The European Society for Medical Oncology (ESMO) has updated its treatment guidelines for prostate cancer on the basis of the new data from the STAMPEDE and HORRAD trials.
Based on new results from the STAMPEDE and HORRAD trials, radiotherapy (RT) is now recommended as an additional treatment option during standard systemic treatment in newly diagnosed metastatic prostate cancer with low tumor load.
The Phase III STAMPEDE trial enrolled approximately 2,000 patients. It showed that radiation therapy in prostate cancer did not improve the overall survival (OS) of the patients. However, the subgroup analysis showed that RT improved OS in patients with low metastatic load (defined according to CHAARTED criteria) from 73% to 81% within three years.
The results of the STAMPEDE trial were confirmed in the HORRAD trial with a total of 432 patients. Here, too, it was shown that there was no OS benefit in unselected patients. A meta-analysis of both trials showed, however, that the additional use of radiotherapy could improve the three-year overall survival of men with < 5 metastases in bone scan by up to 7 %.
Another updated recommendation from ESMO concerns patients with metastatic, castration-resistant prostate cancer. These are not to be treated in the future with the combination of abiraterone acetate plus prednisone/prednisolone and radium-223. The ERA223 study had previously shown that this combination therapy did not improve the survival of patients without skeletal-associated symptoms. Rather, the risk of spontaneous fractures increased statistically significantly.
Source: European Society for Medical Oncology (ESMO). eUpdate - Cancer of the Prostate Treatment Recommendations. (Status: April 2, 2019)