Metastasis-directed therapy plus hormone therapy improves progression-free survival for advanced prostate cancer.

Abstract

CancerVolume 129, Issue 1 p. 9-9 CancerScopeFree Access Metastasis-directed therapy plus hormone therapy improves progression-free survival for advanced prostate cancer First published: 12 December 2022 https://doi.org/10.1002/cncr.34587AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Results from a phase 2 randomized clinical trial show that combining metastasis-directed radiation therapy (MDRT) with intermittent hormone therapy improved progression-free survival (PFS) in patients with oligometastatic prostate cancer.1 These results from the multicenter EXTEND trial, a phase 2 randomized basket trial for multiple solid tumors assessing whether adding MDRT improves PFS in patients with oligometastatic cancer, represent the first randomized evidence of patient outcomes with radiation therapy and hormone therapy. “There has never been a randomized study to assess whether radiation therapy improves patient outcomes when added to hormone therapy,” says Chad Tang, MD, an associate professor of radiation oncology at The University of Texas MD Anderson Cancer Center in Houston, and principal investigator of the study. He presented the study results at the 2022 American Society for Radiation Oncology Annual Meeting. “This is critical, as hormone therapy is considered the standard-of-care treatment for metastatic prostate cancer, with multiple studies showing improved survival in men who receive hormone therapy early.” The trial included 87 men with oligometastatic prostate cancer (≤5 metastases) randomized after 2 months or more of hormone therapy to continuing hormone therapy alone (n = 44) or with MDRT (n = 43). A planned break from hormone therapy occurred at 6 months after enrollment, and hormone therapy was subsequently withheld until disease progression. The main outcome of the study was progression, defined as death or radiographic, clinical, or biochemical progression. At a median follow-up of 22.1 months, the median PFS had not yet been reached in the combination MDRT and hormone therapy group, but the mean PFS was 15.8 months in the hormone-only group. This suggested a significant improvement in median PFS for the men in the combination treatment group. In a secondary analysis for monitoring the time that men could maintain normal testosterone levels while taking a hormone therapy break, investigators found that the addition of MDRT prolonged the time to disease progression. “In oligometastatic prostate cancer, definitive radiation therapy to all sites of metastatic disease with intermittent hormone therapy as a treatment strategy can offer a prolonged time off of hormone therapy, thus maintaining quality of life while providing excellent disease control,” says Dr Tang. Overall, the combination therapy was well tolerated. Three grade 3 toxicities were observed in each treatment arm (i.e., impaired muscle motion and urinary and gastrointestinal side effects). Reference 1 Tang C, Sherry AD, Haymaker C, et al. Addition of metastasis-directed therapy to intermittent hormone therapy for oligometastatic prostate cancer (EXTEND): a multicenter, randomized phase II trial. Late Breaker Abstract 05. ASTRO Annual Meeting 2022. October 25, 2022. https://plan.core-apps.com/myastroapp2022/abstract/9b733a55-1267-4359-9782-d204301bf297 Volume129, Issue11 January 2023Pages 9-9 This article also appears in:CancerScope Articles ReferencesRelatedInformation