Details

Autor(en) / Beteiligte

• Berghen, Charlien
• Joniau, Steven
• Ost, Piet
• Poels, Kenneth
• Everaerts, Wouter
• Decaestecker, Karel
• Haustermans, Karin
• Devos, Gaëtan
• De Meerleer, Gert

Titel

Progression-directed Therapy for Oligoprogression in Castration-refractory Prostate Cancer

Ist Teil von

• European urology oncology, 2021-04, Vol.4 (2), p.305-309

Ort / Verlag

Netherlands: Elsevier B.V

Erscheinungsjahr

2021

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• In metastatic castration-refractory prostate cancer (mCRPC), state-of-the-art treatment consists of androgen biosynthesis inhibition (abiraterone), inhibition of the androgen receptor (enzalutamide), chemotherapy, or radium-223 in combination with androgen deprivation therapy (ADT). A subgroup of these patients show oligoprogression, with the progression of only a limited number of metastatic spots, while all other metastases remain controlled by ongoing systemic therapy. In a bi-institutional retrospective study, we tested the hypothesis that progression-directed therapy (PDT) targeting oligoprogressive lesions might defer the initiation of next-line systemic treatment (NEST). A total of 30 patients were diagnosed with mCRPC and experienced oligoprogression, defined as a total of three or fewer progressive lesions either at known metastatic sites and/or the appearance of new metastasis and/or local recurrence. All patients were under active ADT with or without second-line systemic treatment. All patients received PDT targeting the oligoprogressive lesions, while ongoing systemic treatment was maintained. There was median NEST-free survival of 16mo (95% confidence interval [CI] 10–22) and progression-free survival of 10mo (95% CI 6–15) with only minor radiotherapy- or surgery-related toxicity. These findings encourage further prospective trials. In patients with metastatic castration-refractory prostate cancer, surgical treatment or high-dose radiation therapy directed to only the limited number of progressive metastatic spots, while all other metastases remained controlled by ongoing systemic therapy, led to substantial postponement of next-line systemic treatment in our study. In patients with metastatic castration-refractory prostate cancer, treatment with progression-directed therapy may result in substantial postponement of next-line systemic therapy, at a nearly negligible toxicity rate. Prospective trials are needed to endorse this finding.