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Headline: Stereotactic body radiation (SBRT) for oligometastatic prostate cancer prolongs progression-free survival (PFS).
The Study: Looking for a Gomez trial specific to prostate cancer? Good because we have one, and it comes with bonus features. The phase 2 ORIOLE trial—straight outta Hopkins in Baltimore, where else?—randomized 54 patients with recurrent (after definitive surgery or radiation) hormone-sensitive oligometastatic prostate cancer 2:1 to consolidative SBRT versus observation. The primary endpoint was progression at 6 months captured by clinical symptoms, imaging or rising PSA defined as ≥ 25% from enrollment plus 2 ng/mL above nadir. Per this definition, at 6 months, PFS was drastically improved with SBRT from 19 → 61%. Not impressed after ASTRO 2018? The authors thought you might feel that way, so they included some incredible, albeit small, co-analyses indicating: (1) SBRT to all (versus some) PSMA-avid lesions significantly improves rates of subsequent new sites of disease, (2) circulating tumor-fighting T-cell receptors (i.e., host-tumor immune response) were significantly amplified in the SBRT arm, and (3) absence of pre-treatment genomically “high-risk” circulating tumor DNA predicted a greater benefit with SBRT.
TBL: SBRT for oligometastatic prostate cancer impacts the biology and trajectory of the overall disease course and does so predictably. Wowzers. | Phillips ASTRO 2019