Prostate radiotherapy in the era of intensified systemic treatment of metastatic prostate cancer
Mené sur 1 172 patients atteints d'un cancer de la prostate métastatique de novo et sensible à la castration (durée médiane de suivi : 6 ans), cet essai randomisé européen évalue l'efficacité, du point de vue de la survie sans progression radiographique et de la survie globale, et la sécurité d'une radiothérapie en ajout à la thérapie de privation androgénique avec docétaxel et abiratérone
For men with low-volume de novo metastatic castration-sensitive prostate cancer, radiotherapy to the prostate is a standard of care option due to the significant improvement in overall survival reported in the STAMPEDE trial.1 The HORRAD trial2 similarly investigated prostate radiotherapy in men with bone-only metastatic disease, but did not find a significant improvement in overall survival for patients with up to five bone metastases, likely because the trial overall was underpowered (low numbers in the group of patients with low-volume metastatic disease specifically)was underpowered. The STOPCAP meta-analysis3 of these two trials showed a significant advantage from prostate radiotherapy of 7% in overall survival at 3 years among the cohort of patients with low-volume disease. Patients in the STAMPEDE and HORRAD trials received continuous androgen-deprivation therapy, but docetaxel was also given to 367 (18%) patients in the STAMPEDE trial. Multiple trials have shown a benefit to overall survival with androgen receptor pathway inhibitors in a de novo metastatic setting.4,5 Therefore, it is unknown whether prostate radiotherapy provides a benefit to overall survival in the context of intensified systemic treatment of de novo metastatic prostate cancer.
The Lancet , commentaire, 2023