Radiotherapy & Oligometastatic PCa at Johns Hopkins

[pjoshea13]

New study [1].

"This study analyzed 156 OPCa {oligometastatic prostate cancer} patients and 354 metastatic lesions with median follow-up (fup) of 24.6 months. Of 150 patients with toxicity data, 53 (35%) experienced acute grade 1 toxicity, 8 (5%) had grade 2, and none had grade 3 toxicity. Only 13 (9%) had late toxicities. At 24 months the CI {cumulative incidence} of local failure was 7.4%. Median bPFS {biochemical progression free survival} for the entire cohort was 12.9 months and 52% at one year. On multivariable analysis, factors associated with prolonged bPFS were peri-radiotherapy androgen deprivation (ADT), lower GTV, and hormone sensitive (HS) OPCa. Median TTNI {time to next intervention}, including repeat radiotherapy, was 21.6 months. Median bPFS for men with HSPC was 17.2 months compared to 7.2 months in men with castrate-resistant OPCa (CROPCa) (p <0.0001) and cumulative incidence of local failure at 24 months was lower with HSOPCa (4.8% vs 12.1%; p=0.034). We analyzed 28 men with HSOPCa treated with a course of peri-radiotherapy ADT (median 4.3 months) with recovery of testosterone. At median 33.5 month fup, 20 have not developed bPFS, median bPFS has not yet been reached, and 24 month bPFS was 77%."

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/314...

Int J Radiat Oncol Biol Phys. 2019 Aug 13. pii: S0360-3016(19)33641-7. doi: 10.1016/j.ijrobp.2019.08.008. [Epub ahead of print]

Radiotherapy In The Definitive Management Of Oligometastatic Prostate Cancer: The Johns Hopkins Experience.

Deek MP1, Yu C1, Phillips R1, Song DY2, Deville C1, Greco S1, DeWeese TL2, Antonarakis ES3, Markowski M3, Paller C3, Denmeade S4, Carducci M4, Walsh PC5, Pienta KJ4, Eisenberger M4, Tran PT6.

Author information

1

Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

2

Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

3

Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

4

Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

5

Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

6

Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [e-mail].

Abstract

PURPOSE:

The use of radiotherapy (RT) in consolidating oligometastatic prostate cancer (OPCa) is a rapidly evolving treatment paradigm. Here we review our institutional experience using metastasis directed therapy (MDT) in the definitive management of men with OPCa.

MATERIALS/METHODS:

OPCa treated with definitive RT were included. The Kaplan-Meier method and multivariable Cox regression analysis were performed to assess biochemical progression free survival (bPFS) and time to next intervention (TTNI). Cumulative incidence (CI) functions were used to calculate rates of local failure. Toxicity was assessed using CTCAE v4 criteria.

RESULTS:

This study analyzed 156 OPCa patients and 354 metastatic lesions with median follow-up (fup) of 24.6 months. Of 150 patients with toxicity data, 53 (35%) experienced acute grade 1 toxicity, 8 (5%) had grade 2, and none had grade 3 toxicity. Only 13 (9%) had late toxicities. At 24 months the CI of local failure was 7.4%. Median bPFS for the entire cohort was 12.9 months and 52% at one year. On multivariable analysis, factors associated with prolonged bPFS were peri-RT androgen deprivation (ADT), lower GTV, and hormone sensitive (HS) OPCa. Median TTNI, including repeat RT, was 21.6 months. Median bPFS for men with HSPC was 17.2 months compared to 7.2 months in men with castrate-resistant OPCa (CROPCa) (p <0.0001) and cumulative incidence of local failure at 24 months was lower with HSOPCa (4.8% vs 12.1%; p=0.034). We analyzed 28 men with HSOPCa treated with a course of peri-RT ADT (median 4.3 months) with recovery of testosterone. At median 33.5 month fup, 20 have not developed bPFS, median bPFS has not yet been reached, and 24 month bPFS was 77%.

CONCLUSIONS:

MDT can be effective across a wide ranges of OPCa subtypes, however with differential efficacy. Continued studies investigating the use of RT over the wide range of OPCa patients is warranted.

Copyright © 2019 The Author(s). Published by Elsevier Inc. All rights reserved.

PMID: 31419509 DOI: 10.1016/j.ijrobp.2019.08.008

[cesces]

"Median bPFS {biochemical progression free survival} for the entire cohort was 12.9 months and 52% at one year."

That doesn't seem so impressive to me. Is it?

[pjoshea13 in reply to cesces]

But: "At median 33.5 month {follow-up}, 20 have not developed bPFS, median bPFS has not yet been reached, and 24 month bPFS was 77%."

I suspect that many with oligometastatic PCa would be encouraged by these results.

-Patrick

[tango65 in reply to cesces]

The idea is to delay as much as possible the use of the new anti androgens or chemo. To control the cancer and delay these treatments for one year or more seems pretty impressive to me. The new anti androgens and chemo will eventualy change the cancer to a mutated cancer impossible to stop, to delay using them seems logical to me.

[tango65]

Thanks for posting this article. This is the link to the full article:

pdf.sciencedirectassets.com...

Best of luck.

[GreenStreet]

Thanks for posting. Every little initiative helps and buys some time for some. Do you think that Lu 177 maybe a better option for some?

GreenStreet

[pjoshea13 in reply to GreenStreet]

I can't say if the JH oligo cohort would have fared better or not.

The average number of mets was quite low (2.27). Seems that JH is cautious on who qualifies for oligo therapy.

-Patrick

[j-o-h-n]

oligo = "a little" in Greek... Just practicing what I was taught...

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 08/18/2019 1:48 PM DST

[monte1111 in reply to j-o-h-n]

I thought cohorts were roman. It's all Greek to me.

[pjoshea13 in reply to monte1111]

Ouch! I should have used λόχος στρατού rather than cohort. -P.

[j-o-h-n in reply to monte1111]

This group is all cohorts.... It's Greek to me but Never on a Sunday... OPA!

youtube.com/watch?v=ZAh-RA6...(Not working as expected?)

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/19/2019 4:27 PM DST

[monte1111 in reply to j-o-h-n]

That's just great. I only have paper plates.

[j-o-h-n in reply to monte1111]

hahahahha we burn those....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/19/2019 4:40 PM DST

[paige20180]

Further confirms the reason we left Hopkins. Lots of charts on how long you are going to live.

[j-o-h-n in reply to paige20180]

Charts are for useless business meetings, government bullshit and by people who have too little work to do...... Ignore them.. Your husband will be around for a very very long time.... (based upon my chart).

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/19/2019 4:48 PM DST

[paige20180 in reply to j-o-h-n]

j-o-h-n. Well said! My feelings exactly! You have to have hope. We don’t need charts. We need talent going towards a cure. Hopkins has their Partin tables and now this. It’s all we heard when we were there. Time we had and no ideas. Couldn’t find the door fast enough.

[j-o-h-n in reply to paige20180]

Hopefully you won't have to deal with those type of people/institutions from now on. Greetings to you both, you've come to the right place for information and camaraderie.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/19/2019 5:23 PM DST