BACKGROUND:Patients who develop castration-resistant prostate cancer (CRPCa) typically continue on androgen deprivation therapy (ADT).
Whether these patients need to remain on ADT has not been well studied. We conducted a multicenter randomized trial to compare an intermittent versus continuous approach to ADT in CRPCa patients. Overall survival, health-related quality of life (QOL), and cost were the main endpoints.
METHODS:CRPCa patients were randomized 2:1 to intermittent or continuous luteinizing hormone-releasing hormone agonists (LHRHa). Patients were followed with clinical assessments, laboratory investigations, and QOL questionnaires (EORTC QLQ-C30 or PROSQOLI) every 2 months. If the serum testosterone rose above castrate levels (1.75 nmol/L), LHRHa were reinitiated. The study was designed to close if >50% of patients needed to restart ADT in the intermittent arm.
RESULTS:Thirty-one patients were followed with a median follow-up of 26.8 months-18 in the intermittent arm and 13 in the continuous. Twelve of 18 patients on the intermittent arm were reinitiated on LHRHa at a median time of 17.9 months. There was no difference in overall or cancer-specific survival between the 2 arms. There was no statistically significant difference in QOL between the 2 arms at 0 and 12 months. The total mean costs at 24 months were significantly lower in the intermittent arm ($3135 vs. $8253 Canadian dollars, P=0.0167) compared with the continuous. The main limitation of this study is the small sample size.
CONCLUSIONS: We have observed that intermittent ADT in patients with CRPCa, using a testosterone of >1.75 ngmol/L as a trigger to reinitiate LHRHa, results in a substantial cost savings with no negative impact on oncologic and QOL outcomes.
Written by:
Organ M, Wood L, Wilke D, Skedgel C, Cheng T, North S, Thompson K, Winch S, Rendon R. Are you the author?
Departments of Urology, Medicine and Urology, Radiation Oncology, Atlantic Clinical Cancer Research Unit (ACCRU), Capital Health Medicine; Urology, Centre for Clinical Research, Dalhousie University, Halifax, NS; Department of Medical Oncology, University of Calgary, Tom Baker Cancer Center, Calgary; Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada.
Reference: Am J Clin Oncol. 2012 Aug 2. Epub ahead of print.
PubMed Abstract
PMID: 22868247
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