ADT Decreases Survival Among Black Men With Favorable-Risk Prostate Cancer

Excerpt:

“Definitive treatment with androgen deprivation therapy increased the risk for death among black men with low- or favorable-risk prostate cancer, according to study results published in Cancer.

“ADT should be reserved for black men with high-risk disease, according to the researchers.

“ADT is frequently combined with radiation therapy for the treatment of men with intermediate- or high-risk prostate cancer. No evidence suggests that this treatment platform benefits patients with low- or favorable-risk disease.”

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African-American Men Negatively Impacted by Hormone Therapy for Treatment of Prostate Cancer

Excerpt:

“In a retrospective study analyzing patients’ medical records, researchers at Brigham and Women’s Hospital found that patients’ race significantly affected their longevity by increasing the likelihood of death after receiving androgen deprivation therapy (ADT). ADT was used to reduce the size of the prostate to make a patient eligible for prostate brachytherapy. These findings are published in the August 4, 2016 issue of Cancer.

“Konstantin Kovtun, MD, a resident at BWH, Anthony D’Amico, MD, PhD, chief of Genitourinary Radiation Oncology at BWH, and colleagues, analyzed the medical records of over 7000 men from the Chicago Prostate Cancer Center who had low or favorable-intermediate risk prostate cancer, 20 percent of whom were treated with ADT in order to reduce the size of their prostate gland to make them eligible for brachytherapy. They found that African-American men who were treated with ADT had a 77 percent higher risk of death when compared to non-African American men, the causes of which were not due to prostate cancer.”

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New Research on Triple Negative Breast Cancer Emerges at ASCO 2016


The American Society of Clinical Oncology (ASCO) meeting of 2016 is behind us, but oncologists, patients, and journalists are still analyzing the most interesting presentations made there. Below, we describe some of the more prominent results in triple negative breast cancer (TNBC), both promising and disappointing.

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Radiation Plus ADT Boosts Survival in Metastatic Prostate Ca (CME/CE)

Excerpt:

“A large contemporary analysis of men with metastatic prostate cancer has found that adding radiotherapy to androgen deprivation therapy resulted in substantially better survival than androgen deprivation alone.

“With a median follow-up of 5.1 years, giving prostate radiotherapy plus androgen deprivation was associated on univariate analysis with a longer median overall survival of 53 versus 29 months, for a hazard ratio of 0.562 (95% CI 0.498-0.635, P0.001). The effect held in multivariate, propensity score, and landmark analyses — with the last yielding improved overall survival estimates at 3, 5, and 8 years, reported Chad. G. Rusthoven, MD, of University of Colorado School of Medicine, Denver, and colleagues in the Journal of Clinical Oncology.

“The estimates were 62% versus 43% for 3 years, 49% versus 25% for 5 years, and 33% versus 13% for 8 years (HR 0.562, 95% CI 0.498-0.635, P0.001).”

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Steroid Use With Abiraterone Offers Multidimensional Benefits to Patients With mCRPC

Excerpt:

“For decades, the standard of care for men with advanced prostate cancer has been the depletion or inhibition of androgens. While androgen-deprivation therapy (ADT) often results in temporary tumor regression or symptom relief in some patients, disease progression ultimately occurs over time. For patients with metastatic disease, the median overall survival (OS), until very recently, had been less than 2 years after chemotherapy.

“While tumor progression with ADT was previously believed to be hormone-refractory or androgen-independent, a large body of evidence supports that metastatic castration-resistant prostate cancer (mCRPC) is commonly driven by elevated steroid synthesis, increased expression or splice variants of the androgen receptor (AR), or AR ligand promiscuity, indicating the ongoing need for targeted androgen therapies.”

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Common Prostate Cancer Treatments Suppress Immune Response and May Promote Relapse

Excerpt:

“Prostate cancer patients and their doctors may want to think twice about the best timing for chemotherapy or radiation therapy in conjunction with a common nonsurgical treatment, based on international research findings led by UT Southwestern Medical Center investigators.

“Researchers using mouse models found that many medical androgen deprivation therapies (ADTs) – the most commonly used nonsurgical treatments for prostate cancer – may suppress patients’ adaptive immune responses, preventing immunotherapies from working if both treatments are used but not sequenced properly. ADTs are anti-hormone therapies that decrease the body’s levels of androgens, the type of hormone that is required for prostate cancer to survive and grow.

“The study findings were published this week in Science Translational Medicine.”

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Intermittent Hormonal Therapy Proves to be Viable in Prostate Cancer

“With no significant difference between intermittent and continuous androgen-deprivation therapy, patients with prostate cancer may experience an improvement in their quality of life with the former.

“Androgen-deprivation therapy may be an effective treatment in prostate cancer, though its side effects may result in a loss of quality of life for patients. Allowing low-risk patients to take breaks between treatments—a practice known as intermittent hormonal therapy, or a ‘hormone holiday’—may combat these challenges without impacting survival.

” ‘Intermittent hormonal therapy has been growing in popularity over the years. Patients who receive hormone therapy often have side effects, and giving them so-called “hormone holidays” may improve quality of life. Over the years, there has really been a lot of trials and experimental work that laid the groundwork for this going back 20 years,’ said Leonard G. Gomella, MD, in an interview with Targeted Oncology.”


“Hormone Holiday” Can Improve QoL for Select Patients With Prostate Cancer

“Androgen-deprivation therapy, while an effective treatment for prostate cancer, can result in side effects and a reduced quality of life. Allowing low-risk patients to take breaks between treatments—a practice known as intermittent hormonal therapy, or a ‘hormone holiday’—may combat these challenges without impacting survival.

“A recent systematic review and meta-analysis conducted by JAMA Oncology found no significant difference between intermittent and continuous therapy for overall survival (HR, 1.02; 95% CI, 0.93-1.11; 8 trials, 5352 patients), cancer-specific survival (HR, 1.02; 95% CI, 0.87-1.19; 5 trials, 3613 patients), and progression-free survival (HR, 0.94; 95% CI, 0.84-1.05; 4 trials, 1774 patients).”


Metastatic Hormone-Sensitive Prostate Cancer Should Include Docetaxel Alongside ADT

“Treatment initiation for hormone-sensitive metastatic prostate cancer should include the addition of docetaxel to androgen deprivation therapy (ADT) as standard of care. This recommendation is based on a meta-analysis1 of three large, relatively recent, randomized trials showing that docetaxel improves survival and failure-free survival (FFS) in metastatic hormone-sensitive prostate cancer. These findings move docetaxel up to the hormone-sensitive setting from its previous role as upfront treatment in the castrate-resistant setting.

“In men with metastatic hormone-sensitive prostate cancer, docetaxel added to ADT improved 4-year survival by an absolute value of 9% and reduced FFS by an absolute value of 16%.”