TY  - INPR
N1  - Creative Commons Attribution Non-Commercial No Derivatives 4.0 License: https://creativecommons.org/licenses/by-nc-nd/4.0/
TI  - Sequencing of Androgen-Deprivation Therapy of Short Duration With Radiotherapy for Nonmetastatic Prostate Cancer (SANDSTORM): A Pooled Analysis of 12 Randomized Trials
AV  - public
Y1  - 2022/10/21/
JF  - Journal of Clinical Oncology
A1  - Ma, Ting Martin
A1  - Sun, Yilun
A1  - Malone, Shawn
A1  - Roach, Mack
A1  - Dearnaley, David
A1  - Pisansky, Thomas M
A1  - Feng, Felix Y
A1  - Sandler, Howard M
A1  - Efstathiou, Jason A
A1  - Syndikus, Isabel
A1  - Hall, Emma C
A1  - Tree, Alison C
A1  - Sydes, Matthew R
A1  - Cruickshank, Claire
A1  - Roy, Soumyajit
A1  - Bolla, Michel
A1  - Maingon, Philippe
A1  - De Reijke, Theo
A1  - Nabid, Abdenour
A1  - Carrier, Nathalie
A1  - Souhami, Luis
A1  - Zapatero, Almudena
A1  - Guerrero, Araceli
A1  - Alvarez, Ana
A1  - Gonzalez San-Segundo, Carmen
A1  - Maldonado, Xavier
A1  - Romero, Tahmineh
A1  - Steinberg, Michael L
A1  - Valle, Luca F
A1  - Rettig, Matthew B
A1  - Nickols, Nicholas G
A1  - Shoag, Jonathan E
A1  - Reiter, Robert E
A1  - Zaorsky, Nicholas G
A1  - Jia, Angela Y
A1  - Garcia, Jorge A
A1  - Spratt, Daniel E
A1  - Kishan, Amar U
A1  - Meta-Analysis of Randomized Trials in Cancer of the Prostate (MA
ID  - discovery10157968
N2  - PURPOSE: The sequencing of androgen-deprivation therapy (ADT) with radiotherapy (RT) may affect outcomes for prostate cancer in an RT-field size-dependent manner. Herein, we investigate the impact of ADT sequencing for men receiving ADT with prostate-only RT (PORT) or whole-pelvis RT (WPRT). MATERIALS AND METHODS: Individual patient data from 12 randomized trials that included patients receiving neoadjuvant/concurrent or concurrent/adjuvant short-term ADT (4-6 months) with RT for localized disease were obtained from the Meta-Analysis of Randomized trials in Cancer of the Prostate consortium. Inverse probability of treatment weighting (IPTW) was performed with propensity scores derived from age, initial prostate-specific antigen, Gleason score, T stage, RT dose, and mid-trial enrollment year. Metastasis-free survival (primary end point) and overall survival (OS) were assessed by IPTW-adjusted Cox regression models, analyzed independently for men receiving PORT versus WPRT. IPTW-adjusted Fine and Gray competing risk models were built to evaluate distant metastasis (DM) and prostate cancer-specific mortality. RESULTS: Overall, 7,409 patients were included (6,325 neoadjuvant/concurrent and 1,084 concurrent/adjuvant) with a median follow-up of 10.2 years (interquartile range, 7.2-14.9 years). A significant interaction between ADT sequencing and RT field size was observed for all end points (P interaction < .02 for all) except OS. With PORT (n = 4,355), compared with neoadjuvant/concurrent ADT, concurrent/adjuvant ADT was associated with improved metastasis-free survival (10-year benefit 8.0%, hazard ratio [HR], 0.65; 95% CI, 0.54 to 0.79; P < .0001), DM (subdistribution HR, 0.52; 95% CI, 0.33 to 0.82; P = .0046), prostate cancer-specific mortality (subdistribution HR, 0.30; 95% CI, 0.16 to 0.54; P < .0001), and OS (HR, 0.69; 95% CI, 0.57 to 0.83; P = .0001). However, in patients receiving WPRT (n = 3,049), no significant difference in any end point was observed in regard to ADT sequencing except for worse DM (HR, 1.57; 95% CI, 1.20 to 2.05; P = .0009) with concurrent/adjuvant ADT. CONCLUSION: ADT sequencing exhibits a significant impact on clinical outcomes with a significant interaction with field size. Concurrent/adjuvant ADT should be the standard of care where short-term ADT is indicated in combination with PORT.
SN  - 0732-183X
PB  - American Society of Clinical Oncology (ASCO)
UR  - https://doi.org/10.1200/JCO.22.00970
ER  -