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Prostate Radiotherapy for Metastatic Hormone-sensitive Prostate Cancer: A STOPCAP Systematic Review and Meta-analysis

Sarah Burdett, Liselotte M. Boevé, Fiona C. Ingleby and 14 more

European Urology · 2019 · Meta-analysis

doi:10.1016/j.eururo.2019.02.003

Abstract

Background. Many trials are evaluating therapies for men with metastatic hormone-sensitive prostate cancer (mHSPC).

Objective. To systematically review trials of prostate radiotherapy.

Design, setting, and participants. Using a prospective framework (framework for adaptive meta-analysis [FAME]), we prespecified methods before any trial results were known. We searched extensively for eligible trials and asked investigators when results would be available. We could then anticipate that a definitive meta-analysis of the effects of prostate radiotherapy was possible. We obtained prepublication, unpublished, and harmonised results from investigators.

Intervention. We included trials that randomised men to prostate radiotherapy and androgen deprivation therapy (ADT) or ADT only.

Outcome measurements and statistical analysis. Hazard ratios (HRs) for the effects of prostate radiotherapy on survival, progression-free survival (PFS), failure-free survival (FFS), biochemical progression, and subgroup interactions were combined using fixed-effect meta-analysis.

Results and limitations. We identified one ongoing (PEACE-1) and two completed (HORRAD and STAMPEDE) eligible trials. Pooled results of the latter (2126 men; 90% of those eligible) showed no overall improvement in survival (HR = 0.92, 95% confidence interval [CI] 0.81–1.04, p = 0.195) or PFS (HR = 0.94, 95% CI 0.84–1.05, p = 0.238) with prostate radiotherapy. There was an overall improvement in biochemical progression (HR = 0.74, 95% CI 0.67–0.82, p = 0.94 × 10−8) and FFS (HR = 0.76, 95% CI 0.69–0.84, p = 0.64 × 10−7), equivalent to ∼10% benefit at 3 yr. The effect of prostate radiotherapy varied by metastatic burden—a pattern consistent across trials and outcome measures, including survival (<5, ≥5; interaction HR = 1.47, 95% CI 1.11–1.94, p = 0.007). There was 7% improvement in 3-yr survival in men with fewer than five bone metastases.

Conclusions. Prostate radiotherapy should be considered for men with mHSPC with a low metastatic burden.

Patient summary. Prostate cancer that has spread to other parts of the body (metastases) is usually treated with hormone therapy. In men with fewer than five bone metastases, addition of prostate radiotherapy helped them live longer and should be considered.

References 22

1.
STAMPEDE Clinical Trial Protocol V 9.0 (October 2012) http://www.stampedetrial.org/media/1080/mrcctu-stampede-protocol_v90_final_. 2012.
Not in our library
2.
Parker C.C., Sydes M.R., Mason M.D. Prostate radiotherapy for men with metastatic disease: a new comparison in the Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trial. BJU Int. 2013;111:697-699.
Not in our library10.1111/bju.12087
3.
Fisher D.J. Two-stage individual participant data meta-analysis and generalized forest plots. Stata Journal. 2015;15:369-396.
Not in our library
4.
StataCorp. Stata Statistical Software: Release 15. College Station, TX, USA: StataCorp LLC. 2017.
Not in our library
5.
Tierney J.F., Vale C.L., Burdett S., Fisher D., Rydzewska L.H.M., Parmar M.K.B. Timely and reliable evaluation of the effects of interventions: a framework for adaptive meta-analysis (FAME). Trials. 2017;18(Suppl. 1):P351.
Not in our library
6.
Addition of docetaxel or bisphosphonates to standard of care in men with localised or metastatic, hormone-sensitive prostate cancer: a systematic review and meta-analyses of aggregate data · 2016
Corrected
7.
Adding abiraterone to androgen deprivation therapy in men with metastatic hormone-sensitive prostate cancer: A systematic review and meta-analysis · 2017
No notice
8.
Sweeney C.J., Chen Y.H., Carducci M. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med. 2015;373:737-746.
Not in our library10.1056/nejmoa1503747
9.
Fizazi K., Tran N., Fein L. Abiraterone plus prednisone in metastatic castration-sensitive prostate cancer. N Engl J Med. 2017;377:352-360.
Not in our library10.1056/nejmoa1704174
10.
Higgins J.P., Altman D.G., Gotzsche P.C. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
Not in our library10.1136/bmj.d5928
11.
Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial · 2018
No notice
12.
Boeve L.M.S., Hulshof M.C.C.M., Vis A.N. Effect on survival of androgen deprivation therapy alone compared to androgen deprivation therapy combined with concurrent radiation therapy to the prostate in patients with primary bone metastatic prostate cancer in a prospective randomised clinical trial: data from the HORRAD trial. Eur Urol. 2019;75:410-418.
Not in our library10.1016/j.eururo.2018.09.008
13.
James N.D., de Bono J.S., Spears M.R. Abiraterone for prostate cancer not previously treated with hormone therapy. N Engl J Med. 2017;377:338-351.
Not in our library10.1056/nejmoa1702900
14.
Yusuf S., Peto R., Lewis J., Collins R., Sleight P. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985;27:335-371.
Not in our library10.1016/s0033-0620(85)80003-7
15.
Higgins J.P.T., Thompson S.G. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539-1558.
Not in our library10.1002/sim.1186
16.
Fisher D.J., Copas A.J., Tierney J.F., Parmar M.K.B. A critical review of methods for the assessment of patient-level interactions in individual patient data (IPD) meta-analysis of randomised trials, and guidance for practitioners. J Clin Epidemiol. 2011;64:949-967.
Not in our library10.1016/j.jclinepi.2010.11.016
17.
Meta-analytical methods to identify who benefits most from treatments: daft, deluded, or deft approach? · 2017
No notice
18.
Vale C.L., Fisher D.J., White I.R. What is the optimal systemic treatment for men with metastatic, hormone- naive prostate cancer? A STOPCAP systematic review and network meta-analysis. Ann Oncol. 2018;29:1249-1257.
Not in our library10.1093/annonc/mdy071
19.
Blanchard P., Foulon S., Louvel G., Habibian M., Fizazi K. A randomized controlled trial of metastases-directed treatment in patients with metastatic prostate cancer using stereotactic body irradiation: a GETUG-AFU trial. Cancer Radiother. 2017;21:491-494.
Not in our library10.1016/j.canrad.2017.06.007
20.
Boeve L., Hulshof M., Vis A. A prospective, randomised controlled trial in patients with primary bone metastatic prostate cancer (MPCA) receiving either androgen deprivation therapy (ADT) or ADT combined with concurrent radiation therapy to the prostate. J Urol. 2018;199(4 Suppl.):e231-e232.
Not in our library
21.
Freeman S.C., Fisher D., Tierney J.F., Carpenter J.R. A framework for identifying treatment-covariate interactions in individual participant data network meta-analysis. Res Synth Methods. 2018;9:393-407.
Not in our library10.1002/jrsm.1300
22.
Gillessen S., Attard G., Beer T.M. Management of patients with advanced prostate cancer: the report of the Advanced Prostate Cancer Consensus Conference APCCC 2017. Eur Urol. 2018;73:178-211.
Not in our library10.1016/j.eururo.2017.06.002

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