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Sandy Srinivas, MD


Phase II EXTEND Trial: Metastasis-Directed Therapy for Advanced Prostate Cancer

By: Joshua D. Madera, MS
Posted: Wednesday, April 26, 2023

The addition of metastasis-directed therapy to standard hormone therapy for the management of advanced prostate cancer may improve patients’ progression-free survival, according to the results of the multicenter phase II EXTEND trial, published in JAMA Oncology. Additional investigative efforts should aim to identify specific biomarkers that may indicate which patients will benefit most from this combination treatment, suggested Chad Tang, MD, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues.

“This study provides much-needed data on the benefits of combining these newer radiation techniques with hormone therapy to improve outcomes,” commented Dr. Tang in an MD Anderson press release. “I am encouraged that these data, combined with knowledge gained in future trials, will allow us to safely preserve a man’s quality of life following this diagnosis.”

A total of 87 men with oligometastatic prostate cancer with five or fewer metastases were recruited for the study. All patients were previously treated with hormone therapy for at least 2 months. Patients were randomly assigned to receive combination treatment with metastasis-directed therapy and hormone therapy (n = 43) or hormone therapy alone (n = 44). Hormone therapy was discontinued after 6 months of treatment, and patients’ clinical outcomes were monitored until disease progression.

The study findings revealed an improved progression-free survival in patients who received combination therapy compared with hormone therapy alone (hazard ratio [HR] = 0.25). In addition, eugonadal progression-free survival was also improved in patients who received combination therapy (HR = 0.32). Furthermore, the use of a combined-therapy approach led to increased levels of T-cell activation and proliferation. Moreover, the combination therapy was reported to be well tolerated by patients, with grade 3 adverse events equivalent to those of patients who received hormone therapy alone.

Disclosure: For full disclosures of the study authors, visit

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