented at CT/MRI or WBD-MRI.
2. PSMA-PET/CT positive scan matching with lesions documented on baseline CT/MRI or WBD-MRI.
3. Patients must have had their primary tumor treated with surgery and/or radiation and previous salvage radiation to the prostate bed or pelvis is allowed.
4. Patients will be admitted to the therapeutic phase only if diagnostic PET/CT PSMA SUV max is ≥ 3.
5. Histologic confirmation of malignancy (primary or metastatic tumor).
6. Prostate specific antigen (PSA) ≥ 0.2 ng/mL but ≤ 50 ng/mL and Testosterone ≥ 125 ng/dL.
7. PSA doubling time (PSADT) \< 15 months. PSADT will be calculated using as many PSA values that are available from time of relapse (PSA \> 0.2 ng/dL).
8. Patients unfit or refusing ADT.
9. Patients may have had prior systemic therapy and/or ADT associated with treatment of their primary prostate cancer. Patients may have had ADT associated with salvage radiation therapy.
10. Patients must be ≥ 18 years of age.
11. Patient understands the purpose of the study and the procedures required for it; the patient is willing to participate in the study and to sign a written informed consent document.
12. Patients must have an Eastern Cooperative Oncology Group performance status ≤ 2.
13. Patients should have a life expectancy of at least 6 months.
14. Patients must have normal organ and marrow function as defined as:

    * Leukocytes \>2,000/μL;
    * Absolute neutrophil count \>1,000/μL;
    * Platelets \>75,000/μL;
    * total bilirubin within normal institutional limits (this will not apply to patients with confirmed Gilbert's syndrome);
    * AST(SGOT)/ALT(SGPT) ≤ 2.5 X institutional upper limit of normal;
    * Creatinine within normal institutional limits.
15. If the participant engages in sexual activity with a woman of childbearing potential, a condom must be used together with another highly effective method of contraception during the Treatment Period and for 6 months after the last dose of study intervention. The participant must agree not to donate sperm for the purpose of reproduction during the Treatment Phase and for a minimum of 6 months after receiving the last dose of study intervention.
16. Highly effective birth control methods are required beginning at the screening visit and continuing until 6 months following last treatment with study drug. Patients and female partner who is of childbearing potential must use 2 acceptable methods of birth control (1 of which must include a condom as a barrier method of contraception, see Appendix F) starting at screening and continuing throughout the study period and for 6 months after final study drug administration. Two acceptable methods of birth control thus include Condom (barrier method of contraception) and one of the following is required ( established use of oral, or injected or implanted hormonal method of contraception by the female partner; placement of an intrauterine device (IUD) or intrauterine system (IUS) by the female partner; additional barrier method like occlusive cap with spermicidal foam/gel/film/cream/suppository in the female partner; tubal ligation in the female partner; vasectomy or other procedure resulting in infertility (eg., bilateral orchiectomy), for more than 6 months.

16\. Highly effective birth control methods are required beginning at the screening visit and continuing until 6 months following last treatment with study drug. Patients and female partner who is of childbearing potential must use 2 acceptable methods of birth control (1 of which must include a condom as a barrier method of contraception, starting at screening and continuing throughout the study period and for 6 months after final study drug administration.

Exclusion Criteria:

The participant may not enter the study if ANY of the following apply:

1. No more than 3 years of ADT is allowed, with the most recent ADT treatment having occurred more than 6 months prior to enrollment.
2. PSMA -PET/CT scan more than 3 months.
3. Spinal cord compression or impending spinal cord compression.
4. Suspected pulmonary and/or liver metastases.
5. Bone metastasis in a femoral bone.
6. Previous radiation therapy on the metastatic site.
7. Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier. A window of 3 days is permitted.
8. Participation in another clinical trial with any investigational agents within 30 days prior to study screening. A window of 3 days is permitted.
9. Any condition for which, in the opinion of the investigator, participation would not be in the best interest of the participant.
10. Patients with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
11. History of allergic reactions attributed to compounds of similar chemical or biologic composition to 177-Lu-PSMA- I \& T or other agents used in the study.
12. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
13. Unable to lie flat during or tolerable SABR.
14. Other known malignant neoplastic diseases in the patient's medical history with a disease-free interval of less than 3 years (except for previously treated basal cell carcinoma);
15. Known HIV-positivity, whether or not symptomatic.

Where this trial is running

Cesena, FC and 1 other locations

• UO Medicina Nucleare, AUSL della Romagna — Cesena, Fc, Italy (Recruiting)
• UO Medicina Nucleare, IRCCS IRST — Meldola, Fc, Italy (Recruiting)

Study contacts

• Principal investigator: Federica Matteucci — UO Medicina Nucleare, IRCCS IRST
• Study coordinator: Oriana Nanni

Conditions Prostate Cancer; PSMA PET/CT positive