Prostate cancer: ADT and dose-escalated radiotherapy sequence do not matter

  • Malone S & al.
  • J Clin Oncol
  • 12 Dec 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with newly diagnosed localized prostate cancer, neoadjuvant and concurrent initiations of short-term androgen-deprivation therapy (ADT) with dose-escalated radiotherapy (RT) yield similar biochemical recurrence-free survival (bRFS), OS, and late radiotherapy-related toxicities.

Why this matters

  • Dose-escalated radiotherapy with ADT is a standard definitive treatment for localized prostate cancer, but their optimal sequencing is unclear.

Study design

  • Phase 3 randomized trial of 432 patients with newly diagnosed localized prostate cancer with Gleason score ≤7, clinical stage T1b-T3a, and PSA
  • Participants were randomly assigned to neoadjuvant and concurrent ADT for 6 months starting 4 months before RT (neoadjuvant group) or concurrent and adjuvant ADT for 6 months starting simultaneously with RT (concurrent group).
  • Primary endpoint: bRFS.
  • Funding: AstraZeneca.

Key results

  • Median follow-up was 146 months at data cutoff.
  • Neoadjuvant vs concurrent group showed no significant difference in:
    • 10-year bRFS rates were 80.5% vs 87.4% (HR, 0.66; P=.09).
    • 10-year OS rates were 76.4% vs 73.7% (HR, 0.94; P=.7).
    • 3-year incidence of late RT-related grade ≥3 gastrointestinal (2.5% vs 3.9%) or genitourinary toxicity (2.9% vs 2.9%).

Limitations

  • Open-label design.