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Testing the Addition of Docetaxel (Chemotherapy) to the Usual Treatment (Hormonal Therapy and Apalutamide) for Metastatic Prostate Cancer, ASPIRE Trial

RecruitingPhase 3

Docetaxel Addition in Metastatic Castrate-Sensitive Prostate Cancer (ASPIRE)

Who can join

Ages 18 and older · Men

Full eligibility criteria
Inclusion Criteria:

* Documentation of disease:

  \* Histologically or cytologically confirmed adenocarcinoma of the prostate without small cell histology
* Must have had evidence of metastatic disease (American Joint Committee on Cancer \[AJCC\] metastasis \[M\]1 disease) based on conventional CT/MRI and/or bone scan. This will be defined as:

  * Bone metastases detected by CT, radionuclide technetium-99 (99Tc)- methylene bisphosphonate bone scan, or MRI as defined by PCWG3 criteria; OR
  * Non-pelvic lymph node metastases (measurable lymph nodes above the aortic bifurcation; lymph nodes are measurable if the short axis diameter is ≥ 15 mm) detected on CT or MRI as defined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Subjects with regional lymph node metastases only (nodes \[N\]1, below the aortic bifurcation) will not be eligible for the study; OR
  * Visceral or soft tissue metastases detected on CT or MRI as defined by RECIST version 1.1. Soft tissue/visceral lesions are measurable if the long axis diameter is ≥ 10 mm
  * Evidence of metastatic disease by PSMA-PET only and not visible by CT, radionuclide bone scan, or MRI will not satisfy eligibility criteria
* No metachronous low-volume disease (defined as recurrent metastatic disease after definitive treatment of prostate primary) and with ≤ 4 bone metastasis and no visceral metastasis on conventional imaging by CT, radionuclide 99Tc-biphosphonate bone scan, or MRI)
* Next generation sequencing (NGS) results from any tissue based Clinical Laboratory Improvement Act (CLIA) test must be available at the time of registration. NGS from soft tissue or visceral lesion if available is preferred. NGS from bone or primary prostate will be accepted. Patients with failed NGS testing are not eligible
* Prior treatment

  * ADT (luteinizing hormone-releasing hormone \[LHRH\] agonist/antagonist or orchiectomy) with or without first generation anti-androgen, or second-generation androgen receptor signaling inhibitor (ARSI) within 120 days of registration is permitted. No washout period will be needed for the first generation- androgen or ARSI prior to registration. Anti-androgen treatment is only permitted if used within 120 days of registration
  * No prior chemotherapy for prostate cancer
* Age ≥ 18 years
* Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2
* Absolute neutrophil count (ANC) ≥ 1,500/mm\^3
* Hemoglobin ≥ 9.0 g/dL
* Platelet count ≥ 100,000/mm\^3
* Total bilirubin ≤ 1 x upper limit of normal (ULN) (Note: In subjects with Gilbert's syndrome, if total bilirubin is \> 1.5 × ULN, measure direct and indirect bilirubin and if direct bilirubin is ≤ 1 × ULN, subject may be eligible)
* Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\])/alanine aminotransferase (ALT) (serum glutamate transaminase \[SGT\]) ≤ 1.5 x upper limit of normal (ULN)
* Calculated (Calc.) creatinine clearance \> 30 mL/min
* Serum potassium ≥ 3.5 mmol/L
* Comorbid conditions

  * Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
  * Leptomeningeal metastases: Patients with treated leptomeningeal metastases are eligible if follow-up brain imaging 30 days after central nervous system (CNS)-directed therapy shows no evidence of progression
  * HIV: Patients with known HIV infection on effective anti-retroviral therapy with undetectable viral load within 6 months prior to registration are eligible for this trial
  * Hepatitis B: For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
  * Hepatitis C: Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
  * No seizure or known condition that may pre-dispose to seizure (e.g. prior stroke within 1 year to randomization, brain arteriovenous malformation or condition requiring CNS surgery or radiation therapy)
  * Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association functional classification. To be eligible for this trial, patients should be class II or better. Any condition that in the opinion of the investigator, would preclude participation in this study. Patients with stable asymptomatic deep venous thromboembolism on stable anti-coagulation will be eligible
  * Hypertension: Subjects with uncontrolled hypertension as indicated by a resting systolic blood pressure (BP) \>= 160 mmHg or diastolic BP \>= 100 mmHg despite medical management are not permitted to register
  * Allergies: Subjects with known hypersensitivity to any of the study drugs, or excipients in the formulation of the study drugs are not permitted to register
* Concomitant medications

  * Chronic concomitant treatment with strong inhibitors of cytochrome P450 3A4 (CYP3A4) is not allowed on this study. Patients on strong CYP3A4 inhibitors must discontinue the drug prior to registration on the study. See Section 8.1.9 for more information
  * Chronic concomitant treatment with strong CYP3A4 inducers is not allowed. Patients must discontinue the drug 14 days prior to the start of study treatment
  * Medications known to lower the seizure threshold must be discontinued or substituted prior to study entry. See Section 8.1.9 for more information
* Patient agrees to use a condom (even men with vasectomies) and another effective method of birth control if having sex with a woman of childbearing potential or agrees to use a condom if having sex with a woman who is pregnant while on study drug and for 3 months following the last dose of study drug. Must also agree not to donate sperm during the study and for 3 months after receiving the last dose of study drug

About the study

This phase III trial compares the effect of adding docetaxel to hormonal therapy and apalutamide versus hormonal therapy and apalutamide alone in treating patients with prostate cancer that has spread from where it first started (primary site) to other places in the body (metastatic). Docetaxel is in a class of medications called taxanes. It stops tumor cells from growing and dividing and may kill them. Hormone therapy for prostate cancer, also called androgen deprivation therapy (ADT), uses surgery or drugs to lower the levels of male sex hormones in a man's body. This helps slow the growth of prostate cancer. Apalutamide is in a class of medications called androgen receptor inhibitors. It works by blocking the effects of androgen (a male reproductive hormone) to stop the growth and spread of tumor cells. Giving docetaxel in addition to the usual treatment of hormonal therapy and apalutamide may work better in treating patients with metastatic prostate cancer than the usual treatment alone.

What is being tested

Sponsor: Alliance for Clinical Trials in Oncology · Participants: 1,260 · Started: Dec 1, 2025

Contact the study team

Official record on ClinicalTrials.gov — NCT06931340

Locations in the U.S.

ArizonaBanner University Medical Center - Tucson, Tucson
University of Arizona Cancer Center-North Campus, Tucson
CaliforniaKaiser Permanente Dublin, Dublin
Kaiser Permanente-Fremont, Fremont
Kaiser Permanente Fresno Orchard Plaza, Fresno
UC San Diego Moores Cancer Center, La Jolla
Kaiser Permanente- Modesto MOB II, Modesto
Kaiser Permanente-Modesto, Modesto
Kaiser Permanente-Oakland, Oakland
Eisenhower Medical Center, Rancho Mirage
Kaiser Permanente-Roseville, Roseville
Kaiser Permanente Downtown Commons, Sacramento
Kaiser Permanente-South Sacramento, Sacramento
UC San Diego Medical Center - Hillcrest, San Diego
Kaiser Permanente-San Francisco, San Francisco
Kaiser Permanente-Santa Teresa-San Jose, San Jose
Kaiser Permanente San Leandro, San Leandro
Kaiser San Rafael-Gallinas, San Rafael
Kaiser Permanente Medical Center - Santa Clara, Santa Clara
Kaiser Permanente-Santa Rosa, Santa Rosa
Kaiser Permanente-South San Francisco, South San Francisco
Kaiser Permanente-Vallejo, Vallejo
Kaiser Permanente-Walnut Creek, Walnut Creek
ColoradoKaiser Permanente-Franklin, Denver
Shaw Cancer Center, Edwards
Saint Mary's Hospital and Regional Medical Center, Grand Junction
Kaiser Permanente-Rock Creek, Lafayette
Kaiser Permanente-Lone Tree, Lone Tree
District of ColumbiaMedStar Georgetown University Hospital, Washington D.C.
MedStar Washington Hospital Center, Washington D.C.
FloridaMalcom Randall Veterans Administration Medical Center, Gainesville
GeorgiaNorthside Hospital, Atlanta
Northside Hospital - Duluth, Duluth
Northside Hospital - Gwinnett, Lawrenceville
HawaiiKaiser Permanente Moanalua Medical Center, Honolulu
IdahoSaint Luke's Cancer Institute - Boise, Boise
Kootenai Health - Coeur d'Alene, Coeur d'Alene
Saint Luke's Cancer Institute - Fruitland, Fruitland
Saint Luke's Cancer Institute - Meridian, Meridian
Saint Luke's Cancer Institute - Nampa, Nampa
Kootenai Clinic Cancer Services - Post Falls, Post Falls
Kootenai Clinic Cancer Services - Sandpoint, Sandpoint
IllinoisIllinois CancerCare-Bloomington, Bloomington
Illinois CancerCare-Canton, Canton
Illinois CancerCare-Carthage, Carthage
Centralia Oncology Clinic, Centralia
Rush MD Anderson Cancer Center, Chicago
University of Illinois, Chicago
Carle at The Riverfront, Danville
Cancer Care Specialists of Illinois - Decatur, Decatur
Decatur Memorial Hospital, Decatur
Illinois CancerCare-Dixon, Dixon
Carle Physician Group-Effingham, Effingham
Crossroads Cancer Center, Effingham
Illinois CancerCare-Eureka, Eureka
Illinois CancerCare-Galesburg, Galesburg
Edward Hines Jr VA Hospital, Hines
Illinois CancerCare-Kewanee Clinic, Kewanee
Illinois CancerCare-Macomb, Macomb
Carle Physician Group-Mattoon/Charleston, Mattoon
SSM Health Good Samaritan, Mount Vernon
Carle BroMenn Medical Center, Normal
Carle Cancer Institute Normal, Normal
Cancer Care Center of O'Fallon, O'Fallon
HSHS Saint Elizabeth's Hospital, O'Fallon
Illinois CancerCare-Ottawa Clinic, Ottawa
Illinois CancerCare-Pekin, Pekin
Illinois CancerCare-Peoria, Peoria
Illinois CancerCare-Peru, Peru
Illinois CancerCare-Princeton, Princeton
Memorial Hospital East, Shiloh
Southern Illinois University School of Medicine, Springfield
Springfield Clinic, Springfield
Springfield Memorial Hospital, Springfield
Carle Cancer Center, Urbana
Illinois CancerCare - Washington, Washington
IowaMary Greeley Medical Center, Ames
McFarland Clinic - Ames, Ames
Mercy Hospital, Cedar Rapids
Oncology Associates at Mercy Medical Center, Cedar Rapids
McFarland Clinic - Trinity Cancer Center, Fort Dodge
McFarland Clinic - Marshalltown, Marshalltown
KansasHaysMed, Hays
Lawrence Memorial Hospital, Lawrence
The University of Kansas Cancer Center - Olathe, Olathe
University of Kansas Cancer Center-Overland Park, Overland Park
Salina Regional Health Center, Salina
University of Kansas Health System Saint Francis Campus, Topeka
University of Kansas Hospital-Westwood Cancer Center, Westwood
MichiganTrinity Health IHA Medical Group Hematology Oncology - Brighton, Brighton
Trinity Health IHA Medical Group Hematology Oncology - Canton, Canton
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital, Chelsea
OSF Saint Francis Hospital and Medical Group, Escanaba
Genesys Hurley Cancer Institute, Flint
Hurley Medical Center, Flint
University of Michigan Health - Sparrow Lansing, Lansing
Trinity Health Saint Mary Mercy Livonia Hospital, Livonia
Trinity Health Saint Joseph Mercy Oakland Hospital, Pontiac
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus, Ypsilanti
MinnesotaSanford Joe Lueken Cancer Center, Bemidji
Coborn Cancer Center at Saint Cloud Hospital, Saint Cloud
MissouriSaint Francis Medical Center, Cape Girardeau
Siteman Cancer Center at Saint Peters Hospital, City of Saint Peters
Siteman Cancer Center at West County Hospital, Creve Coeur
University Health Truman Medical Center, Kansas City
University of Kansas Cancer Center - Briarcliff, Kansas City
University of Kansas Cancer Center - North, Kansas City
University of Kansas Cancer Center - Lee's Summit, Lee's Summit
Mercy Hospital Saint Louis, St Louis
Mercy Hospital South, St Louis
Siteman Cancer Center at Christian Hospital, St Louis
Siteman Cancer Center-South County, St Louis
Veteran's Affairs Medical Center - Saint Louis, St Louis
Washington University School of Medicine, St Louis
MontanaCommunity Hospital of Anaconda, Anaconda
Billings Clinic Cancer Center, Billings
Saint Vincent Frontier Cancer Center, Billings
Bozeman Health Deaconess Hospital, Bozeman
Benefis Sletten Cancer Institute, Great Falls
Logan Health Medical Center, Kalispell
Community Medical Center, Missoula
New JerseyMemorial Sloan Kettering Basking Ridge, Basking Ridge
Jefferson Cherry Hill Hospital, Cherry Hill
Memorial Sloan Kettering Monmouth, Middletown
Memorial Sloan Kettering Bergen, Montvale
Sidney Kimmel Cancer Center Washington Township, Sewell
New YorkRoswell Park Cancer Institute, Buffalo
Memorial Sloan Kettering Commack, Commack
Guthrie Cortland Memorial Hospital, Cortland
Memorial Sloan Kettering Westchester, Harrison
Memorial Sloan Kettering Cancer Center, New York
Mount Sinai Hospital, New York
Stony Brook University Medical Center, Stony Brook
Memorial Sloan Kettering Nassau, Uniondale
North CarolinaDuke University Medical Center, Durham
Durham VA Medical Center, Durham
FirstHealth of the Carolinas-Moore Regional Hospital, Pinehurst
North DakotaSanford Bismarck Medical Center, Bismarck
Sanford Broadway Medical Center, Fargo
Sanford Roger Maris Cancer Center, Fargo
OhioAultman Health Foundation, Canton
Ohio State University Comprehensive Cancer Center, Columbus
ProMedica Flower Hospital, Sylvania
OklahomaUniversity of Oklahoma Health Sciences Center, Oklahoma City
PennsylvaniaSaint Vincent Hospital, Erie
Jefferson Hospital, Jefferson Hills
Forbes Hospital, Monroeville
Allegheny Valley Hospital, Natrona Heights
Jefferson Torresdale Hospital, Philadelphia
Thomas Jefferson University Hospital, Philadelphia
Allegheny General Hospital, Pittsburgh
West Penn Hospital, Pittsburgh
Guthrie Medical Group PC-Robert Packer Hospital, Sayre
Wexford Health and Wellness Pavilion, Wexford
Asplundh Cancer Pavilion, Willow Grove
South CarolinaSaint Francis Cancer Center, Greenville
Saint Francis Hospital, Greenville
Self Regional Healthcare, Greenwood
South DakotaRapid City Regional Hospital, Rapid City
Sanford Cancer Center Oncology Clinic, Sioux Falls
Sanford USD Medical Center - Sioux Falls, Sioux Falls
TexasUT Southwestern Simmons Cancer Center - RedBird, Dallas
UT Southwestern/Simmons Cancer Center-Dallas, Dallas
UT Southwestern/Simmons Cancer Center-Fort Worth, Fort Worth
UT Southwestern Clinical Center at Richardson/Plano, Richardson
UtahIntermountain Medical Center, Murray
McKay-Dee Hospital Center, Ogden
LDS Hospital, Salt Lake City
Saint George Regional Medical Center, St. George
VermontCentral Vermont Medical Center/National Life Cancer Treatment, Berlin Corners
University of Vermont Medical Center, Burlington
University of Vermont and State Agricultural College, Burlington
VirginiaHematology Oncology Associates of Fredericksburg Inc, Fredericksburg
VCU Massey Cancer Center at Stony Point, Richmond
VCU Massey Comprehensive Cancer Center, Richmond
VCU Health Tappahannock Hospital, Tappahannock
West VirginiaWest Virginia University Charleston Division, Charleston
WisconsinAspirus Cancer Care-Antigo-Volm Cancer Center, Antigo
Ascension Northeast Wisconsin-Saint Elizabeth Cancer Center-Appleton, Appleton
ThedaCare Regional Cancer Center, Appleton
Ascension Southeast Wisconsin Hospital-Elmbrook Campus-Brookfield, Brookfield
Ascension Calumet Hospital-Chilton, Chilton
Reiman Cancer Center-Ascension Wisconsin Health Center-Rawson, Franklin
Saint Vincent Hospital Cancer Center Green Bay, Green Bay
Saint Vincent Hospital Cancer Center at Saint Mary's, Green Bay
William S Middleton VA Medical Center, Madison
Aspirus Medford Hospital, Medford
Froedtert Menomonee Falls Hospital, Menomonee Falls
Ascension Columbia Saint Mary's Hospital-Ozaukee Campus-Mequon, Mequon
Ascension Columbia Saint Mary's Hospital-Milwaukee Campus, Milwaukee
Medical College of Wisconsin, Milwaukee
Froedtert and MCW Moorland Reserve Health Center, New Berlin
Drexel Town Square Health Center, Oak Creek
Saint Vincent Hospital Cancer Center at Oconto Falls, Oconto Falls
Ascension Northeast Wisconsin-Mercy Hospital-Oshkosh, Oshkosh
Ascension All Saints Hospital-Spring Street-Racine, Racine
Aspirus Cancer Care-Rhinelander-James Beck Cancer Center, Rhinelander
Saint Vincent Hospital Cancer Center at Sheboygan, Sheboygan
Sheboygan Physicians Group, Sheboygan
Aspirus Cancer Care - Stevens Point, Stevens Point
Saint Vincent Hospital Cancer Center at Sturgeon Bay, Sturgeon Bay
Aspirus Cancer Care-Wausau, Wausau
Ascension Southeast Wisconsin Hospital-Mayfair Road-Wauwatosa, Wauwatosa
Froedtert West Bend Hospital/Kraemer Cancer Center, West Bend
Aspirus Cancer Care - Wisconsin Rapids, Wisconsin Rapids

Conditions

From ClinicalTrials.gov, data retrieved Sep 29, 2026. Each study sets its own eligibility; the study team decides who can join.