J Clin Oncol: optimal sequence of radiotherapy for non-metastatic prostate cancer + short-term androgen deprivation therapy

The sequence of androgen deprivation therapy (ADT) versus radiation therapy (RT) may affect the prognosis of prostate cancer patients, which is related
to the size of the RT range.
In the study, researchers evaluated the effect
of ADT sequencing on prostate cancer patients receiving ADT with unspecified prostate RT (PORT) or total pelvic RT (WPRT).

The study included patient data from 12 randomized trials in which patients with prostate cancer received neoadjuvant/synchronized or synced/adjuvant short-term ADT (4-6 months) + local radiotherapy
.
The treatment-weighted inverse probability (IPTW)
was performed using age at source, initial prostate-specific antigen, Gleason score, T stage, RT dose, and propensity score for the year of mid-trial enrollment.
The primary endpoints were metastasis-free survival and overall survival (OS).

Different endpoint outcomes for patients in both groups

Overall, a total of 7409 patients (6325 received neoadjuvant/concurrent ADT and 1084 received synchronized/adjuvant ADT) were included, with a median follow-up of 10.
2 years (interquartile range: 7.
2 to 14.
9 years).

Significant interaction
of ADT sequence with RT range was observed on all endpoints except OS.
In patients receiving PORT (n=4355), synchronization/adjuvant ADT was associated with metastasis-free survival compared with neoadjuvant/synchronous ADT (10-year benefit 8.
0%; HR 0.
65, p<0.
0001), distant metastases (HR 0.
52, p< 0.
0001), prostate cancer-specific mortality (HR 0.
30, p< 0.
0001) and OS (HR 0.
69, p=0.
0001) were correlated
.

However, no significant differences
in ADT sequence were observed in patients receiving WPRT (n=3049), except for a higher incidence of distant metastases with synchronistic/adjuvant ADT therapy (HR 1.
57, p=0.
0009).

In conclusion, the sequence of ADT had a significant impact on clinical outcomes in patients with prostate cancer and interacted significantly with the extent of radiotherapy
.
Synchronous/auxiliary ADT should be the standard scheme
for short-term ADT in conjunction with PORT.

Original source:

Ting Martin Ma, et al.
Sequencing of Androgen-Deprivation Therapy of Short Duration With Radiotherapy for Nonmetastatic Prostate Cancer (SANDSTORM): A Pooled Analysis of 12 Randomized Trials.
Journal of Clinical Oncology.
October 21, 2022.
https://ascopubs.
org/doi/full/10.
1200/JCO.
22.
00970