TY - JOUR
T1 - Prostate Radiotherapy With Adjuvant Androgen Deprivation Therapy (ADT) Improves Metastasis-Free Survival Compared to Neoadjuvant ADT
T2 - An Individual Patient Meta-Analysis
AU - Spratt, Daniel E.
AU - Malone, Shawn
AU - Roy, Soumyajit
AU - Grimes, Scott
AU - Eapen, Libni
AU - Morgan, Scott C.
AU - Malone, Julia
AU - Craig, Julia
AU - Dess, Robert T.
AU - Jackson, William C.
AU - Hartman, Holly E.
AU - Kishan, Amar U.
AU - Mehra, Rohit
AU - Kaffenberger, Samuel
AU - Morgan, Todd M.
AU - Reichert, Zachery R.
AU - Alumkal, Joshi J.
AU - Michalski, Jeff
AU - Lee, W. Robert
AU - Pisansky, Thomas M.
AU - Feng, Felix Y.
AU - Shipley, William
AU - Sandler, Howard M.
AU - Schipper, Mathew J.
AU - Roach, Mack
AU - Sun, Yilun
AU - Lawton, Colleen A.F.
N1 - Funding Information:
Supported by the Prostate Cancer Foundation, Prostate Cancer SPORE, Department of Defense, Rogel Cancer Center, and the National Institutes of Health (D.E.S.), and by AstraZeneca for the Ottawa 0101 Trial (S.W.).
Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2021/1/10
Y1 - 2021/1/10
N2 - PURPOSEThere remains a lack of clarity regarding the influence of sequencing of androgen deprivation therapy (ADT) and radiotherapy (RT) on outcomes in prostate cancer (PCa). Herein, we evaluate the optimal sequencing of ADT with prostate-directed RT in localized PCa.METHODSMEDLINE (1966-2018), Embase (1982-2018), ClinicalTrials.gov, and conference proceedings (1990-2018) were searched to identify randomized trials evaluating the sequencing, but not duration, of ADT with RT. Two randomized phase III trials were identified, and individual patient data were obtained: Ottawa 0101 and NRG Oncology's Radiation Therapy Oncology Group 9413. Ottawa 0101 randomly assigned patients to neoadjuvant or concurrent versus concurrent or adjuvant short-term ADT. Radiation Therapy Oncology Group 9413, a 2 × 2 factorial trial, included a random assignment of neoadjuvant or concurrent versus adjuvant short-term ADT. The neoadjuvant or concurrent ADT arms of both trials were combined into the neoadjuvant group, and the arms receiving adjuvant ADT were combined into the adjuvant group. The primary end point of this meta-analysis was progression-free survival (PFS).RESULTSThe median follow-up was 14.9 years. Overall, 1,065 patients were included (531 neoadjuvant and 534 adjuvant). PFS was significantly improved in the adjuvant group (15-year PFS, 29% v 36%, hazard ratio [HR], 1.25 [95% CI, 1.07 to 1.47], P =.01). Biochemical failure (subdistribution HR [sHR], 1.37 [95% CI, 1.12 to 1.68], P =.002), distant metastasis (sHR, 1.40 [95% CI, 1.00 to 1.95], P =.04), and metastasis-free survival (HR, 1.17 [95% CI, 1.00 to 1.37], P =.050) were all significantly improved in the adjuvant group. There were no differences in late grade ≥ 3 gastrointestinal (2% v 3%, P =.33) or genitourinary toxicity (5% v 5%, P =.76) between groups.CONCLUSIONThe sequencing of ADT with prostate-directed RT has significant association with long-term PFS and MFS in localized PCa. Our findings favor use of an adjuvant over a neoadjuvant approach, without any increase in long-term toxicity.
AB - PURPOSEThere remains a lack of clarity regarding the influence of sequencing of androgen deprivation therapy (ADT) and radiotherapy (RT) on outcomes in prostate cancer (PCa). Herein, we evaluate the optimal sequencing of ADT with prostate-directed RT in localized PCa.METHODSMEDLINE (1966-2018), Embase (1982-2018), ClinicalTrials.gov, and conference proceedings (1990-2018) were searched to identify randomized trials evaluating the sequencing, but not duration, of ADT with RT. Two randomized phase III trials were identified, and individual patient data were obtained: Ottawa 0101 and NRG Oncology's Radiation Therapy Oncology Group 9413. Ottawa 0101 randomly assigned patients to neoadjuvant or concurrent versus concurrent or adjuvant short-term ADT. Radiation Therapy Oncology Group 9413, a 2 × 2 factorial trial, included a random assignment of neoadjuvant or concurrent versus adjuvant short-term ADT. The neoadjuvant or concurrent ADT arms of both trials were combined into the neoadjuvant group, and the arms receiving adjuvant ADT were combined into the adjuvant group. The primary end point of this meta-analysis was progression-free survival (PFS).RESULTSThe median follow-up was 14.9 years. Overall, 1,065 patients were included (531 neoadjuvant and 534 adjuvant). PFS was significantly improved in the adjuvant group (15-year PFS, 29% v 36%, hazard ratio [HR], 1.25 [95% CI, 1.07 to 1.47], P =.01). Biochemical failure (subdistribution HR [sHR], 1.37 [95% CI, 1.12 to 1.68], P =.002), distant metastasis (sHR, 1.40 [95% CI, 1.00 to 1.95], P =.04), and metastasis-free survival (HR, 1.17 [95% CI, 1.00 to 1.37], P =.050) were all significantly improved in the adjuvant group. There were no differences in late grade ≥ 3 gastrointestinal (2% v 3%, P =.33) or genitourinary toxicity (5% v 5%, P =.76) between groups.CONCLUSIONThe sequencing of ADT with prostate-directed RT has significant association with long-term PFS and MFS in localized PCa. Our findings favor use of an adjuvant over a neoadjuvant approach, without any increase in long-term toxicity.
UR - http://www.scopus.com/inward/record.url?scp=85099586804&partnerID=8YFLogxK
U2 - 10.1200/JCO.20.02438
DO - 10.1200/JCO.20.02438
M3 - Article
C2 - 33275486
AN - SCOPUS:85099586804
SN - 0732-183X
VL - 39
SP - 136
EP - 144
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 2
ER -