Sequencing of Androgen-Deprivation Therapy of Short Duration With Radiotherapy for Nonmetastatic Prostate Cancer (SANDSTORM): A Pooled Analysis of 12 Randomized Trials

Autor: Ting Martin, Ma, Yilun, Sun, Shawn, Malone, Mack, Roach, David, Dearnaley, Thomas M, Pisansky, Felix Y, Feng, Howard M, Sandler, Jason A, Efstathiou, Isabel, Syndikus, Emma C, Hall, Alison C, Tree, Matthew R, Sydes, Claire, Cruickshank, Soumyajit, Roy, Michel, Bolla, Philippe, Maingon, Theo, De Reijke, Abdenour, Nabid, Nathalie, Carrier, Luis, Souhami, Almudena, Zapatero, Araceli, Guerrero, Ana, Alvarez, Carmen, Gonzalez San-Segundo, Xavier, Maldonado, Tahmineh, Romero, Michael L, Steinberg, Luca F, Valle, Matthew B, Rettig, Nicholas G, Nickols, Jonathan E, Shoag, Robert E, Reiter, Nicholas G, Zaorsky, Angela Y, Jia, Jorge A, Garcia, Daniel E, Spratt, Amar U, Kishan
Přispěvatelé: Institut Català de la Salut, [Ma TM] Department of Radiation Oncology, University of California, Los Angeles, CA. [Sun Y] Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH. [Malone S] The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. [Roach M 3rd] Department of Radiation Oncology, University of California San Francisco, San Francisco, CA. [Dearnaley D] Academic Urology Unit, Royal Marsden Hospital, London, United Kingdom. Institute of Cancer Research, London, United Kingdom. [Pisansky TM] Department of Radiation Oncology, Mayo Clinic, Rochester, MN. [Maldonado X] Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Urology, APH - Personalized Medicine, APH - Quality of Care, CCA - Imaging and biomarkers
Rok vydání: 2022
Předmět:
neoplasias::neoplasias por localización::neoplasias urogenitales::neoplasias de los genitales masculinos::neoplasias de la próstata [ENFERMEDADES]
Cancer Research
hormonas
sustitutos de hormonas y antagonistas de hormonas::antagonistas de hormonas::antagonistas de andrógenos [COMPUESTOS QUÍMICOS Y DROGAS]
Oncology
Neoplasms::Neoplasms by Site::Urogenital Neoplasms::Genital Neoplasms
Male::Prostatic Neoplasms [DISEASES]
terapéutica::radioterapia [TÉCNICAS Y EQUIPOS ANALÍTICOS
DIAGNÓSTICOS Y TERAPÉUTICOS]
Antiandrògens - Ús terapèutic
Hormones
Hormone Substitutes
and Hormone Antagonists::Hormone Antagonists::Androgen Antagonists [CHEMICALS AND DRUGS]
Pròstata - Càncer - Radioteràpia
Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores]
Therapeutics::Radiotherapy [ANALYTICAL
DIAGNOSTIC AND THERAPEUTIC TECHNIQUES
AND EQUIPMENT]
Other subheadings::Other subheadings::/drug therapy [Other subheadings]
Zdroj: Scientia
Journal of clinical oncology, 41(4), 881-892. American Society of Clinical Oncology
ISSN: 1527-7755
0732-183X
Popis: Càncer de pròstata; Teràpia de privació d'andrògens Cáncer de próstata; Terapia de privación de andrógenos Prostate cancer; Androgen-deprivation therapy PURPOSE The sequencing of androgen-deprivation therapy (ADT) with radiotherapy (RT) may affect outcomes for prostate cancer in an RT-field size-dependent manner. Herein, we investigate the impact of ADT sequencing for men receiving ADT with prostate-only RT (PORT) or whole-pelvis RT (WPRT). MATERIALS AND METHODS Individual patient data from 12 randomized trials that included patients receiving neoadjuvant/concurrent or concurrent/adjuvant short-term ADT (4-6 months) with RT for localized disease were obtained from the Meta-Analysis of Randomized trials in Cancer of the Prostate consortium. Inverse probability of treatment weighting (IPTW) was performed with propensity scores derived from age, initial prostate-specific antigen, Gleason score, T stage, RT dose, and mid-trial enrollment year. Metastasis-free survival (primary end point) and overall survival (OS) were assessed by IPTW-adjusted Cox regression models, analyzed independently for men receiving PORT versus WPRT. IPTW-adjusted Fine and Gray competing risk models were built to evaluate distant metastasis (DM) and prostate cancer–specific mortality. RESULTS Overall, 7,409 patients were included (6,325 neoadjuvant/concurrent and 1,084 concurrent/adjuvant) with a median follow-up of 10.2 years (interquartile range, 7.2-14.9 years). A significant interaction between ADT sequencing and RT field size was observed for all end points (P interaction < .02 for all) except OS. With PORT (n = 4,355), compared with neoadjuvant/concurrent ADT, concurrent/adjuvant ADT was associated with improved metastasis-free survival (10-year benefit 8.0%, hazard ratio [HR], 0.65; 95% CI, 0.54 to 0.79; P < .0001), DM (subdistribution HR, 0.52; 95% CI, 0.33 to 0.82; P = .0046), prostate cancer–specific mortality (subdistribution HR, 0.30; 95% CI, 0.16 to 0.54; P < .0001), and OS (HR, 0.69; 95% CI, 0.57 to 0.83; P = .0001). However, in patients receiving WPRT (n = 3,049), no significant difference in any end point was observed in regard to ADT sequencing except for worse DM (HR, 1.57; 95% CI, 1.20 to 2.05; P = .0009) with concurrent/adjuvant ADT. CONCLUSION ADT sequencing exhibits a significant impact on clinical outcomes with a significant interaction with field size. Concurrent/adjuvant ADT should be the standard of care where short-term ADT is indicated in combination with PORT. Funding support for this study comes from the Prostate Cancer Foundation and ASTRO to AUK. AUK also thanks generous donations from the DeSilva, McCarrick, and Bershad families. A.T. acknowledges support from Cancer Research UK (C33589/A28284 and C7224/A28724) the National Institute for Health Research (NIHR) Cancer Research Network. This project represents independent research supported by the National Institute for Health research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London. N.G.Z. is supported by the American Cancer Society – Tri State CEOs Against Cancer Clinician Scientist Development Grant, CSDG‐20‐013‐01‐CCE (2020).
Databáze: OpenAIRE
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