Hyperpolarized (HP) 13C Pyruvate Magnetic Resonance Imaging (MRI) for Response Monitoring to Neoadjuvant Abiraterone

Launched by IVAN DE KOUCHKOVSKY, MD · Apr 22, 2024

Keywords

ClinConnect Summary

This clinical trial is studying a new imaging technique called hyperpolarized 13C MRI to see how well it can monitor the response of high-risk prostate cancer to a treatment called neoadjuvant abiraterone. This treatment is given before surgery to help shrink the cancer. The researchers hope that by using this advanced MRI, they can measure how the cancer is responding early on, which could help doctors decide on the best treatment plan for patients.

To be eligible for the trial, participants must be at least 18 years old and have confirmed high-risk prostate cancer, meaning their disease meets certain criteria, like having aggressive cancer features or spread to nearby lymph nodes. They should also be planning to have surgery to remove the prostate. Participants will undergo MRI scans and may receive the new treatment before their surgery. It is important that they are in good health, with no serious medical conditions that could interfere with the study. Overall, this trial aims to improve how doctors monitor treatment and enhance the care of men facing prostate cancer.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. Greater than or equal to 18 years of age
• • 2. Histologically confirmed adenocarcinoma of the prostate with archival biopsy tissue available for genomic profiling.
• 3. High-risk disease defined as meeting 1 or more of the 3 following criteria:
• • 1. Gleason grade group \>=4; or
• • 2. Pelvic node involvement by conventional imaging or PSMA PET imaging (cN1); or
• • 3. Tumor stage T3 or higher (i.e. tumor extension outside of the prostate, or spread to tissues near the prostate other than the seminal vesicles, such as the bladder or wall of the pelvis) as determined by conventional imaging (including prostate MRI), transrectal ultrasound or PSMA PET imaging.
• • 4. No evidence of distant metastatic disease as determined by PSMA PET/CT or PET/MR. Nodal disease below the iliac bifurcation (clinical stage N1) is not an exclusion.
• • 5. Participants must be planning to undergo radical prostatectomy (RP) with or without pelvic lymph node dissection and considered surgically resectable by urologic evaluation at the time of study entry. Adjuvant therapy following RP will be allowed per treating provider discretion.
• • 6. Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2.
• 7. Demonstrates adequate organ function as defined below:
• • 1. Absolute neutrophil count (ANC) \>=1,500/microliter (mcL).
• • 2. Platelets \>=100,000/mcL, independent of transfusions/growth factors within 3 months of treatment start.
• • 3. Total bilirubin within normal institutional limits, unless elevated due to Gilbert's syndrome and direct bilirubin is within normal limits.
• • 4. Aspartate aminotransferase (AST)/serum glutamic-oxaloacetic transaminase (SGOT) \<=3 X institutional upper limit of normal.
• • 5. Alanine aminotransferase (ALT)/serum glutamic-pyruvic transaminase (SGPT) \<=3 X institutional upper limit of normal.
• • 6. Estimated creatinine clearance \>=40 mL/min (by the Cockcroft Gault equation).
• • 8. Ability to understand and the willingness to sign a written informed consent document.
• • 9. Human immunodeficiency virus (HIV)-infected individuals on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial.
• • 10. For participants with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated.
• • 11. Individuals with a history of hepatitis C virus (HCV) infection must have been treated and cured. For individuals with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load.
• • 12. Individuals with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial.
• • 13. Abiraterone may cause fetal harm when administered to a pregnant woman. The effects of hyperpolarized \[1-13C\]pyruvate on the developing human fetus are unknown. For this reason, men treated or enrolled on this protocol must agree to use adequate contraception prior to the study, for the duration of study participation and for 8 weeks after last administration of study treatment.
• Exclusion Criteria:
• • 1. Participants unwilling or unable to undergo MR imaging, including patients with contraindications to MRI, such as cardiac pacemakers or non-compatible intracranial vascular clips.
• • 2. Participants who cannot tolerate or have contra-indications to endorectal coil insertion; for example, patients with a prior abdominoperineal resection of the rectum or latex allergy. The use of an endorectal coil may be waived at the discretion of the Principal Investigator upon review of available imaging with radiology, in which case this exclusion criteria will not apply.
• • 3. Participants with contra-indications to injection of gadolinium contrast; for example, participants with prior documented allergy or those with inadequate renal function.
• • 4. Metallic hip implant or any other metallic implant or device that distorts local magnetic field and compromises the quality of MR imaging.
• • 5. Poorly controlled hypertension, with blood pressure at study entry \>160 mmHg systolic or \>100 mmHg diastolic.
• • 6. Congestive heart failure with New York Heart Association (NYHA) status \>=2.
• • 7. A history of clinically significant EKG abnormalities, including QT prolongation, a family history of prolonged QT interval syndrome, or myocardial infarction within 6 months of study entry.
• • 8. Has received prior prostate cancer therapy.
• • a. Prior 5-alpha reductase inhibitors (e.g. finasteride, dutasteride) allowed if discontinued at least 3 weeks prior to first dose.
• • 9. Is currently receiving any other investigational agent(s) or has participated in a study of an investigational product and received study treatment or used an investigational device within 2 weeks of the first dose of treatment.
• • 10. Concurrent use of strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole,clarithromycin, atazanavir, nefazodone, saquinavir, telithromycin, ritonavir, indinavir, nelfinavir, voriconazole) or inducers (e.g., phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital).