Τετάρτη, 25 Νοεμβρίου 2015

NON INFERIORITY OF INTERMITTENT ADT FOR PROSTATE CANCER

In a meta-analysis reported in JAMA Oncology, Magnan et al found that intermittent androgen-deprivation therapy was noninferior to continuous androgen-deprivation therapy with respect to overall survival in patients with prostate cancer.
Study Details
A literature review identified 22 articles from 15 randomized trials comparing intermittent and continuous androgen-deprivation therapy in a total of 6,856 patients between 2000 and 2013. Disease stage was locally advanced in one trial, recurrent following primary radical therapy in two trials, metastatic hormone-sensitive in six trials, metastatic castration-resistant in one trial, mixed in trials, and unspecified in one trial. A noninferiority analysis was conducted for overall survival, with a margin of 1.15 for the hazard ratio (HR) upper boundary.
Survival Outcomes
There was no significant difference between intermittent and continuous androgen-deprivation therapy in overall survival (HR = 1.02, 95% confidence interval [CI] = 0.93–1.11; 8 trials, 5,352 patients), cancer-specific survival (HR = 1.02, 95% CI = 0.87–1.19; 5 trials, 3,613 patients), or progression-free survival (HR = 0.94, 95% CI = 0.84–1.05; 4 trials, 1,774 patients).
Quality of Life
Quality-of-life assessment in 12 trials showed that overall quality of life was better with intermittent androgen-deprivation therapy in two trials and did not differ between intermittent and continuous androgen-deprivation therapy in three trials. In the remaining seven trials, intermittent androgen-deprivation therapy was associated with improvement in some quality-of-life domains, with continuous androgen-deprivation therapy also being associated with improvement in some domains in three of the seven trials. Most trials indicated an improvement in physical and sexual functioning with intermittent androgen-deprivation therapy.
The investigators concluded: “Intermittent androgen deprivation was not inferior to continuous therapy with respect to overall survival. Some quality-of-life criteria seemed improved with intermittent therapy. Intermittent androgen deprivation can be considered as an alternative option in patients with recurrent or metastatic prostate cancer.”
The study was supported by the Fonds de Recherche du Québec-Santé.
Sindy Magnan, MD, MSc, FRCPC, of CHU [Centre Hospitalier Universitaire] de Québec, Québec City, Canada, is the corresponding author of the JAMA Oncology article. 

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