Phase III randomized international open label clinical trial of treatment Intensification with docetaxel plus apalutamide in patients with metastatic hormone-sensitive prostate cancer who did not achieve a deep PSA response After initial treatment with Apalutamide: REINFORCE Trial

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Alianza Multidisciplinar Para La Investigacion De Los Tumores Genitourinarios Guard

Participant type

Patients

Age range

18-64 years, 65+ years

Gender

Male

Therapeutic area

Diseases [C] - Neoplasms [C04]

Decision date (initial)

2026-05-19

Transition trial

No

Low-intervention

No

Rare-disease indication

No

Vulnerable population

No

Funding sources

Johnson & Johnson

External identifiers

EU CT number

2025-524408-30-01

ClinicalTrials.gov

NCT07333066

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Safety, Efficacy

To evaluate the efficacy of treatment intensification with docetaxel plus apalutamide and ADT, assessed by event-free survival, in metastatic hormone-sensitive prostate cancer patients who do not achieve deep PSA response (≤0.2 ng/ml or PSA90 response in combination with a PSA ≤4 ng/ml) after initial treatment with SOC ADT and apalutamide. Therefore, a non-deep PSA response is defined as PSA > 0.2 ng/ml in combination with a PSA response < 90%, or a PSA response ≥90% in combination with a PSA > 4 ng/ml.

Secondary objectives 3

1. To evaluate the efficacy of treatment intensification with docetaxel plus apalutamide and ADT, assessed by: o Time to castration resistance o Radiographic Progression-free survival o PSA progression-free survival o Overall survival o Time to subsequent treatment o Symptomatic skeletal event free survival o Deep and/or ultradeep PSA response rate at 6 months. o Time to initiate opioid use (≥ 7 days)
2. To evaluate the safety profile of treatment intensification with docetaxel plus apalutamide and ADT.
3. To assess the quality of life of patients with the following questionnaires: o Brief Pain Inventory – Short Form (BPI-SF) o Brief Fatigue Inventory (BFI) o Functional Assessment of Cancer Therapy – Prostate (FACT-P)

Conditions and MedDRA coding

Metastatic hormone-sensitive prostate cancer

Regulatory references

Plan to share IPD

No

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 15

1. 1. Written informed consent. Each patient must sign an informed consent form (ICF) indicating that he understands the purpose of and procedures, required for the study, and is willing to participate in the study.
2. 2. Patient must be a man ≥18 years of age.
3. 3. Histologically or cytologically confirmed adenocarcinoma of prostate.
4. 4. Metastatic hormone-sensitive prostate cancer.
5. 5. PSA >5 ng/ml at diagnosis of metastatic disease.
6. 6. Patients eligible to continue treatment with apalutamide and ADT and without contra-indication to receive docetaxel.
7. 7. Patients with at least 24 weeks and no more than 30 weeks of apalutamide.
8. 8. Patients with a maximum of 12 weeks ADT before apalutamide initiation.
9. 9. Lack of achievement of deep PSA response after 24 weeks and no more than 30 weeks of apalutamide. Deep PSA response is defined as PSA ≤ 0.2 ng/ml or PSA response ≥ 90% in combination with a PSA ≤4 ng/ml. Therefore, a non-deep PSA response is defined as PSA > 0.2 ng/ml in combination with a PSA response < 90%, or a PSA response ≥90% in combination with a PSA > 4 ng/ml.
10. 10. Patients who have not progressed on apalutamide.
11. 11. Patients that are tolerating adequately apalutamide 240 mg daily and with no toxicity higher than G1 at inclusion.
12. 12. Be able to swallow whole apalutamide film-coated tablets.
13. 13. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 1.
14. 14. Clinical laboratory values at screening: a. hemoglobin ≥10.0 g/dL, b. absolute neutrophil count ≥1.5 × 109/L, c. platelet count ≥100 × 109/L, The patient must not have received any growth factor within 4 weeks or a blood transfusion within 7 days of the hematology laboratory sample obtained at screening d. serum alanine aminotransferase and/or aspartate transaminase ≤1.5 × the upper limit of normal (ULN), e. total bilirubin ≤ ULN, f. creatinine ≤2.0 × ULN,
15. 15. Sexually active men must agree to use an external condom as an effective barrier method and refrain from sperm donation, and their female partners of childbearing potential must practice a highly effective method of contraception during and for 3 months after treatment with apalutamide and for 6 months after treatment with docetaxel.

Exclusion criteria 18

1. 1. Presence of neuroendocrine histology.
2. 10. Any of the following within 6 months before randomization: a. stroke, b. myocardial infarction, c. severe or unstable angina pectoris, d. uncontrolled arrhythmia, e. coronary or peripheral artery bypass graft, or f. congestive heart failure (New York Heart Association class III or IV)
3. 11. Peripheral neuropathy ≥ grade 2.
4. 12. Uncontrolled hypertension, indicated by resting systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mmHg despite medical management.
5. 13. Prior malignancy, except for adequately treated basal-cell or squamous-cell carcinoma of the skin or superficial bladder cancer that had not spread behind the connective-tissue layer (i.e., stage pTis, pTa, or pT1) or any cancer for which treatment had been completed ≥5 years before randomization and from which the patient was disease-free.
6. 14. A gastrointestinal disorder or procedure that was expected to interfere significantly with absorption of study drug.
7. 15. Active viral hepatitis, known human immunodeficiency virus infection with detectable viral load, or chronic liver disease requiring treatment.
8. 16. Previous (within 28 days before the start of study drug or 5 half-lives of the investigational treatment of the previous study, whichever was longer) or concomitant participation in another clinical study with investigational medicinal products.
9. 17. Any other serious or unstable illness or medical, social, or psychological condition that could jeopardize the safety of the patient and/or their compliance with study procedures or might interfere with their participation in the study or evaluation of the study results.
10. 2. Apalutamide treatment started more than 30 weeks before inclusion.
11. 3. Progression disease by any means, including radiographic, clinical or serological at inclusion.
12. 4. Patient who achieves deep PSA response on apalutamide treatment before randomization
13. 5. Previous androgen-pathway receptor inhibitors, including enzalutamide, darolutamide, abiraterone or other ARPI. Previous treatment with first generation antiandrogens (i.e. bicalutamide) is allowed.
14. 6. Chemotherapy or immunotherapy for prostate cancer before randomization.
15. 7. Treatment with radiotherapy (external-beam radiation therapy, brachytherapy, or radiopharmaceuticals) within 2 weeks before randomization.
16. 8. Known hypersensitivity to any of the study drugs, study drug classes, or excipients in the formulation of the study drugs.
17. 9. Contraindication to both computed tomography and magnetic resonance imaging contrast agent
18. 18. Prolonged QT interval defined as QTcF ≥ 480 ms at screening, based on the mean of triplicate 12-lead ECGs performed after at least 5 minutes of rest. Patients with congenital long QT syndrome will also be excluded.

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

1. Event-free Survival (EFS)

Secondary endpoints 10

1. Time to castration resistance
2. Radiographic progression-free survival (rPFS)
3. PSA progression-free survival
4. Overall survival
5. Time to subsequent treatment
6. Symptomatic skeletal event free survival
7. Deep and/or ultradeep PSA response rate at 6 months
8. Time to initiate opioid use (≥ 7 days)
9. Adverse events, serious adverse events, adverse events leading to treatment discontinuation and death.
10. Change from baseline over time in each of the subscales of FACT-P, BPI-SF interference subscale and BFI .

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 3

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Alianza Multidisciplinar Para La Investigacion De Los Tumores Genitourinarios Guard

Sponsor organisation

Alianza Multidisciplinar Para La Investigacion De Los Tumores Genitourinarios Guard

Address

Calle De Velazquez 7 3º

City

Madrid

Postcode

28001

Country

Spain

Scientific contact point

Organisation

Alianza Multidisciplinar Para La Investigacion De Los Tumores Genitourinarios Guard

Contact name

Enrique González-Billalabeitia

Public contact point

Organisation

Alianza Multidisciplinar Para La Investigacion De Los Tumores Genitourinarios Guard

Contact name

Enrique González-Billalabeitia

Third parties 3

Locations

4 EU/EEA countries · 48 investigational sites

By country

Investigational sites

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 26 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

2 submissions — initial application plus substantial / non-substantial modifications