Adding long-term androgen deprivation therapy (ADT) to post-operative radiotherapy improves metastases-free survival (MFS) compared with short-term ADT in patients with non-metastatic prostate cancer, results from the RADICALS-HD trial showed. However, most patients with short-term ADT also did well.
Current key questions for treating patients with non-metastatic prostate cancer treated with radiotherapy (with or without radical prostatectomy) are: ‘Who should receive ADT added to radiotherapy?’ and ‘What is the optimum duration of ADT?’ stated Prof. Chris Parker (The Royal Marsden Hospital, UK) presented the results. The RADICALS-HD trial (ISRCTN40814031) assessed the use and duration of ADT with post-operative radiotherapy [1,2].
The trial enrolled nearly 3,000 patients who had undergone postoperative radiotherapy (adjuvant or early salvage). 1,480 of these participants were randomised 1:1 to receive short-term (6 months) versus no ADT and 1,523 participants were randomised 1:1 to receive short-term versus long-term ADT (24 months). The participants’ characteristics within the two parts of the trial were well balanced, however, participants in the ‘none versus short-term’ ADT part had less aggressive disease than those selected for the “short- versus long-term’ ADT part. The median follow-up was 9 years in both parts. The primary outcome was metastasis-free survival (MFS). Secondary outcomes included time to salvage ADT and overall survival (OS).
In the ‘none versus short-term’ ADT part, 6 months of ADT did not improve MFS (80% vs 79% at 10 years; HR 0.86; P=0.35;) but delayed time to salvage ADT (HR 0.54; 95% CI 0.42–0.70). In the ‘short- versus long-term’ ADT part, 24 months of ADT improved MFS compared to 6 months of ADT (78% vs 72% at 10-years; HR 0.77; P=0.03;) and delayed time to salvage ADT (HR 0.73; 95% CI 0.59–0.91). There was no interaction between the treatment effect and either the baseline prostate-specific antigen (PSA) or comorbidity score. OS data were not yet mature in either part of the trial.
“When added to post-operative radiotherapy for prostate cancer, long-term ADT improved MFS and improved time to salvage ADT, compared with short-term ADT. Short-term ADT did not improve MFS, but delayed time to salvage ADT, compared with no ADT. The effect size appeared consistent across all pre-specified subgroups,” summarised Dr Parker. Of note, the RADICALS-HD trial started 15 years ago and the management of patients has changed since then.
- Parker CC, et al. Clin Oncol (R Coll Radiol). 2022;34(9):593–597.
- Parker CC, et al. Duration of androgen deprivation therapy (ADT) with post-operative radiotherapy (RT) for prostate cancer: First results of the RADICALS-HD trial (ISRCTN40814031). Abstract LBA9, ESMO Congress 2022, 09–13 September, Paris, France.
Copyright ©2022 Medicom Medical Publishers
« Intensified ADT benefits biochemical progression-free survival in biochemically relapsed prostate cancer Next Article
Overall survival benefit of abiraterone in mHSPC is maintained for 7 years »
Table of Contents: ESMO 2022
Letter from the Editor
High pathological responses to neoadjuvant immune checkpoint inhibition in locally advanced dMMR colon cancer
Fruquintinib: a potential new treatment for patients with refractory mCRC
Second-line avelumab is effective in patients with MSI-H/dMMR mCRC
Upper Gastrointestinal Cancer
Deep learning models predict the risk of relapse and the mutational profile in GIST
Addition of pembrolizumab to lenvatinib does not improve OS in advanced HCC
New, highly selective inhibitor of FGFR2 driver alterations and resistance mutations
Chemo-immunotherapy in gastric cancer is more effective when administered in parallel
Tumour infiltrating lymphocytes identify patients with immunogenic triple-negative breast cancer
OS benefit of abemaciclib in HR-positive/HER2-negative advanced breast cancer not (yet) statistically significant
OS benefit of sacituzumab govitecan in pre-treated HR-positive/HER2-negative metastatic breast cancer
A pathway from air pollution to lung cancer in non-smokers identified
Selective KRASG12C inhibitor sotorasib demonstrates superior PFS and ORR compared to docetaxel in previously treated patients with NSCLC
Promising clinical activity of tepotinib plus osimertinib in NSCLC with MET amplification after progression on first-line osimertinib
High pathological responses in borderline resectable NSCLC patients after induction with dual immunotherapy and concurrent chemoradiotherapy
Treatment with tumour-infiltrating lymphocytes for advanced melanoma outperforms ipilimumab
Neoadjuvant pembrolizumab outperforms adjuvant pembrolizumab in resectable stage III–IV melanomas
Survival-benefit of neoadjuvant T-VEC maintained over 5 years of follow-up
Baseline ctDNA predicts survival in resected stage III–IV melanoma
Genitourinary Cancer – Prostate Cancer
Overall survival benefit of abiraterone in mHSPC is maintained for 7 years
Limited benefit of adding long-term ADT to post-operative radiotherapy in prostate cancer
Intensified ADT benefits biochemical progression-free survival in biochemically relapsed prostate cancer
Genitourinary Cancer – Non-Prostate Cancer
Adjuvant nivolumab plus ipilimumab does not improve survival in patients with localised RCC at high risk of relapse after nephrectomy
Triple therapy improves progression-free survival in patients with advanced RCC versus dual therapy
Adjuvant atezolizumab does not improve outcomes for patients with RCC and increased risk of recurrence
OS benefit for advanced ovarian cancer patients treated with maintenance olaparib
Maintenance tegafur-uracil does not improve survival in locally advanced cervical cancer
Head and Neck Cancer
Adding first-line pembrolizumab to CRT in locally advanced HNSCC does not significantly prolong survival or event-free survival
5-FU-free chemotherapy combination as an alternative for first-line treatment of recurrent or metastatic HNSCC
Epstein Barr virus-specific autologous cytotoxic T lymphocytes do not improve survival in nasopharyngeal carcinoma