Phase 2 EXTEND randomised trial finds adding metastasis directed therapy with radiation to intermittent hormone therapy improves outcomes.

[Graham49]

Howard Sandler, MD, Chair of the Department of Radiation Oncology at Cedars-Sinai in Los Angeles, California, and president-elect of ASTRO, noted that the current study shows a substantial delay in time to progression with MDT. “I was surprised pleasantly with the magnitude of the effect,” Dr Sandler said. “Delaying progression is clinically meaningful to prostate cancer patients since progression leads to more hormone therapy or other impacts of cancer dissemination.”This type of study is highly valued because it is randomized, but more research is warranted. “In this exact space, it would be nice to see patient reported QOL outcomes to confirm that QOL was improved with MDT,” he said. “Also, more information on the immune system impact by MDT would be interesting regarding the potential mechanism of action of MDT in delaying progression.”

Reference

Tang C, Sherry AD, Haymaker C, et al. Addition of metastasis-directed therapy to intermittent hormone therapy for oligometastatic prostate cancer (EXTEND): A multicenter, randomized phase II trial. Presented at: ASTRO 2022 Annual Meeting, October 23-26, San Antonio, Texas. Abstract LBA 05.

[cesces]

In the past Tall_Allen has indicated that the weight of the peer reviewed evidence out there is contrary to this research.

Where is the weight of the evidence today?

[tango65 in reply to cesces]

There is not evidence direct treatment of mets in oligometastatic patients prolongs life, but there is evidence of a better radiography progression free survival or prolonged time to ADT, similar to the evidence reported in the study posted.

jamanetwork.com/journals/ja...

pubmed.ncbi.nlm.nih.gov/325...

pubmed.ncbi.nlm.nih.gov/292...

Direct treatment of metastases in oligometastatic patients is being done in centers of excellence all over the world.

I recently got mine done at UCLA. This treatment was also recommended by MOs at UCSF and by a MO at the Sloan Kettering Cancer Center in NY.

[cesces in reply to tango65]

Thanks

[tango65 in reply to cesces]

Best of luck.

[Graham49 in reply to cesces]

Evidence has been slow coming. Maybe this is because theres a lack of Big Pharma money to pay for trials. The Extend trial was funded by the Cancer Prevention and Research Institute of Texas, the National Cancer Institute of the National Institutes of Health, and the Andrew Sabin Family Fellowship

[Wife32 in reply to tango65]

The doctors at Mayo, Cleveland Clinic, and MD Anderson also agree with your doctors at UCSF and Sloan. They strongly feel that MDT is the proper treatment for oligometastatic disease in many cases, including my husband. New data continues to emerge so it’s extremely important to rely on a team at a reputable cancer center!

Best of luck.