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Radiotherapy plus ADT improves metastasis-free survival after radical prostatectomy
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CHICAGO — The addition of short-term androgen deprivation therapy to salvage radiotherapy significantly improved 10-year metastasis-free survival among patients with biological relapse after radical prostatectomy, according to data presented at ASCO Annual Meeting.
“Clearly, ADT improves metastasis-free survival,” Christian Carrie, MD, of the department of radiation oncology at Centre Léon Bérard in Lyon, France, told HemOnc Today. “When I wrote this trial, I thought that ADT would not be useful for low-risk patients but, in fact, these patients have experienced benefit.”
The current analysis provides additional follow-up to the GETUG-AFU 16 phase 3 randomized trial comparing the efficacy of radiotherapy alone vs. radiotherapy plus short-term ADT among patients with biological relapse after radical prostatectomy.
For the trial, researchers randomly assigned 743 patients (median age, 67 years) to either radiotherapy alone (n = 374) or with ADT (n = 369). Patients assigned ADT received 6 months of goserelin (Zoladex; TerSera AstraZeneca).
At median follow-up of 112 months, the combination continued to demonstrate an overall PFS benefit (HR = 0.54; 95% CI, 0.43-0.68), including among low-risk (HR = 0.47; 95% CI, 0.28-0.8) and high-risk (HR = 0.56; 95% CI, 0.44-0.73) patients.
The 10-year metastasis-free survival rates were 69% for radiotherapy alone and 75% for radiotherapy and ADT.
“Although quality-of-life analysis is not complete, it is difficult for patients to live with a metastatic disease, even knowing that their disease will not lead to death — an impact of quality of life not evaluable on the EORTC scale of quality of life,” Carrie said. “It is important to note that 6 months of ADT is efficient and probably less toxic than the 2 years of the [Radiation Therapy Oncology Group] protocol. A new trial is underway to assess abiraterone as ADT.” – by Jennifer Southall
Reference:
Carrie C, et al. Abstract 5001. Presented at: ASCO Annual Meeting; May 31-June 4, 2019; Chicago.
Disclosures: Carrie reports accommodations and travel expenses from AstraZeneca. Please see the abstract for all other authors’ relevant financial disclosures.
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David I. Quinn, MBBS, PhD
Up until recently, we have performed salvage radiation therapy to the prostate area in patients who have increased PSA levels, but this has now changed a bit with newer imaging techniques. This current trial, which started quite some time ago, looked at giving patients hormone therapy for 6 months overlapping with radiation therapy in a very large number of men. The researchers previously published data showing there was a delay in recurrence among those who received hormone therapy for 6 months, but we had difficulty interpreting these data, because recurrence can be dependent upon how much androgen is in the blood. A man receiving 6 months of ADT may take a very long time to recover testosterone. What was unique about what was presented this time around was that they demonstrated there was a delay in non-PSA-driven progression with metastases. The OS data are not yet mature, but after long-term follow-up, there is evidence that for the short period of hormone therapy given at the time of radiating the pelvis in these men produces a significant benefit.
Keck School of Medicine of USC
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