ESMO 2022: Adding Hormonal Therapy to the Treatment Mix in Biochemically Relapsed Prostate Cancer

By: Celeste L. Dixon
Posted: Monday, September 26, 2022

Intensifying androgen-deprivation therapy (ADT) by adding the androgen receptor agonist apalutamide for a finite period may be of benefit for patients with high-risk biochemically relapsed prostate cancer to prolong biochemical progression-free survival, according to Rahul Aggarwal, MD, of the University of California, San Francisco, and colleagues. The team presented the results of the randomized, phase III PRESTO trial—reportedly the first to evaluate this treatment strategy in this population—during the European Society for Medical Oncology (ESMO) Congress 2022 (Abstract LBA63).

“Patients with a fast-rising PSA after prior surgery to treat their prostate cancer are at high risk for the development of distant metastasis,” said Dr. Aggarwal in a press release. Follow-up for analysis of quality of life, metastasis-free survival, and time to castration resistance is ongoing.

PRESTO enrolled 504 patients with high-risk biochemically relapsed prostate cancer. Patients in the control arm received ADT alone with intensified treatment adding apalutamide or apalutamide and abiraterone acetate plus prednisone for up to 52 weeks. The primary endpoint was prostate-specific antigen (PSA) progression-free survival for both apalutamide and apalutamide with abiraterone acetate plus prednisone. A significant improvement in this endpoint over ADT alone was shown (median 24.9 vs. 20.3 months, hazard ratio [HR] = 0.52, 1-sided P value = .00047; and median 26.0 vs. 20.0 months, HR = 0.48, 1-sided P value = .00008, respectively). Testosterone recovery was similar across the three treatment arms.

Grade 2 or higher adverse effects were similar among arms except for higher hypertension with the addition of abiraterone acetate plus prednisone. In addition, eight patients (1.8%) across all treatment arms stopped treatment because of adverse events.

Disclosure: The study authors’ disclosure information can be found at oncologypro.esmo.org.

ESMO Congress 2022

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