Adding hormone therapy to radiation therapy improves survival for prostate cancer patients

Prostate cancer is the leading cause of cancer in men worldwide, and radiation therapy is one of the most common forms of treatment. In a meta-analysis, the first of its kind, published today in The Lancet Oncologyresearchers from University Hospitals (UH) and Case Western Reserve University show that there is a consistent improvement in overall survival in men with intermediate and high risk prostate cancer with the addition of hormone therapy to radiotherapy treatments.

Over the past 40 years, randomized trials have been conducted on the impact of adding hormone therapy to prostate cancer treatments. Although these trials individually show the benefit of hormone therapy, there are inconsistencies in the timing and duration of treatment recommendations.

“Our research team set out to conduct a comprehensive analysis, the first of its kind, collecting individual patient data from every randomized trial conducted worldwide, and performed a meta-analysis of the impact of various treatment strategies. ‘treatment intensification using hormone therapy with radiation therapy for localized prostate cancer,’ said lead author Daniel E. Spratt, MD, Vincent K. Smith Chair in Radiation Oncology at UH Seidman Cancer Center, professor in the Department of Radiation Oncology at Case Western Reserve School of Medicine, and a member of the Developmental Therapeutics Program at Case Comprehensive Cancer Center.”Our goal is to better personalize treatment for patients with prostate cancer, by providing the most precise and accurate estimates of the benefits of hormone therapy.”

In this analysis, the team made three key discoveries:

1) Men with intermediate and high risk prostate cancer have an increased survival rate with the addition of hormone therapy to radiation therapy. This has been seen in younger and older men, and in men treated with lower and higher doses of radiotherapy.

2) The survival rate in men with prostate cancer improves with prolonged hormone therapy in addition to radiation therapy. This benefit was seen in young and older men, in men treated with lower and higher doses of radiotherapy, and in men with intermediate and high risk prostate cancer. Prior to this analysis, no trial was large enough to show a clear benefit in intermediate-risk disease of extending the duration of adjuvant hormone therapy.

3) Prolonging neoadjuvant hormone therapy before radiation therapy did not benefit men in any measured outcome. This is an important finding, as some countries routinely grant extended periods of hormone therapy before radiation therapy. The team has shown that this method is not advantageous over shorter durations.

We now have estimates that show the benefits of adding and extending adjuvant hormone therapy for clinically relevant subgroups of patients. Our team showed that treating a group of about 10-15 men with hormone therapy or prolonged adjuvant hormone therapy, for at least 18 months, prevented one man from developing metastatic disease ten years after treatment. This depends on patient and tumor specific factors, but gives us a more accurate estimate to work with when recommending treatment options.”

Daniel E. Spratt, MD, lead author

The MARCAP (Meta-Analysis of Randomized Trials in Cancer of the Prostate) Consortium is the first comprehensive international collaboration of Phase III randomized clinical trial data on individual patients. The ability to analyze data from every group of clinical trials in the world, studying the impact of hormone therapy with radiation therapy, demonstrates immense progress in the field of prostate oncology.

“This MARCAP Consortium work will provide confidence in recommending various treatment intensification strategies and enable providers to have more accurate and shared conversations with patients about the benefits of using hormone therapy with radiation therapy for the treatment of prostate cancer,” Dr. Sprat pointed out.

In this MARCAP analysis, 12 randomized trials were included. The research team now has more than 20 trials, and that number continues to grow, from groups around the world who have agreed to share data. In the next steps of this research, this framework will be used to investigate other clinically relevant questions regarding optimal radiation therapy dosage, fractionation, the use of pelvic nodal radiation therapy, and the extension of studies to recurrent disease states and advances.

The UH Seidman Cancer Center’s Prostate Cancer Program is one of the nation’s leading clinical and research programs and serves as one of two international data repositories for the MARCAP Consortium.

Source:

Journal reference:

Kishan, AU, et al. (2022) Use and duration of androgen deprivation therapy with definitive radiotherapy for localized prostate cancer: a meta-analysis of individual patient data. The Lancet Oncology. doi.org/10.1016/S1470-2045(21)00705-1.

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