Phase 3
Completed N=1,038
S0421, Docetaxel and Prednisone With or Without Atrasentan in Treating Patients With Stage IV Prostate Cancer and Bone Metastases That Did Not Respond to Previous Hormone Therapy
Source: ClinicalTrials.gov NCT00134056 ↗Enrolled (actual)
1,038
Serious AEs
33.2%
Results posted
May 2017
Primary outcomePrimary: Compare Survival Between a Control or Standard Therapy Arm of Docetaxel + Placebo + Prednisone With Docetaxel + Atrasentan + Prednisone in Patients With Hormone Refractory Prostate Cancer. — 17.6; 17.8 months — p=0.64
◆ Published Evidence
Highly cited
334citations · ~28 / year
Circulating tumor cell counts are prognostic of overall survival in SWOG S0421: a phase III trial of docetaxel with or without atrasentan for metastatic castration-resistant prostate cancer.
Summary
RATIONALE: Drugs used in chemotherapy, such as docetaxel, prednisone, and atrasentan work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more tumor cells. It is not yet known whether docetaxel, prednisone, and atrasentan are more effective than docetaxel and prednisone in treating prostate cancer.
PURPOSE: This randomized phase III trial is studying docetaxel, prednisone, and atrasentan to see how well they work compared to docetaxel and prednisone in treating patients with stage IV prostate cancer and bone metastases that did not respond to previous hormone therapy.
Linked Publications (3)
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Circulating tumor cell counts are prognostic of overall survival in SWOG S0421: a phase III trial of docetaxel with or without atrasentan for metastatic castration-resistant prostate cancer.
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Docetaxel and atrasentan versus docetaxel and placebo for men with advanced castration-resistant prostate cancer (SWOG S0421): a randomised phase 3 trial.
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Serum biomarkers of bone metabolism in castration-resistant prostate cancer patients with skeletal metastases: results from SWOG 0421.
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Compare Survival Between a Control or Standard Therapy Arm of Docetaxel + Placebo + Prednisone With Docetaxel + Atrasentan + Prednisone in Patients With Hormone Refractory Prostate Cancer. |
17.6; 17.8 | 0.64 |
| PRIMARY Compare Progression-free Survival Between a Control or Standard Therapy Arm of Docetaxel + Placebo + Prednisone With Docetaxel + Atrasentan + Prednisone in Patients With Hormone Refractory Prostate Cancer. |
9.1; 9.2 | 0.81 |
| SECONDARY Compare Pain Progression Between the Two Study Arms. |
59; 41 | — |
| SECONDARY Compare Qualitative and Quantitative Toxicity Between the Two Study Arms |
2; 2; 2; 4; 3; 0 | — |
| SECONDARY Compare Prostate Specific Antigen (PSA) Response Rates Between the Experimental Arm and the Standard Arm. |
243; 249 | — |
| SECONDARY Compare Objective Responses Between the Two Treatment Groups in Patients With Measurable Disease as Defined by RECIST Criteria. |
31; 32; 0; 0; 194; 193 | — |
Eligibility Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed adenocarcinoma of the prostate
- Stage IV disease (any T, any N, M1b)
- Evidence of bone metastases by bone scan or MRI
- Measurable or nonmeasurable disease
- Soft tissue disease that has been irradiated within the past 2 months is not assessable as measurable disease
- Hormone-refractory disease despite androgen deprivation and antiandrogen withdrawal, as defined by 1 of the following criteria:
- Prostate-specific antigen (PSA) progression, defined as 3 consecutive rising PSA levels* taken ≥ 1 week apart
- PSA ≥ 5 ng/mL NOTE: *If the third confirmatory PSA level is the second level
- Progression of measurable disease
- Progression of nonmeasurable disease by bone scan
- Must have undergone surgical or medical (e.g., luteinizing hormone-releasing hormone [LHRH] agonist [e.g., leuprolide or goserelin] or LHRH antagonist therapy) castration
- Patients who have undergone medical castration must continue LHRH agonist or antagonist therapy during study treatment
- Must have completed 12 courses of blinding protocol treatment (atrasentan/placebo) AND stopped docetaxel for any reason (including completion of 12 courses) other than progressive disease
- No symptomatic pleural effusion
- No third space fluid accumulation (e.g., ascites)
- No prior or concurrent brain metastases
- Patients with clinical evidence of brain metastases must have a negative brain CT scan or MRI within the past 8 weeks
PATIENT CHARACTERISTICS:
Age
- 18 and over
Performance status
- Zubrod 0-3* NOTE: For a performance status of 3, the cause must be due to pain secondary to bone metastases
Life expectancy
- Not specified
Hematopoietic
- Not specified
Hepatic
- Not specified
Renal
- Not specified
Other
- Fertile patients must use effective contraception
- Able to take oral medication without crushing, dissolving, or chewing tablets
- No major infection
- No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer or stage I or II cancer in complete remission
- No symptomatic sensory neuropathy ≥ grade 2
- No history of hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80
- No other significant, active medical illness that would preclude study treatment or survival
PRIOR CONCURRENT THERAPY:
Biologic therapy
- No more than 1 prior systemic vaccine or biologic therapy
- At least 4 weeks since prior vaccine or biologic therapy and recovered
- No concurrent biological response modifiers
- No concurrent prophylactic colony-stimulating factors
Chemotherapy
- More than 2 years since prior adjuvant therapy with a single non-taxane-containing cytotoxic regimen
- No prior cytotoxic chemotherapy for metastatic prostate cancer
- No other concurrent chemotherapy
Endocrine therapy
- See Disease Characteristics
- At least 6 weeks since prior bicalutamide or nilutamide AND has subsequent disease progression
- At least 4 weeks since prior flutamide or ketoconazole AND has subsequent disease progression
- Prior or concurrent megestrol for treatment of hot flashes allowed
- No other concurrent corticosteroid or hormonal therapy unless continuing luteinizing hormone-releasing hormone treatment and/or bisphosphonate therapy
Radiotherapy
- See Disease Characteristics
- Prior samarium allowed
- At least 3 weeks since prior radiotherapy and recovered
- No prior radiotherapy to ≥ 30% of the bone marrow
- No prior strontium
- No concurrent radiotherapy
Surgery
- See Disease Characteristics
- At least 3 weeks since prior surgery and recovered
Other
- More than 4 weeks since prior investigational drugs
- Concurrent bisphosphonates allowed provided therapy is started prior to study entry, dose is maintained during the first 12 weeks of study treatment, and patient meets criteria for disease progression
- No initiation of bisphosphonates during the first 12 weeks of study treatment
- No concurrent herbal medications or foo
Data sourced from ClinicalTrials.gov (NCT00134056) and the linked publication. Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication. Informational only — not medical advice.