A Cedars-Sinai cancer study indicates improved survival following a combination of hormone therapy and pelvic lymph node treatment
A combination of androgen deprivation therapy—a common hormone injection—and pelvic lymph node radiotherapy prevented prostate cancer from therapy in nearly 90% of clinical trial participants for five years, according to a ground-breaking study from Cedars-Sinai Cancer. The results were recently published in the peer-reviewed journal The Lancet.
The research also demonstrates that individuals with prostate cancer who did not get pelvic lymph node radiotherapy or androgen restriction treatment had a five-year survival rate of 70%.
“We can now confirm that pelvic lymph node treatment used together with androgen deprivation therapy, or even used as a stand-alone treatment option, greatly improves outcomes in patients with postoperative prostate cancer,” said Howard Sandler, MD, chair of the Department of Radiation Oncology at Cedars-Sinai Cancer and senior author of the study. “These findings are an encouraging step forward, both for the medical community and for the patients and their loved ones seeking curative treatment options.”
Between March 31, 2008, and March 30, 2015, 1,716 participants were recruited in the global Phase III clinical trial that formed the basis of The Lancet research. Three groups of participants were created.
Salvage prostate bed radiotherapy was administered to Group 1; this kind of radiation is often directed towards the prostate’s former location before it was surgically removed. The median five-year survival rate for these individuals was 71%.
The second group underwent androgen deprivation therapy in addition to the conventional radiation therapy. They had an 81% median five-year survival rate.
The third group received salvage prostate bed radiotherapy, androgen deprivation therapy, and pelvic lymph node radiation. These patients had a five-year freedom from progression of just over 87%.
Benefits of Combined Treatment Approach
“The combined treatment approach proved to be the most beneficial approach,” said Sandler, also the Ronald H. Bloom Family Chair in Cancer Therapeutics and professor of Radiation Oncology at Cedars-Sinai.
Prostate cancer is the most common non-skin cancer in the U.S., affecting 1 in every 6 to 7 men. While there are rarely early warning signs of the disease, there is a robust screening test that can catch the disease in its earliest stages. Diagnosis usually accompanies an elevated level of PSA, an acronym for prostate-specific antigen.
Many men diagnosed with prostate cancer will undergo a prostatectomy—the surgical removal of the prostate. After surgery, a man’s PSA level should be near zero. However, some men start to see their PSA levels rise several years after surgery. This is typically an indication that radiation therapy is needed.
Early Intervention and the Importance of Combination Therapy
Sandler says men with postoperative prostate cancer can have excellent outcomes, especially if radiation is given early—when PSA levels are at their lowest—and in combination with proven therapies, as suggested in this new research.
“Improving and extending lives is at the heart of all we do at Cedars-Sinai Cancer,” said Dan Theodorescu, MD, Ph.D., director of Cedars-Sinai Cancer, the PHASE ONE Foundation Distinguished Chair, and professor of Surgery and Pathology and Laboratory Medicine. “These pivotal clinical findings exemplify our mission while showcasing how ideas spur leading-edge research and treatment innovations.”
This study was funded by grants U10CA180868 (NRG Oncology Operations), U10CA180822 (NRG Oncology Statistical and Data Management Center), UG1CA189867 (NCORP), and U24CA180803 (Imaging and Radiation Oncology Core).
Reference: “The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT): an international, multicentre, randomised phase 3 trial” by Professor Alan Pollack, MD; Professor Theodore G Karrison, Ph.D; Alexander G Balogh, MD; Professor Leonard G Gomella, MD; Professor Daniel A Low, Ph.D; Professor Deborah W Bruner, Ph.D; Jeffrey S Wefel, Ph.D; Professor Andre-Guy Martin, MD; Professor Jeff M Michalski, MD; Steve J Angyalfi, MD; Professor Himanshu Lukka, MBChB/ Sergio L Faria, MD; Professor George B Rodrigues, MD; Marie-Claude Beauchemin, MD; R Jeffrey Lee, MD; Samantha A Seaward, MD; Professor Aaron M Allen, MD; Drew C Monitto, MD; Wendy Seiferheld, MS; Professor Oliver Sartor, MD; Prof Felix Feng, MD and Professor Howard M Sandler, MD, 14 May 2022, The Lancet.
DOI: 10.1016/S0140-6736(21)01790-6
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