Addition of Metastasis-Directed Therapy to Intermittent Hormone Therapy for Oligometastatic Prostate Cancer

作者：Chad Z. Tang, Alexander Dean Sherry, Cara Haymaker, Tharakeswara Kumar Bathala, Suyu Liu, Bryan M. Fellman, Lorenzo G. Cohen, Ana Maria Aparicio, Amado J. Zurita, Alexandre Reuben, Enrica Marmonti, Stephen G. Chun, Jay Paul Reddy, Amol Jitendra Ghia, Sean Eric McGuire, Eleni Efstathiou, Jennifer Wang, Jianbo Wang, Patrick Glen Pilie, Craig A. Kovitz, Weiliang Du, Samantha J. Simiele, Rachit Kumar, Yerko O. Borghero, Zheng Shi, Brian Francis Chapin, Daniel Richard Gomez, Ignacio Ivan Wistuba, Paul Gettys Corn · 发表于：JAMA Oncology · 年份：2023 · DOI：10.1001/jamaoncol.2023.0161 · 被引用次数：214 · 研究领域：Prostate Cancer Treatment and Research、Prostate Cancer Diagnosis and Treatment、Radiopharmaceutical Chemistry and Applications

Importance: Despite evidence demonstrating an overall survival benefit with up-front hormone therapy in addition to established synergy between hormone therapy and radiation, the addition of metastasis-directed therapy (MDT) to hormone therapy for oligometastatic prostate cancer, to date, has not been evaluated in a randomized clinical trial. Objective: To determine in men with oligometastatic prostate cancer whether the addition of MDT to intermittent hormone therapy improves oncologic outcomes and preserves time with eugonadal testosterone compared with intermittent hormone therapy alone. Design, Setting, Participants: The External Beam Radiation to Eliminate Nominal Metastatic Disease (EXTEND) trial is a phase 2, basket randomized clinical trial for multiple solid tumors testing the addition of MDT to standard-of-care systemic therapy. Men aged 18 years or older with oligometastatic prostate cancer who had 5 or fewer metastases and were treated with hormone therapy for 2 or more months were enrolled to the prostate intermittent hormone therapy basket at multicenter tertiary cancer centers from September 2018 to November 2020. The cutoff date for the primary analysis was January 7, 2022. Interventions: Patients were randomized 1:1 to MDT, consisting of definitive radiation therapy to all sites of disease and intermittent hormone therapy (combined therapy arm; n = 43) or to hormone therapy only (n = 44). A planned break in hormone therapy occurred 6 months after enrollment, ...