Radiotherapy and abiraterone improve survival in low-volume metastatic castration-sensitive prostate cancer

1. Progression-free survival improved significantly in patients with low-volume disease who received abiraterone and radiotherapy.

2. The addition of radiotherapy did not significantly impact overall survival.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Androgen-deprivation therapy (ADT) combined with docetaxel and abiraterone has been shown to improve survival in patients with metastatic castration-sensitive prostate cancer. However, the benefit of adding radiotherapy remains unclear. This randomized controlled trial aimed to assess the efficacy and safety of incorporating radiotherapy into the standard of care, with or without abiraterone, for these patients. The primary outcome of this study was radiographic progression-free survival, while the key secondary outcome was overall survival. According to study results, adding radiotherapy with abiraterone improved progression-free survival in patients with low-volume disease. Overall survival was similar between groups. Although this study was well done, it was limited by the inability to pool certain groups for analysis due to a qualitative interaction between radiotherapy and abiraterone in low-volume disease patients.

Click to read the study in The Lancet

Relevant Reading: Phase 3 Trial of Stereotactic Body Radiotherapy in Localized Prostate Cancer

In-depth [randomized controlled trial]: Between Nov 27, 2013, and Dec 20, 2018, 1173 patients were assessed for eligibility across 77 hospitals in Europe. Included were patients aged ≥ 18 years with metastatic castration-sensitive prostate cancer and an ECOG performance status of 0–2. Altogether, 1,172 patients (296 to standard care, 292 to standard care plus abiraterone, 293 to standard care plus radiotherapy, and 291 to standard care plus abiraterone and radiotherapy) were included in the final analysis. The primary outcome of progression-free survival improved significantly in patients with low-volume disease who received abiraterone and radiotherapy (median 7.5 years, 99.9% confidence interval [CI] 4.0-not reached; hazard ratio [HR] 0.65, p=0.019), while no benefit was observed in those treated with radiotherapy alone (median 2.6 years, 99.9% CI 1.7-4.6, HR 1.08, p=0.61). The secondary outcome of overall survival was not significantly influenced by adding radiotherapy (HR 0.98, p=0.86), regardless of abiraterone use. Findings from this study suggest that radiotherapy combined with abiraterone enhances progression-free survival in low-volume metastatic prostate cancer.

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