Can targeted radiotherapy keep treatment working for longer in men with advanced cancer?

Grant information

Researchers: Dr Julia Murray and Professor Emma Hall
Institution: Institute of Cancer Research
Grant award: £865,279
Reference: RIA21-ST2-015

What you need to know

• The researchers want to see if a kind of targeted radiotherapy, called stereotactic body radiotherapy, can slow the progression of advanced prostate cancer.
• They will trial the radiotherapy in men on hormone therapy whose cancer is responding and now has five or fewer sites beyond the prostate, or is progressing in five or fewer sites beyond the prostate.
• If this kind of radiotherapy is effective, it could mean that existing medicines can control advanced prostate cancer for longer, extending men’s lives.

What will Dr Murray and Professor Hall’s team do?

Stereotactic body radiotherapy (SBRT) is a very targeted kind of radiotherapy. Instead of using one intense beam of radiation directed straight at the tumour, SBRT uses multiple beams of different intensities. These beams come from different angles and meet at the tumour.

This means the tumour receives a high dose of radiation, while the surrounding areas receive a much lower dose – making it less likely that the person undergoing SBRT will experience side effects.

Previous research has shown that SBRT is safe and effective for people with a small number of metastases (sites where the cancer has spread beyond the original tumour), including in prostate cancer, and the treatment is now widely available in the UK.

The researchers now want to test if it is effective in men with more advanced prostate cancer through a clinical trial called STAR-TRAP.

They will recruit 236 men who are having the standard treatment for metastatic prostate cancer that responds to hormone therapy. Of these, 3/4 will be men who are still responding well to the hormone therapy and the other quarter will be showing signs that their hormone therapy is becoming less effective.
The men will either continue on their existing treatment as normal, or be given a course of SBRT as well as their existing treatment.

This will enable the researchers to see whether SBRT helps extend the effectiveness of their existing treatments. They will also look at the PSMA PET-CT and MRI scans of men on the trial, to see if there are ways to predict which men will benefit most from SBRT.

Further information on the trial can be found on the NIHR website and you can email [email protected] to explore your site joining the trial.

How will this benefit men?

If SBRT can delay the progression of advanced cancer, it could be used to make existing treatments last longer.
Not only could that help men with advanced prostate cancer live longer, but it could also give them a better quality of life as SBRT could delay the need to give these men further treatments that come with additional side effects.

How to get involved with this trial

This trial is looking for men to take part. You can read the information below to see if you may be suitable to take part in this study, and contact your medical team for full details on whether you can take part.
If you’d like support with deciding whether taking part in a clinical trial is right for you, you can speak to your medical team or contact our Specialist Nurses on 0800 074 8383 for general information and support.

Who can take part

You may be able to take part in this study if all these apply to you:

• You are aged 18 or older.
• A biopsy has showed you have the most common kind of prostate cancer, called adenocarcinoma of the prostate. This can usually be confirmed by your healthcare team.
• You are on hormone therapy alongside any of the newer generation of hormone therapies (abiraterone, enzalutamide, apalutamide or darolutamide). It doesn’t matter if you are also on docetaxel chemotherapy.
• You are at 0, 1 or 2 on the WHO performance status scale. This means that you can handle your daily self-care activities (such as washing and dressing) yourself, and spend less than half the day using a wheelchair or in bed.
• You can give written informed consent to take part.

Who can’t take part

You would not be able to take part if any of these apply to you:

• You have already had radiotherapy to, or near to, the tumours beyond your prostate (metastases) that would be treated during the trial.
  • If you have already had radiotherapy to your prostate, but not to your metastases, you may still be able to take part. However, you would not be able to get radiotherapy to your prostate during the trial – only to your metastases.
• Any conditions that would stop doctors working out what stage your cancer is at, planning and delivering your treatment, or giving you a follow-up scan.
• Any of the tumours that have developed beyond your prostate (metastases) are bigger than 6 centimetres in diameter - or bigger than 5 centimetres if they are in your lungs.
• Your cancer is currently pressing on your spine (this is called metastatic spinal cord compression) and you need urgent radiotherapy to treat it. However, you may still be able to take part if you previously had this and no longer need urgent radiotherapy to treat it.
• You have a condition that would make it unsafe to give you radiotherapy during the trial. The trial team will double check what conditions you have before deciding whether you can take part, but this list includes:
  • Ulcerative colitis or Crohn’s disease, if the trial would require you to have radiotherapy to the area around your stomach or intestines (pelvis and abdomen).
  • Certain lung conditions, such as diffuse interstitial lung diseases or idiopathic pulmonary fibrosis, if the trial would require you to have radiotherapy to the area around your lungs.
• You have a cancer other than prostate cancer that is progressing or has needed treatment in the last 36 months.
  • If you have non-muscle invasive bladder cancer, non-melanomatous skin cancer or small renal masses, you may still be able to take part.
  • If the cancer is considered cured with a very low risk of coming back, you may still be able to take part.

For full inclusion and exclusion criteria speak to your medical team.

Where the trial is taking place

• The Royal Marsden, Chelsea, London
• The Royal Marsden, Sutton, Surrey

Visit our clinical trials map for our interactive map of trials funded by us.

Speak to your medical team for the most up to date information on prostate cancer studies you may be eligible for.

For a general discussion about clinical trials, you may like to talk to our Specialist Nurses.