Adding SBRT to frontline abiraterone shows benefit in oligometastatic CRPC.


Adding stereotactic body radiation therapy (SBRT) to first-line abiraterone acetate (Zytiga) and prednisone (AAP) may improve clinical efficacy in patients with oligometastatic castration-resistant prostate cancer (CRPC), according to findings from the phase 2 ARTO trial. Profit generated. (NCT03449719) Published in Journal of Clinical Oncology ,junior commissioned officer,1

“The ARTO trial shows that patients treated with concomitant SBRT and abiraterone acetate have a significant benefit in terms of PSA reduction and progression-free survival at 6 months compared with patients treated with standard systemic treatment alone.” Could. These results were obtained without any meaningful indication of increased rates of adverse events,” Michael A. Carducci, MD, Associate Editor, junior commissioned officerwrote in a commentary published with the manuscript.

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The biochemical response (BR) rate, the primary end point of the trial, was 92% in the SBRT plus AAP arm compared with 68.3% with AAP alone (odds ratio). [OR]5.34 In favor of SBRT branch; P = .001). The overall BR rate (CBR) was 56% versus 23.2%, respectively (OR, 4.22; P <.001).

At a median follow-up of 24.9 months, median progression-free survival was not reached in the SBRT arm compared with 17 months with AAP alone, meaning a 65% reduction in the risk of disease progression or death (HR, 0.35; P <.001).1

“The ARTO trial shows that patients treated with concomitant SBRT and abiraterone acetate have a significant benefit in terms of PSA reduction and progression-free survival at 6 months compared with patients treated with standard systemic treatment alone.” Could. These results were obtained without any meaningful indication of increased rates of adverse events,” Michael A. Carducci, MD, Associate Editor, junior commissioned officerwrote in a commentary published with the manuscript.1

Overall, 157 patients with oligometastatic CRPC were enrolled in the ARTO trial between January 2019 and September 2022. Patients were randomized to AAP alone (n = 82) or in combination with SBRT (n = 75). The mean age of all patients was 74 years and the mean baseline PSA was 3.42 ng/mL. Approximately 82% of patients in each arm had ISUP grade >3 disease.

The study design defined the primary end point of BR as a PSA reduction of ≥50% from baseline 6 months after the start of treatment. Complete BR was defined as a PSA of <0.2 ng/mL at 6 months after the start of treatment.

Regarding safety, 48 (64%) patients in the SBRT arm experienced grade 1/2 adverse events (AEs), compared with 54 (65.8%) patients in the AAP alone arm. The rates of grade >2 AEs were 10.6% (n = 8 patients) and 15.8% (n = 13 patients), respectively. According to the study authors, “most toxicities were mild and related to systemic treatment.”1

“While targeting these sites of disease with SBRT and standard of care agents is safe and feasible, data developed from such studies support the use of this approach in increasing response rates as measured by PSA as well as time to radiographic progression.” Shows stability in profits. These results should be confirmed in larger studies and placed in the context of the changing landscape of treatment options for metastatic hormone sensitive and metastatic castration-resistant disease,” Carducci wrote in his commentary.1

Reference

1. Francolini G, Gaetano Allegra A, Detti B, et al. Stereotactic body radiation therapy and abiraterone acetate for patients with oligometastatic castrate-resistant prostate cancer: a randomized phase II trial (ARTO). [published online ahead of print September 21, 2023], J Clin Oncol, DOI: 10.1200/jco.23.00985

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