ASCO20: Radical Prostatectomy After ADT for High-Risk Prostate Cancer
Posted: Saturday, June 13, 2020
According to research presented during the ASCO20 Virtual Scientific Program (Abstract 5503), a significant number of patients with high-risk prostate cancer who received intense androgen-deprivation therapy (ADT) prior to radical prostatectomy achieved “favorable pathologic responses”. These responses were was defined as having residual tumors < 5 mm. However, “follow-up is necessary to evaluate the significance of a pathologic response on recurrence rates,” noted Rana R. McKay, MD, of the Dana-Farber Cancer Institute, Boston, and colleagues.
The multicenter, phase II trial was conducted across 4 sites with 118 patients. These study participants had a Gleason score of at least 7, with either prostate-specific antigen (PSA) levels higher than 20 ng/mL or T3 disease, and lymph nodes smaller than 20 mm. The majority of patients (n = 111) had high-risk disease. Participants were randomly assigned to receive either abiraterone acetate/prednisone/apalutamide/leuprolide or abiraterone acetate/prednisone/leuprolide for six cycles prior to radical prostatectomy.
A total of 114 patients (97%) completed all cycles plus radical prostatectomy. The apalutamide arm experienced a lower median PSA nadir and quicker time to such nadir was < 0.01 ng/mL and 4.2 months vs. 0.02 ng/mL and 4.6 months in the other arm. Patients in both arms achieved similar pathologic responses. The pathologic complete response/minimal residual disease rate was 20.3% with apalutamide versus 21.8% without (P = .85).
A total of 13 patients (11%; 8 in the apalutamide arm) experienced grade 3 treatment-related adverse events. The most common adverse events were hypertension (5%), elevated aspartate aminotransferase levels (3%), and elevated alanine aminotransferase levels (3%).
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
