Prostate Cancer
Conditions
Keywords
zoledronic acid, bone metastases, prostate cancer, hormone-sensitive
Brief summary
This study aims to determine whether early treatment with zoledronic acid, that is given during the early phase of advanced prostate cancer, will be more efficacious than delayed treatment
Interventions
Zoledronic acid was provided by Novartis in vials containing 4 mg/5 mL liquid concentrate. Prior to administration, the liquid concentrate from one vial was to be further diluted with 100 mL of calcium-free infusion solution (0.9 % weight by volume sodium chloride solution or 5 % weight by volume glucose solution). If refrigerated, the solution had to be allowed to reach room temperature before administration. After addition of the liquid concentrate to the infusion media, the infusion solution was to be used as soon as practicable to reduce the risk of microbiological hazard. If storage of the solution was necessary, it had to be refrigerated at temperatures between 2-8 degrees C and was to be used within 24 hours. The infusion solution containing 4 mg zoledronic acid was to be administered every 4 weeks as an i.v. infusion over no less than 15 minutes.
Androgen deprivation therapy (ADT) was to be administered according to institutional protocols, in accordance with relevant prescribing information. The type and duration of androgen deprivation was at the discretion of the treating specialist, and could include orchiectomy where this would normally have been performed. Androgen deprivation therapy was provided by the investigational center, or obtained by the patient from usual sources. Anti-androgen monotherapy and intermittent ADT were excluded in the first 12 months of the study.
Sponsors
Study design
Eligibility
Inclusion criteria
* prostate cancer * at least one bone metastasis * receiving or about to receive androgen deprivation therapy (ADT)
Exclusion criteria
* previous ADT failure * previous or current treatment with another bone-protecting agent, chemotherapy or targeted therapy * abnormal renal function Other protocol-defined inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Skeletal-related Event-free Survival in Men With Bone Metastases From Prostate Cancer | 18 months | Skeletal-related event free survival is the time from randomization until the first detected Skeletal Related Event (SRE). Patients who were still SRE-free at 18 months were censored. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival at 18 Months and 3 Years | month 18, year 3 | Overall survival (OS) time was measured from the start of study drug to the date of death due to any cause. |
| Time to Occurrence of Skeletal Related Event or Death | 18 Months | Time from randomization to the first detected skeletal related event or death. This endpoint is the same as the primary endpoint with the modification that deaths are considered events. |
| Skeletal-related Event(SRE)-Free Survival | 36 months | Time from randomization until the first detected SRE. Patients who were still SRE-free at 3 years were censored. |
Countries
Australia, Brazil, China, Kuwait, Lebanon, New Zealand, Saudi Arabia, South Korea, Taiwan, Thailand
Participant flow
Recruitment details
552 patients enrolled, but 30 patients were excluded due to GCP issues in one country.
Participants by arm
| Arm | Count |
|---|---|
| Early Group Zoledronic acid 4 mg i.v. infusion every 4 weeks, commencing at Baseline. | 259 |
| Delayed Group Zoledronic acid 4 mg i.v. infusion every 4 weeks, commencing no sooner than 12 months after their baseline visit, and not until they have had three rises in PSA level from Baseline, one of which must be a least 10 ng/mL greater than the baseline PSA level. | 263 |
| Total | 522 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 70 | 43 |
| Overall Study | Disease Progression | 17 | 22 |
| Overall Study | Lack of Efficacy | 2 | 2 |
| Overall Study | Lost to Follow-up | 9 | 19 |
| Overall Study | Other | 14 | 9 |
| Overall Study | Protocol Violation | 12 | 12 |
| Overall Study | Symptomatic deterioration | 9 | 3 |
| Overall Study | Use of an inhibitor of bone resorption | 0 | 2 |
| Overall Study | Withdrawal by Subject | 33 | 28 |
Baseline characteristics
| Characteristic | Early Group | Delayed Group | Total |
|---|---|---|---|
| Age, Continuous | 69.4 years STANDARD_DEVIATION 8.46 | 70.2 years STANDARD_DEVIATION 8.26 | 69.8 years STANDARD_DEVIATION 8.37 |
| Sex: Female, Male Female | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | 259 Participants | 263 Participants | 522 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 220 / 259 | 197 / 263 | 135 / 191 | 62 / 72 |
| serious Total, serious adverse events | 121 / 259 | 104 / 263 | 67 / 191 | 37 / 72 |
Outcome results
Skeletal-related Event-free Survival in Men With Bone Metastases From Prostate Cancer
Skeletal-related event free survival is the time from randomization until the first detected Skeletal Related Event (SRE). Patients who were still SRE-free at 18 months were censored.
Time frame: 18 months
Population: The ITT Population will consist of all patients randomized to treatment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Early Group | Skeletal-related Event-free Survival in Men With Bone Metastases From Prostate Cancer | Patients with event (s) | 58 participants |
| Early Group | Skeletal-related Event-free Survival in Men With Bone Metastases From Prostate Cancer | Patients without event (censored) | 201 participants |
| Delayed Group | Skeletal-related Event-free Survival in Men With Bone Metastases From Prostate Cancer | Patients with event (s) | 49 participants |
| Delayed Group | Skeletal-related Event-free Survival in Men With Bone Metastases From Prostate Cancer | Patients without event (censored) | 214 participants |
Overall Survival at 18 Months and 3 Years
Overall survival (OS) time was measured from the start of study drug to the date of death due to any cause.
Time frame: month 18, year 3
Population: The ITT Population will consist of all patients randomized to treatment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Early Group | Overall Survival at 18 Months and 3 Years | Patients with event (s) - 18 months | 31 participants |
| Early Group | Overall Survival at 18 Months and 3 Years | Patients without event - 18 months | 228 participants |
| Early Group | Overall Survival at 18 Months and 3 Years | Patients with event (s) - 36 months | 49 participants |
| Early Group | Overall Survival at 18 Months and 3 Years | Patients without event - 36 months | 210 participants |
| Delayed Group | Overall Survival at 18 Months and 3 Years | Patients without event - 36 months | 219 participants |
| Delayed Group | Overall Survival at 18 Months and 3 Years | Patients with event (s) - 18 months | 21 participants |
| Delayed Group | Overall Survival at 18 Months and 3 Years | Patients with event (s) - 36 months | 44 participants |
| Delayed Group | Overall Survival at 18 Months and 3 Years | Patients without event - 18 months | 242 participants |
Skeletal-related Event(SRE)-Free Survival
Time from randomization until the first detected SRE. Patients who were still SRE-free at 3 years were censored.
Time frame: 36 months
Population: The ITT Population consisted of all patients randomized to treatment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Early Group | Skeletal-related Event(SRE)-Free Survival | NA Days |
| Delayed Group | Skeletal-related Event(SRE)-Free Survival | NA Days |
Time to Occurrence of Skeletal Related Event or Death
Time from randomization to the first detected skeletal related event or death. This endpoint is the same as the primary endpoint with the modification that deaths are considered events.
Time frame: 18 Months
Population: The ITT Population consisted of all patients randomized to treatment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Early Group | Time to Occurrence of Skeletal Related Event or Death | NA Days |
| Delayed Group | Time to Occurrence of Skeletal Related Event or Death | NA Days |
Time to Occurrence of Skeletal Related Event or Death
Time from randomization to the first detected skeletal related event or death. This endpoint is the same as the primary endpoint with the modification that deaths are considered events.
Time frame: 36 Months
Population: The ITT Population consisted of all patients randomized to treatment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Early Group | Time to Occurrence of Skeletal Related Event or Death | NA Days |
| Delayed Group | Time to Occurrence of Skeletal Related Event or Death | NA Days |