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International study into the use of intermittent hormone therapy in the treatment of carcinoma of the prostate: a meta‐analysis of 1446 patients
Author(s) -
Shaw Greg L.,
Wilson Peter,
Cuzick Jack,
Prowse David M.,
Goldenberg S. Larry,
Spry Nigel A.,
Oliver Tim
Publication year - 2007
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2007.06770.x
Subject(s) - medicine , prostate cancer , oncology , prostate specific antigen , prostate , proportional hazards model , radiation therapy , hazard ratio , clinical endpoint , prospective cohort study , cancer , clinical trial , confidence interval
OBJECTIVE To review pooled phase II data to identify features of different regimens of intermittent hormone therapy (IHT), developed to reduce the morbidity of treating metastatic prostate cancer, and which carries a theoretical advantage of delaying the onset of androgen‐independent prostate cancer, (AIPC) that are associated with success, highlighting features which require exploration with prospective trials to establish the best strategies for using this treatment. METHODS Individual data were collated on 1446 patients with adequate information, from 10 phase II studies with >50 cases, identified through Pubmed. RESULTS Univariate and multivariate Cox proportional hazard models were developed to predict treatment success with a high degree of statistical success. The prostate‐specific antigen (PSA) nadir, the PSA threshold to restart treatment, and medication type and duration, were important predictors of outcome. CONCLUSIONS The duration of biochemical remission after a period of HT is a durable early indicator of how rapidly AIPC and death will occur, and will make a useful endpoint in future trials to investigate the best ways to use IHT based on the important treatment cycling variables described above. Patients spent a mean of 39% of the time off treatment. The initial PSA level and PSA nadir allow the identification of patients with prostate cancer in whom it might be possible to avoid radical therapy.