Podium Session

LBA03-07: Imperial Prostate-4 Comparative Healthcare Research Outcomes of Novel Surgery in prostate cancer (IP4-CHRONOS): Early feasibility, safety and functional outcomes from a pilot RCT

Podium Presenter(s)

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  Deepika Reddy, MD

  Johns Hopkins Hospital

Introduction: Randomised comparative outcomes are unavailable for focal therapy in localised prostate cancer. IP4 CHRONOS is an RCT aimed to optimise recruitment of patients dependent upon clinician and patient equipoise.

Methods: Patients with clinically significant localised prostate cancer could opt for IP4-CHRONOS-A or IP4-CHRONOS-B. IP4-CHRONOS-A randomised patients 1:1 between focal therapy(HIFU or cryotherapy) versus radical therapy(radiation or prostatectomy). Using a multi-arm-multistage(MAMS)design, IP4-CHRONOS-B randomised between focal alone(FTA) and focal combined with neoadjuvant medication (12 weeks of finasteride [FTF] or bicalutamide [FTB]). We report the pilot phase outcomes on feasibility of randomisation, early safety outcomes relative to treatment and genito-urinary functional outcomes following over 12 months treatment in IP4-CHRONOS-B. IP4-CHRONOS had ethics committee approval and was registered(ISRCTN17796995)

Results: Following COVID-19 adjustments, IP4-CHRONOS-A did not meet its feasibility target. Having randomised 36 patients via10 sites with a recruitment rate(95% CI) of 18%(13-23) & randomisation rate of 97%(86-100). IP4-CHRONOS-B did meet its target, randomising 64 patients across 7 sites with a recruitment rate of 43%(35-52) &randomisation rate of 100%(94-100). The only patients to withdraw were randomised to the radical arm of IP4-CHRONOS-A(4[22%]) All patients in IP4-CHRONOS-B were compliant with neoadjuvant treatment. Only 1 patient reported CTCAE V4.0 grade =3 adverse event(AE) in IP4-CHRONOS-A following radical treatment, another patient in each arm reported a serious adverse event(SAE) following treatment. 1 &3 patients reported an AE &SAE following FTB. 2 and 3 patients reported an AE &SAE following FTA. No patients reported any AE or SAE event following FTF. Figure 1 demonstrates generally well preserved genito-urinary function following focal treatment ± neoadjuvant treatment.

Conclusions: IP4-CHRONOS evaluated patient and physician equipoise regarding focal therapy.  Traditional randomisation was not feasible due to strong patient preferences, while a MAMS RCT investigating the role of neoadjuvant agents combined with focal therapy was. SOURCE OF

Funding: Prostate Cancer UK