A Phase 3 interventional study of Darolutamide and Goserelin Acetate in Prostate Carcinoma, sponsored by ECOG-ACRIN Cancer Research Group. Active, not recruiting at 115 sites in United States. Open to male participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-07-28.
Sponsored by ECOG-ACRIN Cancer Research Group · Phase 3, Interventional, and Treatment
This phase III trial compares the effect of adding darolutamide to ADT versus ADT alone after surgery for the treatment of high-risk prostate cancer. ADT reduces testosterone levels in the blood. Testosterone is a hormone made mainly in the testes and is needed to develop and maintain male sex characteristics, such as facial hair, deep voice, and muscle growth. It also plays role in prostate cancer development. Darolutamide blocks the actions of the androgens (e.g. testosterone) in the tumor cells and in the body. Giving darolutamide with ADT may work better in eliminating or reducing the size of the cancer and/or prevent it from returning compared to ADT alone in patients with prostate cancer.
PRIMARY OBJECTIVE:
I. To determine whether 12 months of androgen deprivation therapy (ADT) and darolutamide improves metastasis-free survival (MFS) compared to 12 months of ADT plus placebo in men with high risk prostate cancer (defined by Cancer of the Prostate Risk Assessment Post-surgical [CAPRA-S] score >= 3 and a high Decipher score (>= 0.6) [C3+D+]) who have undergone radical prostatectomy.
SECONDARY OBJECTIVES:
I. To determine whether 12 months of ADT and darolutamide improves recurrence-free survival (RFS) compared to 12 months of ADT plus placebo in men with high-risk prostate cancer that have undergone radical prostatectomy.
II. To determine whether 12 months of ADT and darolutamide improves event-free survival (EFS) compared to 12 months of ADT plus placebo in men with high-risk prostate cancer that have undergone radical prostatectomy.
III. To determine whether 12 months of ADT and darolutamide improves overall survival (OS) compared to 12 months of ADT plus placebo in men with high-risk prostate cancer that have undergone radical prostatectomy.
IV. To determine the rate of testosterone recovery and time to testosterone recovery in each treatment arm.
V. To evaluate the safety and tolerability of ADT and darolutamide.
CORRELATIVE OBJECTIVES FOR EXPLORATORY BIOMARKERS:
I. To discover a novel gene expression signature in the Decipher transcriptome platforms that is predictive of clinical outcome, as defined by the primary and secondary objectives of this study, in response to ADT by intensification with darolutamide versus ADT alone.
II. To assess the prevalence of subclasses of established transcriptome expression signatures and prospectively validate their predictive value for ADT response, these include: (i) androgen (AR) activity (ii) Basal-luminal subtyping based on modified PAM50, and (iii) ADT score.
III. To assess whether the spectrum of high Decipher scores (0.6-1.0), prostate-specific antigen (PSA) levels at presentation and post-radical prostatectomy (RP) and final pathology variables affect the response and outcome to ADT and darolutamide.
QUALITY OF LIFE (QOL) OBJECTIVES:
I. To compare overall quality of life, measured by Functional Assessment of Cancer Therapy-Prostate (FACT-P) total score, at 18 months between the two arms. (Primary) II. To compare the change in overall quality of life, measured by FACT-P total score, from baseline to 18 months between the two arms. (Secondary) III. To compare patient-reported fatigue (Functional Assessment of Chronic Illness Therapy [FACIT]-Fatigue scores) at 12 months between the two treatment arms. (Secondary) IV. To compare the change in subjective patient-reported cognitive function (FACT-Cognitive [Cog]) from baseline to 12 months between the treatment arms. (Exploratory) V. To compare subjective patient-reported cognitive function (FACT-Cog scores) at 12 months between the two treatment arms. (Exploratory)
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I: Patients receive goserelin acetate, leuprolide acetate, or triptorelin via injection every 3 months for 12 months (4 injections), every 4 months for 12 months (3 injections), or every month for 12 months (12 injections) in the absence of disease progression or unacceptable toxicity. Patients also receive a placebo four times daily (QID) for 52 weeks in the absence of disease progression or unacceptable toxicity.
ARM II: Patients receive goserelin acetate, leuprolide acetate, or triptorelin via injection every 3 months for 12 months (4 injections), every 4 months for 12 months (3 injections), or every month for 12 months (12 injections) in the absence of disease progression or unacceptable toxicity. Patients also receive darolutamide QID for 52 weeks in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for 36 months.
6,370 studies on the registry are indexed under Prostatic Neoplasms; 1,400 are open to participants now.
This study's enrollment of 27 is below the median of 58 across 4,822 interventional studies indexed under Prostatic Neoplasms.
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Inclusion Criteria:
Exclusion Criteria:
Patients receive goserelin acetate, leuprolide acetate, or triptorelin via injection every 3 months for 12 months (4 injections), every 4 months for 12 months (3 injections), or every month for 12 months (12 injections) in the absence of disease progression or unacceptable toxicity. Patients also receive a placebo four times daily (QID) for 52 weeks in the absence of disease progression or unacceptable toxicity.
Drug: Goserelin Acetate · Drug: Leuprolide Acetate · Drug: Placebo Administration · Other: Quality-of-Life Assessment · Drug: Triptorelin
Patients receive goserelin acetate, leuprolide acetate, or triptorelin via injection every 3 months for 12 months (4 injections), every 4 months for 12 months (3 injections), or every month for 12 months (12 injections) in the absence of disease progression or unacceptable toxicity. Patients also receive darolutamide QID for 52 weeks in the absence of disease progression or unacceptable toxicity.
Drug: Darolutamide · Drug: Goserelin Acetate · Drug: Leuprolide Acetate · Other: Quality-of-Life Assessment · Drug: Triptorelin
Given PO
Also known as: Antiandrogen ODM-201, BAY 1841788, BAY-1841788, BAY1841788, ODM 201, ODM-201
Given via injection
Also known as: ZDX, Zoladex
Given IV
Also known as: A-43818, Abbott 43818, Abbott-43818, Carcinil, Depo-Eligard, Eligard, Enanton, Enantone, Enantone-Gyn, Ginecrin, LEUP, Leuplin, Leuprorelin Acetate, Lucrin, Lucrin Depot, Lupron, Lupron Depot, Lupron Depot-3 Month, Lupron Depot-4 Month, Lupron Depot-Ped, Lutrate, Procren, Procrin, Prostap, TAP-144, Trenantone, Uno-Enantone, Viadur
Given PO
Ancillary studies
Also known as: Quality of Life Assessment
Given via injection
Also known as: 6-D-Tryptophan-LH-RH, 6-D-Tryptophanluteinizing Hormone-releasing Factor, AY-25650, CL-118,532, Detryptoreline
Metastasis-free survival (MFS)
The primary comparison will be an intention-to-treat analysis of all randomized patients. The method of Kaplan and Meier will be used to characterize the time-to-event endpoints, and a logrank test will be used to compare these endpoints across treatments.
Time frame: From randomization to development of metastatic disease or death, whichever occurs first, assessed up to 36 months
Recurrence-free survival (RFS)
The method of Kaplan and Meier will be used to characterize the time-to-event endpoints, and a logrank test will be used to compare these endpoints across treatments.
Time frame: From randomization to any of the MFS events, pelvic lymph node recurrence or detectable prostate-specific antigen (PSA) (PSA >= 0.2 ng/mL, confirmed by a second PSA of the same level or higher), whichever occurs first, assessed up to 36 months
Event-free survival
The method of Kaplan and Meier will be used to characterize the time-to-event endpoints, and a logrank test will be used to compare these endpoints across treatments.
Time frame: From randomization to any of the RFS events, treatment with salvage radiation therapy with or without systemic therapy, or initiation of systemic therapy for presumed recurrence, whichever occurs first, assessed up to 36 months
Overall survival
The method of Kaplan and Meier will be used to characterize the time-to-event endpoints, and a logrank test will be used to compare these endpoints across treatments.
Time frame: From randomization to death by any cause or date last known alive, assessed up to 36 months
Testosterone recovery rate
Exact binomial confidence intervals will be used to describe the proportions of patients with testosterone recovery in each arm.
Time frame: At time of disease progression, assessed up to 36 months
Time to testosterone recovery
The method of Kaplan and Meier will be used to characterize the time-to-event endpoints, and a logrank test will be used to compare these endpoints across treatments.
Time frame: From randomization to a return of serum testosterone level to greater than or equal to lower limit of normal for the testosterone assay, assessed up to 36 months
Incidence of adverse events
Toxicity will be defined using the Common Terminology Criteria for Adverse Events version 5.0.
Time frame: Up to 78 weeks
Change in quality of life: Functional Assessment of Cancer Therapy (FACT)
Will be assessed by the Functional Assessment of Cancer Therapy (FACT) - Prostate, FACT - Cognitive, and Functional Assessment of Chronic Illness Therapy - Fatigue. Fatigue instruments at baseline, 6, 12 and 18 months, and descriptive statistics will be used to characterize quality of life over time in each arm. Each item is answered on a 5-point Likert-type scale, where a value of 0 indicates the statement is not applicable, and a value of 5 indicates the statement is applicable to the respondent. Subgroup analysis will be performed among patients who receive adjuvant radiation therapy and patients who do not receive adjuvant radiation therapy in each arm. Mixed effect models will be constructed as an exploratory analysis to estimate the time profile of quality of life assessments in the two arms and to evaluate treatment-by-time interactions.
Time frame: Baseline up to 18 months
Overall quality of life: Functional Assessment of Cancer Therapy (FACT)
Will be assessed by the Functional Assessment of Cancer Therapy (FACT) - Prostate total score. The total score can range from 0 to 156, where a higher value indicates a better quality of life. Mixed effect models will be constructed as an exploratory analysis to estimate the time profile of quality of life assessments in the two arms and to evaluate treatment-by-time interactions.
Time frame: At 18 months
Change in Functional Assessment of Cancer Therapy (FACT) - Prostate score
A paired t test will be used to compare Functional Assessment of Cancer Therapy (FACT) - Prostate scores at these two time points in each arm. The total score can range from 0 to 156, where a higher value indicates a better quality of life. A two-sample t test will be performed to compare the changes in FACT - Prostate scores from baseline to 18 months between the two arms. Mixed effect models will be constructed as an exploratory analysis to estimate the time profile of quality of life assessments in the two arms and to evaluate treatment-by-time interactions.
Time frame: Baseline up to 18 months
Cognitive function
Will be measured between the two arms by Functional Assessment of Cancer Therapy (FACT) - Cognitive. The FACT-Cognitive has four subscales: perceived cognitive impairments (PCI), perceived cognitive abilities, impact of perceived cognitive impairment on quality of life, and comments from others on cognitive function. Summary statistics will be used to describe each subscale at each time point and the PCI subscale score, which ranges from 0-72, where higher values indicate better quality of life, at 12 months will be the primary measurement of this analysis. Bonferroni correction will be employed for the 3 follow-up time points of interest (6, 12, and 18 months) to make the analysis conservative. Mixed effect models will be constructed as an exploratory analysis to estimate the time profile of quality of lifeassessments in the two arms and to evaluate treatment-by-time interactions.
Time frame: At 12 months (completion of treatment)
Change in cognitive function
Will be measured between the two arms by Functional Assessment of Cancer Therapy (FACT) - Cognitive. The FACT-Cognitive has four subscales: perceived cognitive impairments (PCI), perceived cognitive abilities, impact of perceived cognitive impairment on quality of life, and comments from others on cognitive function. Summary statistics will be used to describe each subscale at each time point and the PCI subscale score, which ranges from 0-72, where higher values indicate better quality of life, at 12 months will be the primary measurement of this analysis. Bonferroni correction will be employed for the 3 follow-up time points of interest (6, 12, and 18 months) to make the analysis conservative. Mixed effect models will be constructed as an exploratory analysis to estimate the time profile of quality of life assessments in the two arms and to evaluate treatment-by-time interactions.
Time frame: Baseline up to 12 months (completion of treatment)
Identification of novel gene expression signatures
The associations between the gene expression signatures and clinical outcomes will be assessed by Cox proportional hazards models and logrank test.
Time frame: Up to 36 months
Prognostic value of established signatures
Will include androgen receptor activity, basal-luminal subtyping by modified PAM50 and androgen deprivation therapy score using Cox proportional hazards models. Similar analysis will be performed to evaluate the prognostic value of luminal-basal subtype. The treatment-by-subtype interaction will also be assessed. For androgen deprivation therapy score, patients will be categorized into either low or high androgen deprivation therapy score using a cutoff of 0.36.
Time frame: Up to 36 months
Decipher scores
Will be associated with MFS as well as disease characteristics. Cox proportional hazards models will be performed with adjustment for important disease characteristics, including prostate-specific antigen, Gleason score, disease stage, pathology of the radical prostatectomy specimen, etc. Decipher score could be categorized into a few risk groups and the Akaike information criterion method will be used to determine the optimal number of cutoff points. To assess whether treatment effect is affected by Decipher score levels, the treatment-by-Decipher interactions will be included in the model as well. Decipher scores range from 0.00 to 1.00, where higher values indicate higher risk disease.
Time frame: Up to 36 months
Genome-wide alterations
Prostate cancer specimens will be banked for future studies to perform genome-wide alterations in coding and non-coding deoxyribonucleic acid sequences. To identify the genetic alterations that are associated with development of metastasis, Cox proportional hazards models and logrank test will be used. The analysis will focus on actionable alterations first. The treatment-by-alteration interactions will also be assessed to determine whether response to darolutamide is affected by distinct genomic subgroups. Ultimately the findings on gene expression signatures and deoxyribonucleic acid alterations will be assessed in the models simultaneously to identify subsets of patients who might benefit most from the treatment of ADT with or without darolutamide.
Time frame: Up to 36 months
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ECOG-ACRIN Cancer Research Group