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Updated: Jun 27, 2025
A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
Progression-directed Therapy in Oligoprogressive Castration-resistant Prostate Cancer: Final Results from the
Kato Rans1, Steven Joniau2, Charlien Berghen1
1Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
Background And Objective:
Next-line systemic treatment (NEST) is the standard of care for patients presenting with progressive metastatic castration-resistant prostate cancer (mCRPC). Progression-directed therapy (PDT), defined as a lesion-directed approach in patients with a limited number of progressive and/or new lesions, could postpone the need for NEST in these patients with so-called oligoprogressive mCRPC. Our aim was to investigate the feasibility of postponing NEST initiation in oligoprogressive mCRPC by using PDT.
Methods:
MEDCARE was a prospective, single-arm, nonrandomized phase 2 trial. Eligible patients had oligoprogressive mCRPC and were treated with PDT while their ongoing systemic therapy was continued. The primary endpoint was NEST-free survival (NEST-FS). Secondary endpoints were prostate-specific antigen response, clinical progression-free survival (cPFS), prostate cancer-specific survival (PCSS), overall survival (OS), and PDT-induced toxicity.
Key Findings And Limitations:
Twenty patients underwent PDT for 38 oligoprogressive lesions. At median follow-up of 28 mo, median NEST-FS was 17 mo and the 2-yr NEST-FS rate was 35%. Median PCSS and median OS were not reached. The PCSS and OS rates at 2 yr were 80% and 70%, respectively. The 2-yr local control rate was 95%. No patient experienced early or late grade ≥3 toxicity. NEST-FS was longer for patients who received PDT to all lesions visible on 18F-PSMA positron emission tomography/computed tomography (30 vs 13 mo; p = 0.002).
Conclusions And Clinical Implications:
This single-center, single-arm, phase 2 trial demonstrated that PDT in oligoprogressive mCRPC resulted in median NEST-FS of 17 mo without any early or late grade ≥3 toxicity.
Patient Summary:
For patients with metastatic prostate cancer no longer responding to hormone therapy, we investigated radiotherapy targeted at progressive cancer lesions while continuing their ongoing systemic treatment. The results show that this targeted therapy had very low toxicity and delayed the need to start a new line of systemic treatment by 17 months.
Insights
Progression-directed therapy (PDT) can delay the need for next-line systemic treatment (NEST) in patients with oligoprogressive metastatic castration-resistant prostate cancer (mCRPC). This approach showed a median NEST-free survival of 17 months with minimal toxicity.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- Metastatic castration-resistant prostate cancer (mCRPC) often progresses despite standard treatments.
- Oligoprogressive mCRPC, characterized by limited lesions, presents a unique challenge for treatment sequencing.
- Next-line systemic treatment (NEST) is the current standard for progressive mCRPC.
Purpose of the Study:
- To evaluate the feasibility of postponing NEST initiation in patients with oligoprogressive mCRPC.
- To assess the efficacy of progression-directed therapy (PDT) in delaying the need for NEST.
Main Methods:
- A prospective, single-arm, phase 2 trial (MEDCARE) was conducted.
- Eligible patients with oligoprogressive mCRPC received PDT while continuing their existing systemic therapy.
- The primary endpoint was NEST-free survival (NEST-FS); secondary endpoints included survival rates and toxicity.
Main Results:
- Twenty patients with 38 oligoprogressive lesions were treated with PDT.
- Median NEST-free survival was 17 months, with a 2-year NEST-FS rate of 35%.
- High rates of prostate cancer-specific survival (80% at 2 years) and overall survival (70% at 2 years) were observed, with 95% local control and no grade ≥3 toxicity.
Conclusions:
- PDT is a feasible strategy to postpone NEST in oligoprogressive mCRPC.
- The treatment demonstrated a median NEST-free survival of 17 months.
- PDT showed a favorable safety profile with no significant early or late toxicity.
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