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ADT plus radiation better than ADT alone in locally advanced prostate cancer
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ASCO 2010 Annual Meeting
CHICAGO — The combination of radiation therapy and androgen deprivation therapy reduced the risk for disease-specific death by 43% in men with locally advanced or high-risk prostate cancer compared with ADT alone.
“Patients treated with combined therapy, radiation and hormones, live longer and are less likely to die from prostate cancer,” said Padraig Warde, MBChB, deputy head of the radiation medicine program at the University of Toronto’s Princess Margaret Hospital. “We are confident that radiation treatment should be part of the treatment package for these patients.”
Warde presented results from the randomized, phase 3 trial Sunday at the 2010 ASCO Annual Meeting.
Current clinical guidelines recommend that radiation be combined with ADT for locally advanced prostate cancer, but it is unclear whether ADT alone was sufficient therapy for these patients, and whether the adverse effects of radiation could be avoided. Warde and colleagues set out to determine whether radiation could be safely eliminated for these patients.
The researchers randomly assigned patients to ADT monotherapy (n=602) or ADT plus radiation (n=603).
After 7 years, OS was 74% in the combination arm compared with 66% in the ADT alone arm (HR=0.77, P=.0331). There were 175 deaths in the ADT alone arm vs. 145 in the ADT and radiation arm.
“What this HR means is that patients who got both treatments were 23% less likely to die during the duration of the study,” Warde said. “Similarly, when we looked at deaths from prostate cancer, the HR was 0.57. Patients who got both treatments were 43% less likely to die from prostate cancer.”
In the ADT alone group, 21% of patients died from prostate cancer compared with 10% in the combination (P=.001). The researchers estimated that the 10-year cumulative disease-specific death rate would be 7% lower for men who received ADT plus radiation compared with those who received ADT alone.
Additionally, men in the combination arm lived 6 months longer on average. According to Warde, combination therapy was not associated with any increase in significant, long-term gastrointestinal toxicity. – by Jason Harris
We’ve long known that the outcome of radiation therapy is better if we use androgen deprivation therapy. What we haven’t known, and what researchers tried to answer here, is whether we can treat patients with ADT alone. The message from this trial is clear: Radiation is an indispensible element in the treatment of patients with high-risk prostate cancer.
– Jennifer C. Obel, MD
Attending
Physician, Northshore University Health System
For more information:
- Warde P. #CRA4504. Presented at: the 2010 ASCO Annual Meeting; June 4-8; Chicago.
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