Chad Tang, MD

Chad Tang, MD, The University of Texas MD Anderson Cancer Center, discusses where he sees the future of the treatment landscape for patients with oligometastatic prostate cancer heading.

, Tang discussed the findings of the phase 2 EXTEND trial (NCT03599765) that showed an improvement in progression-free survival for patients with oligometastatic prostate cancer given a combination of metastasis-directed therapy and intermittent hormone therapy.

 that the basket study showed that between patients given hormone therapy with (n = 43) or without (n = 44) local therapy those given the combination therapy had a longer median PFS at 15.8 months vs not reached for those patients given hormone therapy alone (HR, 0.25; 95% CI, 0.12-0.55, 

 < .001). Moreover, patients who eventually hit their normal level of testosterone also saw improved PFS.

Tang discusses how this study could impact the future of treatment for this patient population. Moreover, he looks at how the future of treatment of these patients is going towards preventing adverse events while maintaining efficacy results.  

 There may be some interest in the future potentially utilizing, not only metastasis-directed therapy, but also an intermittent hormone therapy regime, as these men can often be years without hormone therapy. It can convert universally lethal disease when you compare these 2 modalities in select patients with chronic disease.

 Not only that, but there are substantial amounts of time with a chronic disease when you get to recover your testosterone and all men benefit from that because. Not only does it prevent all these adverse events, such as hot flashes, night sweats, loss of libido, it also causes increased incidence of cardiovascular risk of stroke, obese, adiposity, etc. I think it's a big win for patients if we can develop these chronic strategies that not only treat the disease with extra control, but also maintain a quality of life.

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Chad Tang discusses where he sees the future of treatment for patients with oligometastatic prostate cancer heading and how the phase 2 EXTEND trial will impact this patient population.  

Discussing the Future of Treatment in Oligometastatic Prostate Cancer

Chad Tang, MD, The University of Texas MD Anderson Cancer Center, discusses the design of the randomized, phase 2, basket EXTEND trial (NCT03599765).


In EXTEND, investigators examined whether or not the addition of metastasis directed therapy improved progression-free survival in men with oligometastatic solid tumors, including prostate cancer.


Patients were randomly assigned to continue hormone therapy with or without metastasis directed therapy after at least 2 months of hormone therapy alone. Hormone therapy was then stopped 6 months after enrollment and patients did not resume until progression.

 EXTEND is a basket study, which means we were looking at multiple histologies where each basket is powered by itself to look at a question. In this intermittent hormone therapy basket, patients with oligometastatic prostate cancer chosen to be on intermittent hormone therapy were randomized to radiation therapy versus not. Then the hormone therapy was stopped 6 months later, so you get a minimum of 8 months, because you needed 2-4 months before.

This kind of mirrors an intermittent hormone regime. Then, patients were monitored and when their PSA [prostate specific antigen] rises, we call it progression when they meet certain thresholds, you put the patient's back on hormone therapy. The primary end point was progression-free survival, which could be from PSA or from your graphical assessment. Secondarily, we were trying to see how long patients could be off the hormones and have normal testosterone because all men who were on hormone therapy hate it. They want their testosterone back as it is a big quality of life impact for them.

Chad Tang, MD, The University of Texas MD Anderson Cancer Center, discusses the design of the randomized, phase 2, basket EXTEND trial.


Chad Tang, MD | Authors

Articles

Discussing the Future of Treatment in Oligometastatic Prostate Cancer

About the EXTEND Trial of Patients With Oligometastatic Prostate Cancer