Fascinating report/study making salient points on the continued need to characterize patients’ neoplasm from a genomic standpoint and the impact of direct management of oligometastatic disease in patients with high-risk mutational signature.
The initial STOMP and ORIOLE trial reports suggested that metastasis-directed therapy (MDT) in oligometastatic castration-sensitive prostate cancer (omCSPC) was associated with improved treatment outcomes. Here, we present long-term outcomes of MDT in omCSPC by pooling STOMP and ORIOLE and assess the ability of a high-risk mutational signature to risk stratify outcomes after MDT. The primary end point was progression-free survival (PFS) calculated using the Kaplan-Meier method. High-risk mutations were defined as pathogenic somatic mutations within ATM, BRCA1/2, Rb1, or TP53. The median follow-up for the whole group was 52.5 months. Median PFS was prolonged with MDT compared with observation (pooled hazard ratio [HR], 0.44; 95% CI, 0.29 to 0.66; P value < .001), with the largest benefit of MDT in patients with a high-risk mutation (HR high-risk: 0.05; HR no high-risk: 0.42; P value for interaction: .12). Within the MDT cohort, the PFS was 13.4 months in those without a high-risk mutation, compared with 7.5 months in those with a high-risk mutation (HR, 0.53; 95% CI, 0.25 to 1.11; P = .09). Long-term outcomes from the only two randomized trials in omCSPC suggest a sustained clinical benefit to MDT over observation. A high-risk mutational signature may help risk stratify treatment outcomes after MDT.
Our radiation oncologists will find this article particularly interesting – more radiation is NOT better.
Pembrolizumab plus olaparib did not significantly improve radiographic progression-free survival or overall survival versus new generation hormonal agent and was more toxic.
Combination PARP with androgen blocker, regardless of HRR gene alterations showed benefit vs. androgen blocker alone.
High burden prostate cancer patients benefit form androgen deprivation and Taxotere combination.
Large phase III study showing short-term ADT + EBRT did not show an improvement in OS compared to EBRT alone. There was an improvement in PSA failure, metastasis rates and prostate cancer-related deaths. If used, SADT+EBRT should be highly individualized, preferably in patients with longer life expectancies and higher SE risk tolerance.
FCS Hematology Oncology Review creates a platform for our physician network to observe the most recent articles and studies available in the oncology and hematology world. By sharing these articles we are building our wealth of knowledge of new observations and treatments as they come available.
