Multi-institutional Analysis of Metastasis-directed Therapy with or Without Androgen Deprivation Therapy in Oligometastatic Castration-sensitive Prostate Cancer.

Autor: Deek MP; Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA., Sutera P; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Jing Y; The James Buchanan Brady Urological Institute of Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Gao R; Department of Radiation Oncology, The Mayo Clinic, Rochester, MN, USA., Rothman E; Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, USA., Day H; Department of Radiation Oncology, Australian Prostate Cancer Research Center, Queensland, Australia., Chang D; Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia., Dirix P; Department of Radiation-Oncology, GasthuisZusters Antwerp (GZA) 'Sisters of the Hospital', Antwerp, Belgium., Armstrong AJ; Department of Medicine, Division of Medical Oncology, Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University Medical Center, Durham, NC, USA., Campbell B; Urology Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia., Lopez Campos F; Department of Radiation Oncology, Hospital Ramón y Cajal, Madrid, Spain., Berenguer M; Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Ramotar M; Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada., Conde-Moreno A; Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Berlin A; Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Bosetti DG; Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland., Corcoran N; Urology Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia., Koontz B; GenesisCare US, Fort Myers, FL, USA., Mercier C; Department of Radiation-Oncology, GasthuisZusters Antwerp (GZA) 'Sisters of the Hospital', Antwerp, Belgium., Siva S; Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia., Pryor D; Department of Radiation Oncology, Australian Prostate Cancer Research Center, Queensland, Australia., Ost P; Department of Human Structure and Repair, Ghent University, Ghent, Belgium., Huynh MA; Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, USA., Kroeze S; Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland., Stish B; Department of Radiation Oncology, The Mayo Clinic, Rochester, MN, USA., Kiess A; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Trock B; The James Buchanan Brady Urological Institute of Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Tran PT; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA., Gillessen S; Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland., Sweeney C; South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia. Electronic address: christopher.sweeney@adelaide.edu.au.
Jazyk: angličtina
Zdroj: European urology oncology [Eur Urol Oncol] 2024 Dec; Vol. 7 (6), pp. 1403-1410. Date of Electronic Publication: 2024 Apr 03.
DOI: 10.1016/j.euo.2024.03.010
Abstrakt: Background: Metastasis-directed therapy (MDT) is increasingly being used in oligometastatic castration-sensitive prostate cancer (omCSPC). However, it is currently unclear how to optimally integrate MDT with the standard of care of systemic hormonal therapy.
Objective: To report long-term outcomes of MDT alone versus MDT and a defined course of androgen deprivation therapy (ADT) in omCSPC.
Design, Setting, and Participants: Here, a multicenter, international retrospective cohort of omCSPC as defined by conventional imaging was reported.
Outcome Measurements and Statistical Analysis: Biochemical progression-free survival (bPFS), distant progression-free survival (dPFS), and combined biochemical or distant progression-free survival (cPFS) were evaluated with Kaplan-Meier and multivariable Cox proportional hazard regression models.
Results and Limitations: A total of 263 patients were included, 105 with MDT + ADT and 158 with MDT alone. The majority of patients had metachronous disease (90.5%). Five-year bPFS, dPFS, and cPFS were, respectively, 24%, 41%, and 19% in patients treated with MDT + ADT and 11% (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.36-0.64), 29% (HR 0.56, 95% CI 0.40-0.78), and 9% (HR 0.50, 95% CI 0.38-0.67) in patients treated with MDT alone. On a multivariable analysis adjusting for pretreatment variables, the use of ADT was associated with improved bPFS (HR 0.43, p < 0.001), dPFS (HR 0.45, p = 0.002), and cPFS (HR 0.44, p < 0.001).
Conclusions: In this large multi-institutional report, the addition of concurrent ADT to MDT appears to improve time to prostate-specific antigen progression and distant recurrence, noting that about 10% patients had durable control with MDT alone. Ongoing phase 3 studies will help further define treatment options for omCSPC.
Patient Summary: Here, we report a large retrospective review evaluating the outcomes of metastasis-directed therapy with or without a limited course of androgen deprivation for patients with oligometastatic castration-sensitive prostate cancer. This international multi-institutional review demonstrates that the addition of androgen deprivation therapy to metastasis-directed therapy (MDT) improves progression-free survival. While a proportion of patients appear to have long-term disease control with MDT alone, further work in biomarker discovery is required to better identify which patients would be appropriate for de-escalated therapy.
(Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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