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| ID | Type | Description | Link |
|---|---|---|---|
| CSET number 2025 / 4163 | Other Identifier | Gustave Roussy |
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| Name | Class |
|---|---|
| PHRC, Ministry of Health France | UNKNOWN |
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The current standard of patients with de novo metastatic hormone sensitive prostate cancer (mHSPC) is to offer androgen deprivation therapy (ADT) with androgen receptor pathway inhibitors (ARPI). In addition, upfront 6 cycles of docetaxel, if patient is eligible, and prostate radiotherapy for those with low-volume disease are recommended. BRCA mutations (BRCAm) and neuroendocrine differentiation (NED) confer a poor prognosis in mHSPC and the current standard of care for these patients remains suboptimal. While PARP inhibitors have shown efficacy in BRCAm castration-resistant prostate cancer, concerns exist about their toxicity and resistance when used earlier in the mHSPC setting. Carboplatin has demonstrated activity in BRCAm and neuroendocrine tumors but has not been extensively studied in mHSPC. The combination of carboplatin and docetaxel is expected to enhance treatment efficacy and delay progression.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental arm | Experimental | Lifelong continuous ADT and darolutamide, similarly to standard of care, with the addition of docetaxel (60mg/m² per cycle) and carboplatin, with an area under the curve (AUC) of 4 mg/mL/min (AUC 4), 6 cycles + G-CSF support. For eligible patients, prostate radiotherapy, at least 3 weeks after the completion of chemotherapy. |
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| Control arm: Standard of care (SoC) | No Intervention | Standard of care therapies consisting of lifelong ADT and continuous darolutamide, docetaxel (75 mg/m² per cycle, 6 cycles + G-CSF support) and for eligible patients, prostate radiotherapy, at least 3 weeks after the completion of chemotherapy. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Experimental | Drug | Lifelong continuous ADT and darolutamide, similarly to standard of care, with the addition of docetaxel (60mg/m² per cycle) and carboplatin, with an area under the curve (AUC) of 4 mg/mL/min (AUC 4), 6 cycles + G-CSF support. For eligible patients, prostate radiotherapy, at least 3 weeks after the completion of chemotherapy. |
| Measure | Description | Time Frame |
|---|---|---|
| Radiographic progression-free survival | To demonstrate that the addition of carboplatin to SoC therapies prolongs radiographic progression-free survival in patients with de novo mHSPC harboring a BRCA gene alteration and in patients with de novo mHSCPC showing neuroendocrine differentiation. Radiographic progression is defined according to the Prostate Cancer Working Group 4 (PCWG4) criteria. | from randomization to radiographic progression or death, maximum 10 years |
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Inclusion Criteria:
Histologically or cytologically proven adenocarcinoma of the prostate (any T stage, Gleason score or PSA level).
De novo metastatic disease documented by a positive bone scan or CT scan or an MRI. For patients with nodal metastases only, only patients with extra-pelvic enlarged lymph nodes (lymph nodes located above the iliac bifurcation) can be included if they have either: at least one extra-pelvic lymph node ≥ 2 cm, or extra-pelvic lymph node(s)≥1 cm if the patients also have at least one pelvic lymph node ≥ 1.5 cm.
Presence of pathogenic BRCA gene alteration (BRCAm cohort) OR histologically adenocarcinoma of the prostate with neuroendocrine differentiation (NED cohort)
For the BRCAm cohort: confirmation of a pathogenic BRCA gene alteration by historical analysis, using one of the following:
For the NED cohort: histologically adenocarcinoma of the prostate with neuroendocrine differentiation41. NED is defined as either:
Patients with ECOG PS ≤ 1, or patient with PS 2, provided PS alteration is disease-related.
Life expectancy of at least 6 months.
Male aged ≥ 18 years old and ≤ 80 years old.
Hematology values: Hemoglobin ≥ 10.0 g/dL, Platelet count ≥ 100,000/mL, Neutrophil ≥ 1500 cells/mm³ (or neutrophil ≥ 1000 cells/mm³ in case of ethnic neutropenia).
Biochemistry values: Renal function: Serum creatinine < 1.5 x ULN or a calculated creatinine clearance ≥ 60 mL/min, Liver function: Serum bilirubin ≤ 1.5 x ULN (except for patients with documented Gilbert's disease), AST and ALT ≤ 1.5 x ULN (and ≤ 5 ULN in case of liver metastases), ALK-P ≤ 2.5 x ULN (in case of bone metastasis, ALK-P<1000U/L if bilirubin is normal).
Patients must have received ADT and ARPI (abiraterone, enzalutamide, apalutamide, darolutamide) for a maximum of 3 months before randomization. Prior ARPI in mHSPC is allowed if required prior to randomization, with no radiographic evidence of disease progression or rising PSA levels prior to Day 1.
Patients willing and clinically fit to receive docetaxel with no contraindication to docetaxel according to the Summary of Product Characteristics (SmPC) of the drug.
Patients able to take oral medication.
Patients who have received the information sheet and signed the informed consent form
Patients must be affiliated to a social security system or beneficiary of the same.
Male patients who have partners of childbearing potential and/or pregnant partners must use a method of birth control in addition to an adequate barrier protection (condoms) as determined to be acceptable by the study doctor during the treatment period and for 6 months after the last dose of Docetaxel.
Exclusion criteria:
Male aged ≥ 18 years old and ≤ 80 years old.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Alice BERNARD-TESSIER, MD. | Contact | + 33(0)1 42 11 64 44 | ALICE.BERNARD-TESSIER@gustaveroussy.fr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hôpital Saint André | Bordeaux | 33075 | France | |||
| CLCC-Léon Bérard |
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|
| Lyon |
| 69008 |
| France |
| CLCC Paoli-Calmettes | Marseille | 13009 | France |
| CLCC-ICL | Nancy | 54519 | France |
| Gustave Roussy | Villejuif | 94805 | France |
| ID | Term |
|---|---|
| D011471 | Prostatic Neoplasms |
| ID | Term |
|---|---|
| D005834 | Genital Neoplasms, Male |
| D014565 | Urogenital Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D005832 | Genital Diseases, Male |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D011469 | Prostatic Diseases |
| D052801 | Male Urogenital Diseases |
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