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Sandy Srinivas, MD
Sandy Srinivas, MD
Posted: Friday, October 21, 2022
According to an analysis of long-term outcomes from the STOMP and ORIOLE clinical trials, presented in the Journal of Clinical Oncology, metastasis-directed therapy appears to result in sustained improvement in survival outcomes versus observation for patients with metachronous oligometastatic castration-sensitive prostate cancer. The trials evaluated the effect that stereotactic ablative radiation therapy, a metastasis-directed option, may have on androgen-deprivation–free and progression-free survival as well as the potential value of biomarkers, such as high-risk mutations, as prognostic tools.
“Genomic alterations appear to have prognostic value in this patient population, suggesting that biomarkers should be evaluated in future studies to optimize patient selection,” concluded Phuoc T. Tran, MD, PhD, of Johns Hopkins University, Baltimore, and colleagues.
Combined, the studies included a total of 116 evaluable patients stratified by treatment type: metastasis-directed therapy (n = 67) or observation (n = 49). At a median follow-up of 52.5 months, median progression-free survival was 11.9 months in the metastasis-directed therapy group versus 5.9 months in the observation group. Median progression-free survival was 7.5 months for patients in the metastasis-directed therapy group who tested positive for a high-risk mutation, such as a pathogenic somatic mutation in ATM, BRCA1/2, Rb1, or TP53, versus 2.8 months for patients with a high-risk mutation who underwent observation. Patients in that group who did not have a high-risk mutation had a median progression-free survival of 13.4 months. Long-term follow-up revealed that progression-free survival was between 15% and 20% for patients who received metastasis-directed therapy regardless of their biomarker status. No difference in radiographic progression-free survival based on genomic profile was observed.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
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