Unmet Needs in Oligometastatic Prostate Cancer

Chad Tang, MD, The University of Texas MD Anderson Cancer Center, discusses the unmet needs for patients with oligometastatic prostate cancer.

There have been randomized trials for oligometastatic prostate cancer, including STOMP (NCT01558427) and ORIOLE (NCT02680587), which randomized patients to receive radiation in metastatic patients vs observation. These trials showed that radiation delayed the PSA progression that occurs among this patient population, and radiation by itself, delays the progression.

According to Tang, other trials have also shown that radiation therapy can combine synergistically with hormone therapy. In earlier trials, upfront hormonal therapy for metastatic disease has also resulted in benefits in overall survival when compared with delaying hormone therapy.

Then, the EXTEND trial (NCT03599765) recently evaluated patients with oligometastatic prostate cancer and showed there to be improvements in progression-free survival (PFS) and eugonadal PFS when given the combination of metastasis-directed therapy with intermittent hormone therapy.

However, Tang notes that questions still remain regarding how experts think about oligometastatic prostate cancer, the way it is defined, and how it is treated.

Transcription:

0:10 | I think the biggest unmet need is how we think about oligometastatic prostate cancer. In my opinion, there are 2 ways that you can change therapy with high level evidence. One is to do a randomized control compared with standard of care and number 2 is staging changes. With PSMA PETS and with improved imaging overall, maybe we need to better define, biologically, what oligometastatic prostate cancer is. If that's true, then maybe we should treat them like metastatic prostate cancers to understand these processes a little bit better and find the optimum treatment recommendations for these patients.

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. J Radiat Oncol. 2022;114(5):P1059-1060. doi:10.1016/j.ijrobp.2022.09.006