Transcript Continuous versus intermittent androgen deprivation

Continuous versus Intermittent Androgen
Deprivation Therapy for Prostate Cancer
Robert Dreicer, M.D., M.S., FACP, FASCO
Chair Dept of Solid Tumor Oncology
Taussig Cancer Institute
Cleveland Clinic
Professor of Medicine
Cleveland Clinic Lerner College of Medicine
A Brief ADT for the Management of
Advanced Prostate Cancer
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Despite 70 + years of understanding the
clinical benefit of ADT in advanced prostate
cancer, the “optimal” timing of initiating
therapy remains unclear
VA Cooperative group studies (VACURG)
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After 9 years all men with metastatic disease in
the control arm ( orchiectomy vs. delayed
treatment) received ADT, thus interpreted as early
vs. late treatment: no difference in survival,
however palliative end points not recorded
Intermittent Androgen Suppression for Rising PSA Level
after Radiotherapy
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Pts with a PSA > 3 more than 1 year after primary
or salvage EBRT for localized prostate cancer
Intermittent rx was given in 8-month cycles, with
non-treatment periods determined according to
the PSA level
The primary end point was OS
Secondary end points included QOL , time to
castration-resistant disease, duration of nontreatment intervals.
Crook, JM, et al. n engl j med 367;10 2012
Intermittent Androgen Suppression for Rising PSA Level
after Radiotherapy
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1386 pts were randomized with a median
follow-up of 6.9 years
In the intermittent-therapy group, full
testosterone recovery occurred in 35% of
patients, and testosterone recovery to the
trial-entry threshold occurred in 79%
Crook, JM, et al. n engl j med 367;10 2012
Intermittent Androgen Suppression for Rising PSA Level
after Radiotherapy
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Median overall survival was 8.8 years in the
intermittent-therapy group versus 9.1 years in
the continuous-therapy group (hazard ratio
for death, 1.02; 95% confidence interval, 0.86
to 1.21)
Intermittent therapy provided potential
benefits with respect to physical function,
fatigue, urinary problems, hot flashes, libido,
and erectile function
Crook, JM, et al. n engl j med 367;10 2012
Crook, JM, et al. n engl j med 367;10
2012
Intermittent versus Continuous Androgen
Deprivation in Prostate Cancer
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3040 metastatic patients were enrolled, of whom
1535 were included in the analysis
The median follow-up period was 9.8 years
Median survival was 5.8 years in the continuoustherapy group and 5.1 years in the intermittenttherapy group (HR ratio for death with IT, 1.10;
90% confidence interval, 0.99 to 1.23)
IT was associated with better erectile function
and mental health respectively) at month 3 but
not thereafter
Hussain M, et al. N Engl J Med 368;14 2013
Hussain M, et al. N ENGL J MED 368;14 2013
minimal disease was disease
confined to the spine, pelvic bones, or lymph
nodes
Commentary
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The Canadian study is silent on the critical
question i.e. early ADT
SWOG intergroup study is statistically
inconclusive, but certainly non an
endorsement of routine use of IT
The recent initial report of E 3805 will impact
to some extent on management, as it
consisted of continuous ADT