Plasma Analysis for Response Assessment and to DIrect the manaGement of Metastatic Prostate Cancer


This research study is looking into plasma tumour deoxyribonucleic acid (ptDNA), a substance that is shed by cancer cells and can be detected in blood samples. Analysing ptDNA may therefore be able to provide more information about the characteristics of prostate cancer. This study will involve taking additional blood samples during standard treatment. The samples will be analysed in laboratories for levels of Prostate Specific Antigen (PSA); which gives information on the activity of the cancer; ptDNA; circulating tumour cells (ones that are derived from the cancer) (CTCs) and cells that affect immune system. The PARADIGM study is not, therefore, testing a new drug. Instead, the study is investigating if a new blood test can provide information about which current treatments for prostate cancer will work best for future patients with this disease. In the future and PARADIGM's ultimate aim is to identify which of the current treatment options will work best for patients. The research may also identify new opportunities for the development of drugs potentially useful in treating prostate cancer.

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: November 28, 2022

Detailed Description

In the UK, prostate cancer is the most common cancer in men and with about 1 in 8 men diagnosed with prostate cancer in their lifetime. Up to a third of prostate cancer deaths occur when cancer spreads to other parts of the body known as metastatic prostate cancer, which is a major healthcare burden. Currently, physicians use a maximum of six cycles of Docetaxel and continue Abiraterone until disease progression with long term androgen deprivation therapy (ADT). There is no early test to indicate if treatment is working for patients with metastatic prostate cancer. Currently Prostate Specific Antigen (PSA) is not sensitive enough to guide treatment alone. Studies in colorectal, lung and prostate cancers have started looking at substance called Plasma tumour deoxyribonucleic acid (ptDNA) and correlated presence of ptDNA will early relapse. Therefore, this study will investigate if the detection of ptDNA after initiating treatment is associated a worse clinical outcome. Our ultimate aim, is to identify which of the current treatment options will work best for patients in the future. This research may also identify new targets for the development of new drugs to test in clinical trials in the future. Assessments will include blood taken before and during treatment and at cancer progression. In selected centres, an optional Whole Body Magnetic Resonance Imaging (WBMRI) will be performed before and during treatment for those patients who are eligible. Patients will be followed up for a maximum of 5 years at the time they register onto the study. We expect recruitment duration to be 18 months.

Arms, Groups and Cohorts

    • Newly diagnosed metastatic prostate cancer patients starting long term therapy with Docetaxel with androgen deprivation therapy (ADT).
    • Newly diagnosed metastatic prostate cancer patients starting long term therapy with Abiraterone with androgen deprivation therapy (ADT).

Clinical Trial Outcome Measures

Primary Measures

  • Progression Free Survival (PFS) for PARADIGM-D and PARADIGM-A will be reported separately and will be defined as the interval from start of docetaxel or abiraterone to disease failure as determined by at least one or more of these factors
    • Time Frame: Following completion of cycle 3 of each patient – PARADIGM A, cycle length is 28 days. PARADIGM D, cycle length is 21 days
    • Symptomatic or asymptomatic progression of or new distant metastases confirmed by imaging. Symptomatic progression of cancer in the prostate confirmed by imaging, Serum PSA progression in PARADIGM-D. Prostate cancer specific death, defined as time from start of abiraterone or docetaxel with ADT to death from prostate cancer.

Secondary Measures

  • Prostate Cancer Specific Survival (PCSS)
    • Time Frame: 5 years after last patient has been registered
    • defined as time from start of abiraterone or docetaxel with ADT to death from prostate cancer
  • Overall survival (OS)
    • Time Frame: 5 years after last patient has been registered
    • defined as time from start of abiraterone or docetaxel with ADT to death from any cause.

Participating in This Clinical Trial

Inclusion Criteria

1. Able and willing to provide written informed consent 2. Prostate adenocarcinoma confirmed on biopsy obtained in previous 6 months 3. Polymetastatic disease defined as two of the following: i. Gleason score of ≥ 8, ii. Presence of ≥3 lesions on bone scan, iii. Presence of measurable visceral lesion 4. Eastern Cooperative Oncology Group (ECOG) Performance status 0 to 2 5. No medical contra-indications to abiraterone or docetaxel 6. Patients should be either of the following: i. Planned to start long-term Luteinizing hormone (LH) suppression, or ii. within 10 weeks of starting long-term LHRH antagonist, or iii. within 12 weeks of starting LHRH agonist or an anti-androgen when the latter is used in combination with or prior to LHRH agonist for flare protection. 7. Patients should be planned for addition of docetaxel (PARADIGM-D) or abiraterone (PARADIGM-A) 5 to 10 weeks after start of LHRHa (or 7 to 12 weeks if LHRH agonist is started without anti-androgen) with a target of 6 cycles or continuation until progression respectively. 8. No concomitant medical conditions likely to reduce life expectancy. 9. Patient agrees to be followed up in the recruiting centre and to having sequential plasma samples collected as per the study protocol. Exclusion Criteria:

1. Medically unsuitable for either abiraterone, prednisolone or docetaxel. 2. Concurrent or planned for (within the first 5 cycles of docetaxel or abiraterone) treatment with any experimental drugs, oestrogen patches, radiotherapy or surgery to the primary tumour. Patients randomised to the standard of care (SOC) arm in open-label clinical trials are eligible. Patients who are still to be randomised to STAMPEDE may be included where the randomisation will be limited to SOC or arm K. Patients can participate in other observational studies. 3. Prior systemic therapy for prostate cancer other than for LHRHa +/- anti-androgen (started within the time limits defined in inclusion criterion 6). 4. Metastatic brain disease or leptomeningeal disease. 5. Any surgery planned prior to Cycle 3 Day 1 (C3 D1) 6. Other current malignancy or malignancy diagnosed or relapsed within the past 5 years (other than non-melanomatous skin cancer, stage 0 melanoma in situ and non-muscle invasive bladder cancer). 7. Patients who consent to the whole-body magnetic resonance imaging (WBMRI) translational sub-study should

Gender Eligibility: Male

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University College, London
  • Collaborator
    • Epic Sciences
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Contact(s)
    • Salahah Ahmed-Laskar, 02076799112,

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