International study into the use of intermittent hormone therapy in the treatment of carcinoma of the prostate: a meta-analysis of 1446 patients

Authors

  • Greg L. Shaw,

    1. St Bartholomew’s Hospital, and *Cancer Research UK, London, UK, †The Prostate Centre at VGH, Vancouver, Canada, and ‡Sir Charles Gairdner Hospital, and University of Western Australia, Perth, Australia
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  • Peter Wilson,

    1. St Bartholomew’s Hospital, and *Cancer Research UK, London, UK, †The Prostate Centre at VGH, Vancouver, Canada, and ‡Sir Charles Gairdner Hospital, and University of Western Australia, Perth, Australia
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  • Jack Cuzick,

    1. St Bartholomew’s Hospital, and *Cancer Research UK, London, UK, †The Prostate Centre at VGH, Vancouver, Canada, and ‡Sir Charles Gairdner Hospital, and University of Western Australia, Perth, Australia
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  • David M. Prowse,

    1. St Bartholomew’s Hospital, and *Cancer Research UK, London, UK, †The Prostate Centre at VGH, Vancouver, Canada, and ‡Sir Charles Gairdner Hospital, and University of Western Australia, Perth, Australia
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  • S. Larry Goldenberg,

    1. St Bartholomew’s Hospital, and *Cancer Research UK, London, UK, †The Prostate Centre at VGH, Vancouver, Canada, and ‡Sir Charles Gairdner Hospital, and University of Western Australia, Perth, Australia
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  • Nigel A. Spry,

    1. St Bartholomew’s Hospital, and *Cancer Research UK, London, UK, †The Prostate Centre at VGH, Vancouver, Canada, and ‡Sir Charles Gairdner Hospital, and University of Western Australia, Perth, Australia
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  • Tim Oliver

    1. St Bartholomew’s Hospital, and *Cancer Research UK, London, UK, †The Prostate Centre at VGH, Vancouver, Canada, and ‡Sir Charles Gairdner Hospital, and University of Western Australia, Perth, Australia
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Greg Shaw, Department of Urology, 2nd Floor Maple House, University College Hospital, London WC1E 5DB, UK.
e-mail: gregshaw@doctors.org.uk

Abstract

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.

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