Prostate Radiotherapy, ADT May Extend Metastatic Prostate Cancer Survival

Excerpt:

“The addition of prostate radiotherapy to androgen deprivation may prolong survival in men with newly diagnosed metastatic prostate cancer, according to a study published in Journal of Clinical Oncology.

” ‘Prostate radiotherapy represents an attractive local treatment strategy for patients with metastatic prostate cancer, given its noninvasive administration and broad patient candidacy, advancements in delivery allowing for an increasingly favorable toxicity profile, the established role of radiotherapy in the management of locally advanced nonmetastatic prostate cancer, and recent associations between radiotherapy and improved survival for men with lymph node–positive prostate cancer,’ Chad G. Rusthoven, MD, radiation oncologist and assistant professor of radiation oncology at University of Colorado School of Medicine, and colleagues wrote.”

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Psychological Effects From ADT a Growing Challenge in Prostate Cancer

Excerpt:

“Androgen-deprivation therapy (ADT) can be associated with significant psychological effects in patients with prostate cancer.

“Additionally, these side effects—which include depression, Alzheimer disease, and coronary disease—are often underreported by patients, according to Heather Jim, MD.

“ ‘It is really important for the clinician to let [patients] know that a lot of men experience this. Let’s get them help and try to help them feel better,’ said Jim, who discussed these significant events in her lecture at the 2016 OncLive State of the Science Summit on Genitourinary Cancers.”

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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.”