Can Intermittent Hormone Therapy Fulfil its Promise?

Abstract

Context Hormone therapy (HT) is the mainstay treatment for patients with metastatic prostate cancer (PCa) and is increasingly being used in patients with advanced PCa and those with relapse in a prostate-specific antigen (PSA) level after local therapy. Intermittent HT (IHT) is being investigated as an alternative to continuous HT with a potential for reduced morbidity and a delay of the progression to hormone refractory PCa (HRPC). Objective This paper aims to give an overview of the current status of IHT in PCa. Evidence acquisition This paper was based on a presentation given at a satellite symposium on PCa that was held at the 2008 annual meeting of the European Association of Urology in Milan, Italy. Data were retrieved from recent review articles, original articles, and abstracts on IHT. Evidence synthesis Several phase 2 trials have demonstrated the feasibility of IHT, its beneficial effects on quality of life (QoL), and its potential for reduced morbidity. In these studies IHT did not appear to have a negative effect on time-to-progression or on survival. Phase 3 trials are currently ongoing, and preliminary results suggest that indeed IHT has no negative impact on overall or progression-free survival compared with continuous therapy. In these studies patients treated with IHT also had a better overall QoL and a reduced frequency of side-effects. However, the phase 3 studies are not yet mature, and final data regarding survival and time-to-progression to HRPC are awaited. Conclusions Although final data from phase 3 trials are awaited, IHT appears to have no negative impact on overall and progression-free survival, and it may improve QoL.