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Podcast - Amar U. Kishan, MD@AmarUKishan @UCLA @DrSpratticus #GURadiotherapy #ProstateCancer #Cancer #Research Individual Patient Data Meta-Analysis of Randomized Trials in Cancer of the...
0:07:53

Podcast - Amar U. Kishan, MD@AmarUKishan @UCLA @DrSpratti...

Amar U. Kishan, MD, Associate Professor, is the Vice Chair of Clinical and Translational Research and Chief of the Genitourinary Oncology Service for the Department of Radiation Oncology at the David Geffen School of Medicine at UCLA and the UCLA Jonsson Comprehensive Cancer Center speaks about the ASTRO 2021 Abstract Individual Patient Data Meta-Analysis of Randomized Trials in Cancer of the Prostate (MARCAP) Consortium.

Link to Abstract:
https://plan.core-apps.com/myastroapp2021/abstract/3a92a692-4d67-4c3e-8090-17b848cb1ee5

Body:

Purpose/Objective(s):

To analyze the impact of androgen deprivation therapy (ADT) use and duration with definitive radiotherapy (RT) in localized prostate cancer in the first global individual patient data (IPD) meta-analysis of randomized trials.

Materials/Methods:

International trial groups (NRG/RTOG, EORTC, TROG, DART/GICOR, and ICORG) founded the MARCAP Consortium. For three pre-specified meta-analyses, IPD for 10,131 patients enrolled across 11 RT trials was available: addition of ADT to RT (5 trials; n=4736), addition of long-term adjuvant ADT (12-30 months) to short-term ADT (4 trials; n=3674), and addition of longer neoadjuvant ADT (3-7 months) to short-term ADT (3 trials; n=2213). Overall survival (OS) was the primary endpoint in all meta-analyses, with metastasis-free survival (MFS) as a secondary endpoint. Interaction experiments were performed between treatment and dose-escalated RT (74 Gy in 2 Gy halves).

Results:

The addition of ADT to RT improved 12-year OS (absolute 7.2 percent, HR 0.87, 95 percent CI 0.8-0.95) and 12-year MFS after a median follow-up of 12.0 years (absolute 8.3 percent, HR 0.85, 95 percent CI 0.79-0.92). Prolongation of adjuvant ADT increased 12-year OS (absolute 6.3 percent, HR 0.86, 95 percent CI 0.78-0.94) and 12-year MFS after a median follow-up of 10.9 years (absolute 6.3 percent, HR 0.83, 95 percent CI 0.77-0.90). Prolongation of neoadjuvant ADT was not linked with a meaningful benefit in any endpoint after a median follow-up of 10.3 years (MFS HR 0.95, 95 percent CI 0.83-1.09; OS HR 0.94, 95 percent CI 0.82-1.09). On subgroup analysis, there was no evidence of a treatment effect interaction (OS p-interaction 0.59) or adjuvant ADT prolongation between RT dose and ADT use (OS p-interaction 0.59). (OS p-interaction 0.13). Adjuvant ADT prolongation enhanced OS considerably in the case of dose-escalated RT (HR 0.70, 95 percent CI 0.53-0.92).

Conclusion:

This study provides the greatest evidence to date to support the use of ADT in localized prostate cancer, as well as the extension of adjuvant ADT to at least 18 months in conjunction with definitive RT. Regardless of RT dose-escalation, the relative advantage of ADT usage and adjuvant ADT extension was consistent. Prolonging neoadjuvant ADT beyond 2 months, on the other hand, did not improve survival results and should not be used frequently.

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1 year Ago
Cancer News
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Prostate

The Importance of Prostate Cancer Screening - 2022 Program: Testing and Early Diagnosis
0:03:24
The Importance of Prostate Cancer Screening - 2022 Progra...
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2 months Ago
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Resources and Tools: Part 7 - High Quality Decisions in Prostate Cancer with Dr. Kwon
0:14:51
Resources and Tools: Part 7 - High Quality Decisions in P...
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2 months Ago
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Personal Preferences: Part 6 - High-Quality Decisions in Prostate Cancer with Dr. Kwon
0:07:40
Personal Preferences: Part 6 - High-Quality Decisions in ...
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2 months Ago
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Starting Hormone Treatment Later: Part 4 - High Quality Decisions in Prostate Cancer with Dr. Kwon
0:09:42
Starting Hormone Treatment Later: Part 4 - High Quality D...
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2 months Ago
Cancer
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Starting Hormone Treatment Immediately: Part 5, High-Quality Decisions - Prostate Cancer, Dr. Kwon
0:05:00
Starting Hormone Treatment Immediately: Part 5, High-Qual...
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2 months Ago
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Treatment Options: Part 3 - High Quality Decisions in Prostate Cancer with Dr. Kwon
0:08:45
Treatment Options: Part 3 - High Quality Decisions in Pro...
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2 months Ago
Cancer
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MIRAGE Trial Phase 3: CT / MRI SBRT Which is Better? [2022]
MIRAGE Trial Phase 3: CT / MRI SBRT Which is Better? [2022]
64 Views
4 months Ago
UCLA Health
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MIRAGE Trial Phase 3: CT / MRI SBRT Which is Better? [2022]
0:15:13
MIRAGE Trial Phase 3: CT / MRI SBRT Which is Better? [2022]
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4 months Ago
UCLA Health
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Cribriform CAP Intraductal Carcinoma Prostate [2022]
Cribriform CAP Intraductal Carcinoma Prostate [2022]
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4 months Ago
ASTRO
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Cribriform CAP Intraductal Carcinoma Prostate [2022]
0:11:46
Cribriform CAP Intraductal Carcinoma Prostate [2022]
142 Views
5 months Ago
ASTRO
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DASL-HiCaP Phase 3 Trial [2022]: Update David Wise MD
0:11:36
DASL-HiCaP Phase 3 Trial [2022]: Update David Wise MD
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6 months Ago
NYU Langone
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Lutetium-177–PSMA-617 [2022]: Update David Wise MD
0:14:33
Lutetium-177–PSMA-617 [2022]: Update David Wise MD
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6 months Ago
NYU Langone
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