Clinical trial finds combination hormone therapy delivers superior prostate cancer treatment (For high risk, relapsed cancer)

Medical Xpress / University of California, San Francisco / Journal of Clinical Oncology ^ | Jan. 23, 2024 | Rahul Aggarwal et al

[ConservativeMind]

Combining testosterone-blocking drugs in patients with prostate cancer relapse prevents the spread of cancer better than treatment with a single drug, a multi-institution, Phase 3 clinical trial led by researchers has found.

The approach can extend the time between debilitating drug treatments without prolonging the time it takes to recover from each treatment.

Prostate cancer is usually treated with one of several testosterone-lowering drugs for a set period of time.

"This adds to a growing body of evidence in favor of more intensive testosterone-blocking therapy in patients with higher-risk prostate cancer," said Rahul Aggarwal, MD.

The new study focused on patients who had surgery for prostate cancer, and yet the cancer relapsed and was detected through a sudden jump in the blood levels of a protein called prostate-specific antigen (PSA).

"We looked at patients who had a fast rise in their PSA—an indicator of a higher-risk form of relapsed prostate cancer," Aggarwal said.

Between 2017 and 2022, 503 patients were randomly assigned to take a single testosterone-lowering therapy chosen by their oncologist, or to combine it with one or two other testosterone-lowering drugs. The additional drugs were already FDA-approved for other cancers but hadn't been tested in this way with prostate cancer.

The patients stayed on the assigned therapy for a year. Whether given singly or in combination, the drugs caused their testosterone to plummet. That put the brakes on their cancer, but also caused fatigue and other problems for patients.

Compared to prostate cancer patients who only received a single drug therapy during their year of treatment, patients who received either one or two additional drugs stayed cancer-free, with low PSA levels, for longer.

Once off the treatment, patients who took the combination therapies saw their testosterone levels recover just as fast as others who took the single drug.

[ConservativeMind]

Getting the testosterone down as thoroughly as possible helped patients prevent a stronger relapse.

[ConservativeMind]

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[WASCWatch]

I have metastatic prostate cancer. Diagnosed almost 10 years ago. Until recently, I was on two androgen deprivation therapy drugs. PSA has been undetectable.

Currently on a Lupron “vacation” for the last eight months. Still take Xtandi at a lower dose. Reason for the “vacation” was because I had a very tiny TIA in July and the combo of the ADT with the TIA caused unbelievable fatigue

Will get back on Lupron as soon as my PSA becomes detectable. The fatigue has improved considerably in the last two months.

Thus study is nothing new, but I go-to MDA, and they are the #1 cancer center in the world.

[linMcHlp]

bkmk

[Java4Jay]

Five years ago diagnosed with PC, Gleason score 9. Radical prostatectomy was not advised as cancer had metastasized to lymph nodes and surrounding tissue. After 2 rounds of radiation (one on prostate, another on a lymph node in my back), Xtandi and monthly Lupron Depot injections, my last PSA count went from undetectable to .2

I’m wondering if I should add Apalutamide to my treatment.