Multi-Drug Combo May Be Best Against Prostate Cancer...I thought it was a known fact already!

[Maxone73]

"Combining two or three testosterone-blocking drugs prevents the spread of prostate cancer better than just a single medication, a new clinical trial has found." Dr Aggrawal again!

usnews.com/news/health-news...

[Purple-Bike]

Most interesting, although I find it confusing that the improvement in hazard ratio is very significant at 0.48/0.52 for the combo which to me is contradictory to the in my eyes apparently limited improvement in progression-free survival 25 vs 20 months. Should the combo be regarded as a major improvement or not compared to ADT only? But the authors say the 24.9 vs 20.3 months is significant so I suppose it is so...... and that it´s my lack of statistical knowledge that is the cause for me finding the latter not significant.

Patients were randomly assigned 1:1:1 to receive a finite 52-week treatment course with ADT control, ADT + apalutamide, or ADT + apalutamide + AAP. The primary end point was PSA progression-free survival (PSA-PFS), defined as serum PSA >0.2 ng/mL after treatment completion.

Results

Five hundred three patients were enrolled. The median PSA was 1.8 ng/mL (IQR, 1.0-3.6). At the first planned interim analysis, both experimental arms significantly prolonged PSA-PFS compared with the control arm (median, 24.9 months for ADT + apalutamide v 20.3 months for ADT; hazard ratio [HR], 0.52 [95% CI, 0.35 to 0.77]; P = .00047; median, 26.0 months for ADT + apalutamide + AAP v 20.0 months for ADT; HR, 0.48 [95% CI, 0.32 to 0.71]; P = .00008). Median time to testosterone recovery did not differ across treatment arms. The most common grade ≥3 adverse event was hypertension (7.5%, 7.4%, and 18% in ADT, ADT + apalutamide, and ADT + apalutamide + AAP arms, respectively).

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“Progression-free survival” (PFS) is a measure of the length of time during and after treatment that a patient lives with a disease without it getting worse 1. It is often used as an endpoint in clinical trials to evaluate the effectiveness of a treatment.

On the other hand, “hazard ratio” (HR) is a statistical measure that compares the risk of an event occurring in one group to the risk of the same event occurring in another group 1. In the context of clinical trials, HR is used to compare the risk of disease progression or death between two groups of patients receiving different treatments 1.

In summary, PFS measures the length of time a patient lives with a disease without it getting worse, while HR is a statistical measure that compares the risk of an event occurring in one group to the risk of the same event occurring in another group.

[Maxone73 in reply to Purple-Bike]

Well, from the point of view of a researcher (even if it's frustrating for us patients to hear it) 25 months means an extra 25% from 20, which is significant. An HR of 1 means both groups have the same risk, so 0.48 and 0.52 means almost 50% risk.

But an HR of 0.52 or 0.48 indicates that the experimental groups had about half the risk of reaching the defined endpoint (e.g., progression of disease) at any given time compared to the control group.

So HR compares the hazard rates between two groups, indicating the likelihood of an event happening at any given time. The median time, on the other hand, identifies the middle point in time at which half of the study population has experienced the event. HR gives a relative risk, median time provides a specific time point, offering a direct understanding of how long it takes for an event to occur in the median case.

[KocoPr in reply to Maxone73]

Your hurting my brain Max! Lol

[Maxone73 in reply to KocoPr]

Man, that’s why I am only interested in median duration! And I always put myself in the other 50%

[MoonRocket in reply to Maxone73]

If offer 25 vs 20, who would complain?..I get we all want 120 or more but 25 in the hand is worth 30 in the bush.

[Maxone73 in reply to MoonRocket]

Yup!

[KocoPr in reply to Maxone73]

One never knows what new treatments or trials are coming in the next few years and if you do the medical gauntlet you can probably qualify for those.