Tuesday’s news update: December 23, 2008

Today’s news items deal with timing of hormone therapy for men with lymph node-positive prostate cancer, the impact of adjuvant LHRH agonist therapy on cardiovascular mortality in men receiving radiotherapy for locally advanced prostate cancer, and the status of the epothilones in treatment of metastatic prostate cancer.

First and foremost, yet another (retrospective) analysis has questioned the value of the early use of hormone therapy. Using data from the SEER database, Wong et al. investigated the use of adjuvant androgen deprivation therapy (ADT) for patients with node-positive prostate cancer in the prostate-specific antigen (PSA) era. They identified 731 patients treated with radical prostatectomy (RP) between 1991 and 1999 and who had positive regional lymph nodes. Men were classified as receiving adjuvant ADT if they received ADT within 120 days of RP, and we compared them to the men who had not received adjuvant ADT. A total 209/731 men received ADT within 120 days of RP. There was no statistically significant difference in overall survival between the adjuvant ADT and non-ADT groups. There were also no statistically significant survival differences withwhen other times periods (90, 150, 180, and 365 days) were used as the criterion of length of time to initiation of ADT to define adjuvant ADT. Wong et al conclude that deferring immediate ADT in men with positive lymph nodes after RP may not significantly compromise survival. However, they add that these results should be validated in a prospective fashion in a similar patient population.

Secondly, based on an analysis of data from the RTOG 85-31 trial, which enrolled 945 patients between 1989 and 1992, Efstathiou et al. have demonstrated that there appears to be no increase in cardiovascular mortality in men treated with radiation therapy + LHRH therapy as compared to men receiving radiation therapy alone alone. In RTOG 85-31, patuients with locally advanced prostate cancer (clinical stage T2b-T3 disease) were randomized to receive external beam radiotherapy (EBRT) alone or EBRT + goserelin acetate. Since this study has previously shown an overall survival benefit for men receiving hormone therapy in combination with EBRT, it is not suprising to find that the addition of hormone therapy had no impact on survival. Indeed at 9 years of follow-up the authors state that “cardiovascular mortality for men receiving adjuvant goserelin was 8.4% v 11.4% for men treated without adjuvant goserelin.”

Lee and Kelly have reviewed available data on the potential of epothilones (a new class of drugs that have properties similar to the taxanes) in the treatment of advanced prostate cancer. As yet there are limited data on the use of these drugs for prostate cancer, but some of it does show promise. In particular, two agents (ixabepilone and patupilone) have shown potential in the treatment of men who became resitant to prior taxane therapy.

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