Prostatic Neoplasms
Conditions
Brief summary
PyL, also known as \[18F\]DCFPyL, is a second-generation fluorinated prostate-specific membrane antigen (PSMA) targeted PET imaging agent. In preliminary studies it demonstrates a higher detection of metastatic prostate lesions compared to standard imaging. Its ability to image metastatic prostate cancer sites was comparable to 68Ga-PSMA with high tumor-to-background ratios.Additionally, \[18F\] PyL demonstrated higher mean tumor-to-background ratios when using kidney, spleen, or parotid as reference organs. However, the role of \[18F\] PyL in tumor response to therapy has not been evaluated, specifically the potential to serve as a predictive biomarker of response. Given the high cost of current therapeutic agents in mCRPC, there is a need for an early response biomarker to stratify which patients will benefit from therapy and which will not. This will also allow for earlier change in management of patients who will not response to these therapies, potentially improving patient outcomes.
Detailed description
The investigators will conduct a prospective phase II/III study of 300 men diagnosed with prostate cancer with a rising prostate-specific antigen (PSA). Upon enrollment, subjects will undergo standard of care imaging (defined as a CT or MRI of the chest, abdomen, and pelvis, and 99mTc bone scans) if not obtained within 45 days of enrollment. Subjects will have standard of care laboratory evaluations and undergo 18F- DCFPyL PET/CT. \[18F\]DCFPyL will be used for study imaging.
Interventions
DRUG18F- DCFPyL PET/CT
A CT scan using a radioactive marker to better image tumors
Sponsors
Columbia University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Intervention model description
Prospective, non-randomized
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Histologically confirmed diagnosis of prostate cancer 2. PSA ≥ 0.2ng/ml 3. Age ≥ 18 years of age 4. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 (karnofsky ≥ 60%) 5. Ability to understand and willingness to sign a written informed consent document 6. Wiling to comply with clinical trial instructions and requirements 7. Willing to cover the cost of PyL PET/CT imaging if funds are not available
Exclusion criteria
1. History of another active malignancy within 3 years, other than basal cell and squamous cell carcinoma of the skin 2. Presence of prostate brachytherapy implants unless approved by the PI 3. Administration of another radioisotope within five physical half-lives of trial enrollment 4. Radiation or chemotherapy within 2 weeks prior to trial enrollment 5. Serum creatinine \> 3 times the upper limit of normal 6. Serum total bilirubin \> 3 times the upper limit of normal 7. Aspartate transaminase (AST) or alanine aminotransferase (ALT) \>5 times the upper limit of normal 8. Inadequate venous access
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| To determine the positive predictive value of 18F-DCFPyL PET/CT on a per-patient basis | 3.5 years | To determine the positive predictive value of 18F-DCFPyL PET/CT on a per-patient basis |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| To determine the positive predictive value of 18F-DCFPyL PET/CT on a per-region basis, with regions being the prostate or prostate bed, pelvis, extra pelvis, and bones | 3.5 years | To determine the positive predictive value of 18F-DCFPyL PET/CT on a per-region basis |
| To determine the sensitivity and specificity of 18F-DCFPyL PET/CT on a per patient and region basis | 3.5 years | To determine the sensitivity and specificity of 18F-DCFPyL PET/CT on a per patient and region basis |
Other
| Measure | Time frame | Description |
|---|---|---|
| To characterize ctDNA and exosomes in patients with prostate cancer | 3.5 years | To characterize ctDNA and exosomes in patients with prostate cancer |
| To determine correlation with ctDNA and/or exosome levels with disease burden | 3.5 years | To determine correlation with ctDNA and/or exosome levels with disease burden |
Countries
United States
Outcome results
None listed