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Abiraterone Acetate in Asymptomatic or Mildly Symptomatic Patients With Metastatic Castration-Resistant Prostate Cancer

A Phase 3, Randomized, Double-blind, Placebo-Controlled Study of Abiraterone Acetate (CB7630) Plus Prednisone in Asymptomatic or Mildly Symptomatic Patients With Metastatic Castration-Resistant Prostate Cancer

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00887198
Enrollment
1088
Registered
2009-04-23
Start date
2009-04-28
Completion date
2017-05-25
Last updated
2025-02-04

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Prostate Cancer

Keywords

Prostate cancer, Abiraterone acetate, CB7630, CRPC, Metastatic castration-resistant prostate cancer, hormone refractory prostate cancer

Brief summary

This is a phase 3 study to compare the clinical benefit of abiraterone acetate plus prednisone with placebo plus prednisone in asymptomatic or mildly symptomatic patients with metastatic castration-resistant prostate cancer (CRPC).

Detailed description

This is a randomized (individuals will be assigned by chance to study treatments), double-blind (individuals and study personnel will not know the identity of study treatments), placebo (an inactive substance that is compared with a drug to test whether the drug has a real effect in a clinical trial)-controlled study in approximately 1,000 medically or surgically castrated male patients with metastatic CRPC who have shown tumor progression and are asymptomatic or mildly symptomatic. The study period will consist of screening, treatment, and follow-up phases. Patients will receive study treatment (abiraterone acetate or placebo) plus prednisone until radiographic progression of disease and/or unequivocal clinical progression. Efficacy evaluations will be performed throughout the treatment period and safety will be assessed until 30 days after the last dose of abiraterone acetate. throughout the study. Follow-up will continue for up to 60 months (5 years) or until the patient dies, is lost to follow-up, or withdraws informed consent. At the interim analysis of overall survival (OS; 43% of death events), the independent data monitoring committee (IDMC) reviewed the efficacy and safety data and concluded that all of the data pointed to a significant advantage for patients in one arm of the study compared with the other arm thereby unanimously recommending unblinding the study and allowing crossover from the placebo arm to active therapy. Patients currently receiving placebo will be offered crossover therapy to abiraterone acetate. Treatment for patients who were originally randomized to the abiraterone acetate treatment group will not change. Patients will be discontinued from long term follow-up at the time of the Clinical Cut-Off Date for Final Analysis (CCO-FA); however, patients still receiving treatment with abiraterone acetate at the CCO-FA will be offered to receive continued treatment for an additional period of up to 3 years or until disease progression or unacceptable toxicity. For these patients, safety assessment will be performed while continuing treatment, and for 30 days after the last dose of abiraterone acetate.

Interventions

DRUGAbiraterone acetate

1000 mg per day (4 x 250-mg tablets) taken orally.

DRUGPlacebo

4 placebo tablets per day taken orally.

DRUGPrednisone

5 mg tablet orally twice daily.

Sponsors

Janssen Research & Development, LLC
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Metastatic castration-resistant prostate cancer (CRPC) * Previous anti-androgen therapy and progression after withdrawal * ECOG performance status of either 0 or 1 * Medical or surgical castration with testosterone less than 50 ng/dL * Life expectancy of at least 6 months

Exclusion criteria

* Prior cytotoxic chemotherapy or biologic therapy for CRPC * Prior ketoconazole for prostate cancer * Known brain metastasis or visceral organ metastasis * Use of opiate analgesics for cancer-related pain, including codeine and dextropropoxyphene, currently or anytime within 4 weeks of Cycle 1 Day 1

Design outcomes

Primary

MeasureTime frameDescription
Overall SurvivalFrom randomization (Day 1) up to end of study (Month 60)Overall survival is defined as the time from randomization to date of death from any cause.
Radiographic Progression-free Survival (rPFS)From randomization (Day 1) up to first radiographic progression or cutoff date (Month 18)The rPFS was defined as the time from randomization to the occurrence of one of the following: 1) a participant was considered to have progressed by bone scan if - a) the first bone scan with greater than or equal to (\>=) 2 new lesions compared to baseline was observed in less than (\<) 12 weeks from randomization and was confirmed by a second bone scan taken \>=6 weeks later showing \>=2 additional new lesions (a total of \>=4 new lesions compared to baseline), b) the first bone scan with \>=2 new lesions compared to baseline was observed in \>=12 weeks from randomization and the new lesions were verified on the next bone scan \>=6 weeks later (a total of \>=2 new lesions compared to baseline); 2) progression of soft tissue lesions measured by computerized tomography (CT) or magnetic resonance imaging (MRI); 3) death from any cause.

Secondary

MeasureTime frameDescription
Time to Deterioration in Eastern Cooperative Oncology Group (ECOG) Performance Score by >=1 PointFrom randomization (Day 1) up to first radiographic progression or cutoff date (Month 18)The time interval from the date of randomization to the first date at which there was at least a 1 grade change (worsening) in the ECOG performance status grade. Participants who had no deterioration in ECOG performance status grade at the time of the analysis were censored at the last known date of no deterioration. ECOG is a 5-point scale, where 0=Fully active, 1=Ambulatory, carry out work of sedentary nature, 2=Ambulatory, capable of all self-care, 3=Capable of limited self-care, confined to bed or chair more than 50% of waking hours, 4=Completely disabled, no self-care, totally confined to bed or chair, 5=Dead. Participants with no assessment were censored at the date of randomization.
Time to Prostate-specific Antigen (PSA) ProgressionFrom randomization (Day 1) up to date of PSA progerssion or cutoff date (Month 18)The time interval from the date of randomization to the date of PSA progression as defined in the protocol-specific prostate cancer Working Group 2 (PCWG2) criteria. A participant was considered to have a PSA progression if the PSA level had a 25 percent (%) or greater increase from nadir and an absolute increase of 2 nanogram/milliliter ((ng/mL) or more, which is confirmed by a second value obtained in 3 or more weeks. Participants who had no PSA progression at the time of the analysis were censored at the last known date of no PSA progression. Participants with no on-study PSA assessment or no baseline PSA assessment were censored at the date of randomization.
Number of Participants With Treatment Emergent Adverse EventsFrom first dose of study drug up to 30 days after the last dose of study drugAn adverse event (AE) was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. A serious adverse event (SAE) was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. Treatment-emergent were events between administration of study drug and up to 30 days after last dose of study drug that were absent before treatment or that worsened relative to pre-treatment state.
Time to Opiate Use for Prostate Cancer PainFrom randomization (Day 1) up to first opiate use or end of study (Month 60)The time interval from the date of randomization to the date of opiate use for cancer pain. Participants who have no opiate use at the time of analysis were censored at the last known date of no opiate use for cancer pain. Participants with no assessment were censored at the date of randomization.
Maximum Plasma Concentrations of AbirateroneUp to Cycle 5, Day 1
Area Under the Plasma Concentration-time Curve From Time 0 to Time the Last Quantifiable Concentration of Abiraterone (AUC[0-infinity])Up to Cycle 5, Day 1The AUC (0-infinity) is the area under the plasma concentration-time curve from time zero to infinite time, calculated as the sum of AUC(last) and C(last)/lambda(z); wherein AUC(last) is area under the plasma concentration-time curve from time zero to last quantifiable time, C(last) is the last observed quantifiable concentration, and lambda(z) is elimination rate constant.
Elimination Half-Life (t1/2)Up to Cycle 5, Day 1The elimination half-life (t1/2) is the time measured for the plasma concentration to decrease by 1 half to its original concentration. It is associated with the terminal slope of the semi logarithmic drug concentration-time curve, and is calculated as 0.693/lambda(z).
Mean Plasma Concentrations of AbirateroneUp to Cycle 5, Day 1
Time to Initiation of Cytotoxic ChemotherapyFrom randomization (Day 1) up to initiation of cytotoxic chemotherapy or cutoff date (Month 18)The time interval from the date of randomization to the date of initiation of cytotoxic chemotherapy for prostate cancer. Participants who had no cytotoxic chemotherapy administration at the time of analysis were censored at the last known date when no cytotoxic chemotherapy was administered. Participants with no assessment were censored at the date of randomization.

Countries

Australia, Belgium, Canada, France, Germany, Greece, Netherlands, Spain, Sweden, United Kingdom, United States

Participant flow

Participants by arm

ArmCount
Abiraterone Acetate + Prednisone (AAP)
Participants received 1000 milligram (mg) abiraterone acetate tablets (as 4\*250 mg tablets) orally once daily along with prednisone 5 mg tablet orally twice daily, from Day 1, Cycle1 (each cycle consist of 28 days) up to radiographic progression of disease and/or unequivocal clinical progression.
546
Placebo
Participants received placebo matched to abiraterone acetate tablets orally once daily along with prednisone 5 mg tablet orally twice daily, from Day 1, Cycle1 (each cycle consist of 28 days) up to radiographic progression of disease and/or unequivocal clinical progression.
542
Total1,088

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Cross Over (Placebo to AA)Adverse Event009
Cross Over (Placebo to AA)Ongoing0035
Cross Over (Placebo to AA)Other0019
Cross Over (Placebo to AA)Progressive disease0020
Cross Over (Placebo to AA)Started other prostate cancer treatment008
Cross Over (Placebo to AA)Withdrawal by Subject002
Randomized PeriodAdverse Event50330
Randomized PeriodCross-over to AA (under amendment 3)0510
Randomized PeriodLost to Follow-up100
Randomized PeriodOngoing4200
Randomized PeriodOther42300
Randomized PeriodProgressive disease3663700
Randomized PeriodRandomized, Not treated420
Randomized PeriodWithdrawal by Subject41560

Baseline characteristics

CharacteristicAbiraterone Acetate + Prednisone (AAP)TotalPlacebo
Age, Continuous70.5 years
STANDARD_DEVIATION 8.8
70.3 years
STANDARD_DEVIATION 8.76
70.1 years
STANDARD_DEVIATION 8.72
Region of Enrollment
Australia
60 Participants132 Participants72 Participants
Region of Enrollment
Belgium
25 Participants42 Participants17 Participants
Region of Enrollment
Canada
63 Participants100 Participants37 Participants
Region of Enrollment
France
24 Participants53 Participants29 Participants
Region of Enrollment
Germany
46 Participants78 Participants32 Participants
Region of Enrollment
Greece
7 Participants14 Participants7 Participants
Region of Enrollment
Italy
1 Participants7 Participants6 Participants
Region of Enrollment
Netherlands
15 Participants30 Participants15 Participants
Region of Enrollment
Spain
25 Participants45 Participants20 Participants
Region of Enrollment
Sweden
4 Participants17 Participants13 Participants
Region of Enrollment
United Kingdom
42 Participants98 Participants56 Participants
Region of Enrollment
United States
234 Participants472 Participants238 Participants
Sex: Female, Male
Female
0 Participants0 Participants0 Participants
Sex: Female, Male
Male
546 Participants1088 Participants542 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
530 / 542505 / 54086 / 93
serious
Total, serious adverse events
215 / 542156 / 54040 / 93

Outcome results

Primary

Overall Survival

Overall survival is defined as the time from randomization to date of death from any cause.

Time frame: From randomization (Day 1) up to end of study (Month 60)

Population: Intent-to-treat (ITT) population included all the randomized participants who were classified according to their assigned treatment group, regardless of the actual treatment received.

ArmMeasureValue (MEDIAN)
Abiraterone Acetate + Prednisone (AAP)Overall Survival34.66 Months
PlaceboOverall Survival30.29 Months
Primary

Radiographic Progression-free Survival (rPFS)

The rPFS was defined as the time from randomization to the occurrence of one of the following: 1) a participant was considered to have progressed by bone scan if - a) the first bone scan with greater than or equal to (\>=) 2 new lesions compared to baseline was observed in less than (\<) 12 weeks from randomization and was confirmed by a second bone scan taken \>=6 weeks later showing \>=2 additional new lesions (a total of \>=4 new lesions compared to baseline), b) the first bone scan with \>=2 new lesions compared to baseline was observed in \>=12 weeks from randomization and the new lesions were verified on the next bone scan \>=6 weeks later (a total of \>=2 new lesions compared to baseline); 2) progression of soft tissue lesions measured by computerized tomography (CT) or magnetic resonance imaging (MRI); 3) death from any cause.

Time frame: From randomization (Day 1) up to first radiographic progression or cutoff date (Month 18)

Population: ITT population included all the randomized participants who were classified according to their assigned treatment group, regardless of the actual treatment received.

ArmMeasureValue (MEDIAN)
Abiraterone Acetate + Prednisone (AAP)Radiographic Progression-free Survival (rPFS)NA Months
PlaceboRadiographic Progression-free Survival (rPFS)8.28 Months
Secondary

Area Under the Plasma Concentration-time Curve From Time 0 to Time the Last Quantifiable Concentration of Abiraterone (AUC[0-infinity])

The AUC (0-infinity) is the area under the plasma concentration-time curve from time zero to infinite time, calculated as the sum of AUC(last) and C(last)/lambda(z); wherein AUC(last) is area under the plasma concentration-time curve from time zero to last quantifiable time, C(last) is the last observed quantifiable concentration, and lambda(z) is elimination rate constant.

Time frame: Up to Cycle 5, Day 1

Population: Data was not reported as non-compartmental analysis was not performed due to sparse sampling.

Secondary

Elimination Half-Life (t1/2)

The elimination half-life (t1/2) is the time measured for the plasma concentration to decrease by 1 half to its original concentration. It is associated with the terminal slope of the semi logarithmic drug concentration-time curve, and is calculated as 0.693/lambda(z).

Time frame: Up to Cycle 5, Day 1

Population: Data was not reported as non-compartmental analysis was not performed due to sparse sampling.

Secondary

Maximum Plasma Concentrations of Abiraterone

Time frame: Up to Cycle 5, Day 1

Population: Data was not reported as non-compartmental analysis was not performed due to sparse sampling.

Secondary

Mean Plasma Concentrations of Abiraterone

Time frame: Up to Cycle 5, Day 1

Population: Data was not reported as non-compartmental analysis was not performed due to sparse sampling.

Secondary

Number of Participants With Treatment Emergent Adverse Events

An adverse event (AE) was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. A serious adverse event (SAE) was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. Treatment-emergent were events between administration of study drug and up to 30 days after last dose of study drug that were absent before treatment or that worsened relative to pre-treatment state.

Time frame: From first dose of study drug up to 30 days after the last dose of study drug

Population: Safety analysis set included all participants in the randomized population who received any study drug.

ArmMeasureGroupValue (NUMBER)
Abiraterone Acetate + Prednisone (AAP)Number of Participants With Treatment Emergent Adverse EventsWith Treatment-Emergent Adverse Events541 Participants
Abiraterone Acetate + Prednisone (AAP)Number of Participants With Treatment Emergent Adverse EventsWith Treatment-Emergent Serious Adverse Events208 Participants
PlaceboNumber of Participants With Treatment Emergent Adverse EventsWith Treatment-Emergent Adverse Events524 Participants
PlaceboNumber of Participants With Treatment Emergent Adverse EventsWith Treatment-Emergent Serious Adverse Events148 Participants
Placebo to Abiraterone AcetateNumber of Participants With Treatment Emergent Adverse EventsWith Treatment-Emergent Adverse Events93 Participants
Placebo to Abiraterone AcetateNumber of Participants With Treatment Emergent Adverse EventsWith Treatment-Emergent Serious Adverse Events39 Participants
Secondary

Time to Deterioration in Eastern Cooperative Oncology Group (ECOG) Performance Score by >=1 Point

The time interval from the date of randomization to the first date at which there was at least a 1 grade change (worsening) in the ECOG performance status grade. Participants who had no deterioration in ECOG performance status grade at the time of the analysis were censored at the last known date of no deterioration. ECOG is a 5-point scale, where 0=Fully active, 1=Ambulatory, carry out work of sedentary nature, 2=Ambulatory, capable of all self-care, 3=Capable of limited self-care, confined to bed or chair more than 50% of waking hours, 4=Completely disabled, no self-care, totally confined to bed or chair, 5=Dead. Participants with no assessment were censored at the date of randomization.

Time frame: From randomization (Day 1) up to first radiographic progression or cutoff date (Month 18)

Population: ITT population included all the randomized participants who were classified according to their assigned treatment group, regardless of the actual treatment received.

ArmMeasureValue (MEDIAN)
Abiraterone Acetate + Prednisone (AAP)Time to Deterioration in Eastern Cooperative Oncology Group (ECOG) Performance Score by >=1 Point12.29 Months
PlaceboTime to Deterioration in Eastern Cooperative Oncology Group (ECOG) Performance Score by >=1 Point10.87 Months
Secondary

Time to Initiation of Cytotoxic Chemotherapy

The time interval from the date of randomization to the date of initiation of cytotoxic chemotherapy for prostate cancer. Participants who had no cytotoxic chemotherapy administration at the time of analysis were censored at the last known date when no cytotoxic chemotherapy was administered. Participants with no assessment were censored at the date of randomization.

Time frame: From randomization (Day 1) up to initiation of cytotoxic chemotherapy or cutoff date (Month 18)

Population: ITT population included all the randomized participants who were classified according to their assigned treatment group, regardless of the actual treatment received.

ArmMeasureValue (MEDIAN)
Abiraterone Acetate + Prednisone (AAP)Time to Initiation of Cytotoxic Chemotherapy25.17 Months
PlaceboTime to Initiation of Cytotoxic Chemotherapy16.82 Months
Secondary

Time to Opiate Use for Prostate Cancer Pain

The time interval from the date of randomization to the date of opiate use for cancer pain. Participants who have no opiate use at the time of analysis were censored at the last known date of no opiate use for cancer pain. Participants with no assessment were censored at the date of randomization.

Time frame: From randomization (Day 1) up to first opiate use or end of study (Month 60)

Population: ITT population included all the randomized participants who were classified according to their assigned treatment group, regardless of the actual treatment received.

ArmMeasureValue (MEDIAN)
Abiraterone Acetate + Prednisone (AAP)Time to Opiate Use for Prostate Cancer Pain33.38 Months
PlaceboTime to Opiate Use for Prostate Cancer Pain23.39 Months
Secondary

Time to Prostate-specific Antigen (PSA) Progression

The time interval from the date of randomization to the date of PSA progression as defined in the protocol-specific prostate cancer Working Group 2 (PCWG2) criteria. A participant was considered to have a PSA progression if the PSA level had a 25 percent (%) or greater increase from nadir and an absolute increase of 2 nanogram/milliliter ((ng/mL) or more, which is confirmed by a second value obtained in 3 or more weeks. Participants who had no PSA progression at the time of the analysis were censored at the last known date of no PSA progression. Participants with no on-study PSA assessment or no baseline PSA assessment were censored at the date of randomization.

Time frame: From randomization (Day 1) up to date of PSA progerssion or cutoff date (Month 18)

Population: ITT population included all the randomized participants who were classified according to their assigned treatment group, regardless of the actual treatment received.

ArmMeasureValue (MEDIAN)
Abiraterone Acetate + Prednisone (AAP)Time to Prostate-specific Antigen (PSA) Progression11.07 Months
PlaceboTime to Prostate-specific Antigen (PSA) Progression5.55 Months

Source: ClinicalTrials.gov · Data processed: Jun 20, 2026