mHSPC: add-on RT yields survival benefit in low-burden disease

  • Burdett S & al.
  • Eur Urol
  • 27 Feb 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Adding prostate radiotherapy (RT) to androgen deprivation therapy (ADT) improves survival in men with metastatic hormone-sensitive prostate cancer (mHSPC) who have
  • RT improves 3-year biochemical progression and failure-free survival (FFS) in unselected patients.

Why this matters

  • Framework for adaptive meta-analysis (FAME) helps anticipate emerging trial results and identify the earliest opportunity for reliable meta-analysis.
  • Future research should focus on timing and optimal dose of radiotherapy.

Study design

  • STOPCAP FAME meta-analysis of 3 randomized trials (ongoing PEACE-1, completed HORRAD and STAMPEDE) involving 2126 men with mHSPC.
  • Patients were randomly assigned to RT+ADT or ADT alone.
  • Funding: UK Medical Research Council.

Key results

  • No significant overall difference between groups in OS (2 studies; HR, 0.92; P=.195) or PFS (HR, 0.94; P=.238).
  • Add-on RT yielded a significant reduction in biochemical progression (HR, 0.74; P=.94×10−8; absolute improvement in 3-year survival, 11%).
  • FFS improved significantly with radiotherapy (HR, 0.76; P=.64×10−7).
  • 4% of men who received prostate radiotherapy experienced severe acute bladder toxicity, and 1% reported severe acute bowel toxicity.
  • Effect of radiotherapy varied with bone metastases: men with

Limitations

  • Meta-analysis included 1 ongoing trial.

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