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Adding ADT to Radiotherapy Ups Mets-Free Survival in Prostate Cancer

In meta-analysis, adjuvant ADT prolongation also linked to improvement in metastasis-free survival, but not neoadjuvant ADT extension

TUESDAY, Feb. 1, 2022 (HealthDay News) — The addition of androgen-deprivation therapy (ADT) to radiotherapy and adjuvant ADT prolongation improve metastasis-free survival in men with localized prostate cancer, according to a meta-analysis published online Jan. 17 in The Lancet Oncology.

Amar U. Kishan, M.D., from the University of California Los Angeles, and colleagues conducted a meta-analysis to quantify the benefit of various ADT intensification strategies in men receiving radiotherapy for treatment of prostate cancer in aggregate and clinically relevant subgroups. Data were included from 12 eligible trials, which provided individual patient data for 10,853 patients, with a median follow-up of 11.4 years.

The researchers observed a significant improvement in metastasis-free survival with the addition of ADT to radiotherapy (hazard ratio, 0.83; 95 percent confidence interval, 0.77 to 0.89; P < 0.0001) and for adjuvant ADT prolongation (hazard ratio, 0.84; 95 percent confidence interval, 0.78 to 0.91; P < 0.0001), but not for neoadjuvant ADT extension (hazard ratio, 0.95; 95 percent confidence interval, 0.83 to 1.09; P = 0.50). Regardless of radiotherapy dose, patient age, or National Comprehensive Cancer Network risk group, treatment effects were similar.

“We provide the strongest level of evidence for the routine recommendation for the addition of ADT to radiotherapy in men with intermediate-risk disease, and the use and prolonged adjuvant ADT for men with high-risk disease, irrespective of radiotherapy dose,” the authors write. “However, the strategy of prolongation of neoadjuvant ADT should not be routinely recommended.”

Several authors disclosed financial ties to the biopharmaceutical and medical device industries.

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