However, the difference in side effects was highlighted by 1 of the study authors, the principal investigator of the United Kingdom portion of the trial. "Although intermittent ADT appears to provide an overall quality-of-life benefit, as compared with continuous ADT, the difference is not as profound as one might expect," the authors comment in the paper. 006), and showed a trend toward improvement in the level of fatigue ( P =. For symptoms, however, the difference between the 2 groups was greater, and the intermittent group had significantly better scores for hot flashes ( P <. In the quality-of-life assessments, the scores for functional domains were slightly better in the intermittent groups compared with the continuous group, but not significantly so. The median overall survival was 8.8 years with intermittent therapy and 9.1 years for continuous therapy, and the statistical analysis found that intermittent therapy was not inferior to continuous therapy. The authors note that the cost of drugs in the intermittent group was about one-third that in the continuous group, but was offset to some extent by the closer monitoring that was required. ADT was composed of a luteinizing hormone-releasing hormone agonist (LHRHa) combined with a nonsteroidal antiandrogen. They were randomized to receive ADT continuously or intermittently (in 8-month cycles). The trial was conducted in 1386 men with rising PSA levels more than a year after receiving radiation for localized prostate cancer. The new paper, authored by Juanita Crook, MD, from the British Columbia Cancer Agency, in Kelowna, Canada, and colleagues, reports results from a median follow-up of 6.9 years. "This question bedevils our field, and we are no closer to an answer now than we were before." "Does early ADT in asymptomatic men with rising PSA levels provide more benefit than treatment in symptomatic men with metastases?" he writes. There are, however, many questions about ADT administration and its timing that remain unanswered, comments Oliver Sartor MD, from Tulane University School of Medicine, in New Orleans, Louisiana, in an editorial published in the New England Journal of Medicine. Those study authors concluded that continuous ADT should remain the standard of care in this patient population. These findings contrast with the results reported earlier this year from a trial in men with metastatic prostate cancer (the SWOG 9346 study), which showed that continuous ADT was superior to intermittent administration in terms of overall survival. One of the study authors suggested that intermittent ADT should become a standard of care in this patient population, as it reduces side effects without reducing survival. The results show that overall survival was similar for continuous and intermittent ADT, although some of the quality-of-life factors favored intermittent administration. The patients in this study, the Southwest Oncology Group (SWOG) JPR 7 trial, were men with localized prostate cancer treated with radiation (either primary or salvage) who had then developed raised levels of prostate-specific antigen (PSA > 3 ng/mL) a year or more later. Results just published in the September 6 issue of the New England Journal of Medicine show that, in earlier disease, there is little difference between the 2 administration schedules. This answer appears to depend on the specific patient population. SeptemA big question in the treatment of prostate cancer is whether to give androgen deprivation therapy (ADT) continuously, or whether there can be breaks in the treatment without detriment to the outcome.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |