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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT03392428
Registration number
NCT03392428
Ethics application status
Date submitted
11/12/2017
Date registered
8/01/2018
Date last updated
13/06/2022
Titles & IDs
Public title
A Trial of 177Lu-PSMA617 Theranostic Versus Cabazitaxel in Progressive Metastatic Castration Resistant Prostate Cancer
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Scientific title
TheraP: A Randomised Phase 2 Trial of 177Lu-PSMA617 Theranostic Versus Cabazitaxel in Progressive Metastatic Castration Resistant Prostate Cancer (ANZUP Protocol 1603)
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Secondary ID [1]
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ANZUP 1603
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Universal Trial Number (UTN)
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Trial acronym
TheraP
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Cancer of the Prostate
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Metastatic Cancer
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Condition category
Condition code
Cancer
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Prostate
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Other interventions - 177Lu-PSMA617
Treatment: Drugs - Cabazitaxel
Experimental: 177Lu-PSMA617 - Patients randomised to the 177Lu-PSMA617 arm will receive 6-8.5GBq of 177Lu-PSMA617 by intravenous injection once every 6 weeks until progressive disease, prohibitive toxicity or a maximum of 6 cycles.
The first dose will be administered at 8.5GBq, reducing by 0.5GBq with every cycle given (i.e. to 6.0GBq on the sixth cycle, if reached). In some patients who have an exceptional response, treatment will be paused but can be re-commenced up to the maximum of 6 cycles upon progression.
Active comparator: Cabazitaxel - Patients randomised to the Cabazitaxel arm will receive 20mg/m2 Cabazitaxel by intravenous infusion once every 3 weeks until progressive disease, prohibitive toxicity or a maximum of 10 cycles.
Patients in this arm will also receive prednisolone 10mg orally per day for the duration of their cabazitaxel treatment.
Other interventions: 177Lu-PSMA617
Patients randomised to the 177Lu-PSMA617 arm will receive 6-8.5GBq of 177Lu-PSMA617 by intravenous injection once every 6 weeks until progressive disease, prohibitive toxicity or a maximum of 6 cycles.
The first dose will be administered at 8.5GBq, reducing by 0.5GBq with every cycle given (i.e. to 6.0GBq on the sixth cycle, if reached). In some patients who have an exceptional response, treatment will be paused but can be re-commenced up to the maximum of 6 cycles upon progression.
Treatment: Drugs: Cabazitaxel
Patients randomised to the Cabazitaxel arm will receive 20mg/m2 Cabazitaxel by intravenous infusion once every 3 weeks until progressive disease, prohibitive toxicity or a maximum of 10 cycles.
Patients in this arm will also receive prednisolone 10mg orally per day for the duration of their cabazitaxel treatment.
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Intervention code [1]
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Other interventions
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Intervention code [2]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Prostate Specific Antigen response rate (PSA RR)
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Assessment method [1]
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PSA RR defined as the proportion of participants in each group with a PSA reduction of = 50% from baseline.
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Timepoint [1]
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Through study completion, on average 4 years
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Secondary outcome [1]
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Pain Response (PPI and Analgesic Score)
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Assessment method [1]
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Pain response rate, defined as:
* \>=2 point reduction in PPI score from baseline with no increase in analgesic score; and/or
* \>=50% decrease in analgesic score with no increase in PPI PPI: McGill-Melzack Present Pain Intensity Scale (PPI) Analgesic score: Using Morphine Equivalent Daily Dose (MEDD)
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Timepoint [1]
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Through study completion, on average 4 years
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Secondary outcome [2]
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Objective Tumour Response Rate
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Assessment method [2]
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Objective Tumour Response Rate - defined as the proportion of participants with a confirmed complete response (CR) or partial response (PR) divided by the total number of participants (using RECIST 1.1).
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Timepoint [2]
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Through study completion, on average 4 years
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Secondary outcome [3]
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Progression free survival
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Assessment method [3]
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Progression free survival - the time from randomisation to date of PSA progression (blood samples), pain progression (on PPI) or radiographic progression (PCWG3 for bone and RECIST 1.1 for soft tissue), whichever occurs first
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Timepoint [3]
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Through study completion, on average 4 years
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Secondary outcome [4]
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PSA progression free survival
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Assessment method [4]
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PSA progression free survival, defined as the time from randomisation to PSA progression, assessed using PCWG3 criteria on blood test results.
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Timepoint [4]
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Through study completion, on average 4 years
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Secondary outcome [5]
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Pain progression free survival
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Assessment method [5]
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Pain progression free survival - defined as the time from randomisation to pain progression (\>=1 point increase on PPI from nadir and \>=25% increase in analgesic score (MEDD) from nadir, OR need for palliative radiotherapy).
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Timepoint [5]
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Through study completion, on average 4 years
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Secondary outcome [6]
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Radiographic progression free survival
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Assessment method [6]
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Radiographic progression free survival - defined as the time from randomisation to radiographic progression (assessed using PCWG3 criteria for bone lesions and RECIST 1.1 for soft tissue lesions).
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Timepoint [6]
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Through study completion, on average 4 years
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Secondary outcome [7]
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Health-related quality of life
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Assessment method [7]
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Health-related quality of life, assessed using a composite of the EORTC core quality of life questionnaire (QLQ C-30) and the Patient Disease and Treatment Assessment Form (PDF).
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Timepoint [7]
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Through study completion, on average 4 years
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Secondary outcome [8]
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Overall survival
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Assessment method [8]
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Overall survival - time from registration to death from any cause or last known follow-up alive.
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Timepoint [8]
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Through study completion, on average 4 years
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Secondary outcome [9]
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Frequency and severity of adverse events
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Assessment method [9]
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Frequency and severity of adverse events (composite), assessed using CTCAE v4.03.
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Timepoint [9]
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From first study dose to 12 weeks after completing study treatment
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Eligibility
Key inclusion criteria
1. Male aged 18 or older with metastatic adenocarcinoma of the prostate defined by:
* Documented histopathology of prostate adenocarcinoma OR
* Metastatic disease typical of prostate cancer (i.e. involving bone or pelvic lymph nodes or para-aortic lymph nodes)
2. Castration-resistant prostate cancer (defined as disease progressing despite castration by orchiectomy or ongoing Luteinizing Hormone-Releasing Hormone (LHRH) analog
3. Progressive disease with rising PSA on 3 consecutive measurements, and PSA = 20 ng/mL
4. Target or non-target lesions according to RECIST 1.1
5. Prior treatment with docetaxel
6. Significant PSMA avidity on 68Ga-PSMA PET/CT, defined as a minimum uptake of SUVmax 20 at a site of disease, and SUVmax > 10 at sites of measurable disease =10mm (unless subject to factors explaining a lower uptake, e.g. respiratory motion, reconstruction artefact)
7. ECOG Performance status 0 to 2
8. Assessed by a medical oncologist as suitable for chemotherapy with cabazitaxel
9. Adequate renal function:
• Cr Cl = 40mL/min (Cockcroft-Gault formula)
10. Adequate bone marrow function:
* Platelets = 100 x10 billion /L
* Hb = 90g/L (no red blood cell transfusion in last 4 weeks)
* Neutrophils > 1.5 x10 billion/L
11. Adequate liver function:
* Bilirubin < 1.5 x upper limit of normal (ULN) (or if bilirubin is between 1.5-2x ULN, must have a normal conjugated bilirubin)
* AST or ALT = 2.0 x ULN (or = 5.0 x ULN in the presence of liver metastases)
12. Estimated life expectancy > 12 weeks
13. Study treatment both planned and able to start within 21 days of randomisation
14. Willing and able to comply with all study requirements, including all treatments (cabazitaxel or Lu-PSMA); and, the timing and nature of all required assessments
15. Signed, written informed consent
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Males
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Prostate cancer with significant sarcomatoid or spindle cell or neuroendocrine small cell components
2. Site(s) of disease that are FDG positive with minimal PSMA expression defined as FDG intensity > 68Ga-PSMA activity OR 68Ga-PSMA SUVmax < 10
3. Sjogren's syndrome
4. Prior treatment with cabazitaxel or Lu-PSMA
5. Contraindications to the use of corticosteroid treatment
6. Active malignancy other than prostate cancer
7. Concurrent illness, including severe infection that may jeopardise the ability of the participant to undergo the procedures outlined in this protocol with reasonable safety
8. Presence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule, including alcohol dependence or drug abuse
9. Patients who are sexually active and not willing/able to use medically acceptable forms of barrier contraception
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 2
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
29/01/2018
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
31/12/2021
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Sample size
Target
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Accrual to date
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Final
201
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,SA,VIC,WA
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Recruitment hospital [1]
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Liverpool Hospital - Liverpool
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Recruitment hospital [2]
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St Vincent's Hospital - Sydney
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Recruitment hospital [3]
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Royal North Shore Hospital - Sydney
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Recruitment hospital [4]
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Calvary Mater Newcastle Hospital - Waratah
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Recruitment hospital [5]
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Royal Brisbane and Womens Hospital - Brisbane
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Recruitment hospital [6]
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Royal Adelaide Hospital - Adelaide
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Recruitment hospital [7]
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Peter MacCallum Cancer Centre - Melbourne
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Recruitment hospital [8]
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Austin Hospital - Melbourne
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Recruitment hospital [9]
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Monash Moorabbin Hospital - Moorabbin
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Recruitment hospital [10]
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Fiona Stanley Hospital - Murdoch
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Recruitment hospital [11]
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Sir Charles Gairdner Hospital - Nedlands
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Recruitment postcode(s) [1]
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2170 - Liverpool
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Recruitment postcode(s) [2]
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2010 - Sydney
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Recruitment postcode(s) [3]
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2065 - Sydney
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Recruitment postcode(s) [4]
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2298 - Waratah
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Recruitment postcode(s) [5]
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4029 - Brisbane
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Recruitment postcode(s) [6]
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5000 - Adelaide
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Recruitment postcode(s) [7]
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3008 - Melbourne
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Recruitment postcode(s) [8]
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3084 - Melbourne
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Recruitment postcode(s) [9]
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3165 - Moorabbin
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Recruitment postcode(s) [10]
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6450 - Murdoch
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Recruitment postcode(s) [11]
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6009 - Nedlands
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Funding & Sponsors
Primary sponsor type
Other
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Name
Australian and New Zealand Urogenital and Prostate Cancer Trials Group
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Address
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Other collaborator category [1]
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Other
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Name [1]
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Australian Nuclear Science and Technology Organisation (ANSTO)
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Address [1]
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Country [1]
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Other collaborator category [2]
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Commercial sector/industry
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Name [2]
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Endocyte
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Address [2]
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Other collaborator category [3]
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Other
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Name [3]
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Prostate Cancer Foundation of Australia (PCFA)
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Address [3]
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Country [3]
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Other collaborator category [4]
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Other
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Name [4]
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Australasian Radiopharmaceutical Trials network (ARTnet)
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Address [4]
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Country [4]
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Other collaborator category [5]
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Other
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Name [5]
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Movember Foundation
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Address [5]
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Country [5]
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Ethics approval
Ethics application status
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Summary
Brief summary
This open label, randomised, stratified, 2-arm, multicentre, phase 2 trial aims to determine the activity and safety of Lu-PSMA vs cabazitaxel in men with progressive metastatic castration resistant prostate cancer
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Trial website
https://clinicaltrials.gov/study/NCT03392428
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Trial related presentations / publications
Viljoen B, Hofman MS, Chambers SK, Dunn J, Dhillon HM, Davis ID, Ralph N. Experiences of participants in a clinical trial of a novel radioactive treatment for advanced prostate cancer: A nested, qualitative longitudinal study. PLoS One. 2022 Nov 9;17(11):e0276063. doi: 10.1371/journal.pone.0276063. eCollection 2022. Buteau JP, Martin AJ, Emmett L, Iravani A, Sandhu S, Joshua AM, Francis RJ, Zhang AY, Scott AM, Lee ST, Azad AA, McJannett MM, Stockler MR, Williams SG, Davis ID, Hofman MS; TheraP Trial Investigators and the Australian and New Zealand Urogenital and Prostate Cancer Trials Group. PSMA and FDG-PET as predictive and prognostic biomarkers in patients given [177Lu]Lu-PSMA-617 versus cabazitaxel for metastatic castration-resistant prostate cancer (TheraP): a biomarker analysis from a randomised, open-label, phase 2 trial. Lancet Oncol. 2022 Nov;23(11):1389-1397. doi: 10.1016/S1470-2045(22)00605-2. Epub 2022 Oct 16. Viljoen B, Hofman MS, Chambers SK, Dunn J, Dhillon H, Davis ID, Ralph N. Advanced prostate cancer experimental radioactive treatment-clinical trial decision making: patient experiences. BMJ Support Palliat Care. 2021 Aug 9:bmjspcare-2021-002994. doi: 10.1136/bmjspcare-2021-002994. Online ahead of print. Hofman MS, Emmett L, Sandhu S, Iravani A, Joshua AM, Goh JC, Pattison DA, Tan TH, Kirkwood ID, Ng S, Francis RJ, Gedye C, Rutherford NK, Weickhardt A, Scott AM, Lee ST, Kwan EM, Azad AA, Ramdave S, Redfern AD, Macdonald W, Guminski A, Hsiao E, Chua W, Lin P, Zhang AY, McJannett MM, Stockler MR, Violet JA, Williams SG, Martin AJ, Davis ID; TheraP Trial Investigators and the Australian and New Zealand Urogenital and Prostate Cancer Trials Group. [177Lu]Lu-PSMA-617 versus cabazitaxel in patients with metastatic castration-resistant prostate cancer (TheraP): a randomised, open-label, phase 2 trial. Lancet. 2021 Feb 27;397(10276):797-804. doi: 10.1016/S0140-6736(21)00237-3. Epub 2021 Feb 11. Iravani A, Violet J, Azad A, Hofman MS. Lutetium-177 prostate-specific membrane antigen (PSMA) theranostics: practical nuances and intricacies. Prostate Cancer Prostatic Dis. 2020 Mar;23(1):38-52. doi: 10.1038/s41391-019-0174-x. Epub 2019 Oct 8.
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Public notes
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Contacts
Principal investigator
Name
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Michael Hofman, A/Prof
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Address
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Peter MacCallum Cancer Centre, Melbourne, Australia
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Address
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Country
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Fax
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Email
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Contact person for scientific queries
No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT03392428
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