Hormoonbehandeling regelmatig onderbreken geeft zelfde resultaat op overleving en progressievrije tijd dan continue hormoontherapie maar geeft betere kwaliteit van leven

2 april 2014: Bron: BMC Urol. 2014 Jan 25;14:9. doi: 10.1186/1471-2490-14-9. en Prostate Cancer Prostatic Dis. 2014 Apr 1. doi: 10.1038/pcan.2014.10. [Epub ahead of print]

Een hormoonbehandeling bij mannen met prostaatkanker regelmatig onderbreken met rustpauzes (IAD - Intermittent Androgen Deprivation) geeft dezelfde resultaten op progressie vrij tijd en overall overleving, maar de kwaliteit van leven wordt door de rustpauzes verbeterd in vergelijking met continue hormoontherapie zonder onderbreking. (CAD - Continuous Androgen Deprivation) Met name sexuele activiteit en opvliegers scoorden veel beter bij IAD aanpak. Dit geldt zowel voor niet uitgezaaide prostaatkanker als voor wel uitgezaaide prostaatkanker.

Bedenk hoeveel geld hiermee bespaard had kunnen worden en nog kan worden naast de voordelen voor de mannen met prostaatkanker op hun kwaliteit van leven. En dan praat ik nog niet over de niet-toxische alternatieven voor een hormoonbehandeling zoals prostasol - prostectan en bepaalde andere voedingsupplementen zoals o.a. Maitake D-fraction. Zie o.a verhaal van meneer van Waveren. Die dus niet worden vergoed en mensen zelf moeten betalen of vaak niet meer kunnen betalen. Ik zou zeggen ziektekostenverzekeraars wordt eens wakker.

Hier de gelijkluidende conclusies van twee grote meta analyses van resp. 13 en 8 gerandomiseerde langjarige studies, die recent zijn gepubliceerd.

Dit zijn de conclusies:

Uit Prostate Cancer Prostatic Dis. 2014 Apr 1. op basis van 8 gerandomiseerde studies

IAD - Intermittent Androgen Deprivation is niet slechter dan CAD - Continuous Androgen Deprivation in termen van overall overleving (OS) en kanker specifieke overleving en is zeker niet slechter in termen van progressie vrije tijd. Deze meta analyse bevestigt dat IAD als een gerechtvaardige standaard behandeling kan worden gegeven aan mannen met prostaatkanker.

BMC Urol. 2014 Jan 25;14:9

Overall overleving was gelijk tussen IAD en CAD bij patiënten met lokaal gevorderde, recidief of uitgezaaide hormoon gevoelige prostaat kanker. Databewijs op kanker specifieke overleving - CSS zijn zwak en het profijt van IAD op deze resultaten blijven onzeker. Impact op kwaliteit van leven (QoL) was gelijk voor beide groepen, echter, sexuale activiteitscores waren hoger voor IAD en ook de opvliegers waren lager voor IAD.

Het volledige studierapport: Intermittent versus continuous androgen deprivation for locally advanced, recurrent or metastatic prostate cancer: a systematic review and meta-analysis is gratis in te zien. Onderaan het abstract.

Het abstract van de meta-analyse: Intermittent androgen deprivation is a rational standard-of-care treatment for all stages of progressive prostate cancer: results from a systematic review and meta-analysis over 8 gerandomiseerde studies luidt als volgt. Hier is nog geen volledig studierapport ter beschikking omdat het pas gisteren online is gepubliceerd:

Abstract

Background: The optimal hormone treatment strategy in prostate cancer is uncertain, particularly in patients with metastatic disease. We aimed to compare the relative benefits and harms of intermittent androgen deprivation (IAD) to continuous androgen deprivation (CAD) in all stages of prostate cancer.

Methods:We included eight randomised control trials (4668 patients) in our systematic review and meta-analysis. Median follow-up ranged from 29 to 118 months. Pooled hazard ratios (HRs) were calculated for overall survival (OS), cancer-specific survival, time to cancer progression and mortality unrelated to prostate cancer. The relative effect of treatment in patients with metastatic and those with non-metastatic disease was compared using pre-planned subgroup analysis.

Results: There was no difference in OS between patients treated with IAD and CAD (HR 1.01, 95% confidence interval (CI) 0.93-1.10); nor was there any difference in cancer-specific survival (HR 1.03; 95% CI 0.88-1.21). There was a non-significant trend towards longer time to prostate cancer progression for IAD (HR 0.93, 95% CI 0.84-1.04), raising the possibility of slower selection for castrate resistance. There was no significant difference in OS when analysis was restricted to patients with metastatic disease (HR 1.04, 95% CI 0.91-1.19) or patients without metastatic disease (HR 1.06, 95% CI 0.91-1.23) (test for subgroup differences P=0.84). Most studies found an improvement in quality of life or toxicity profile with IAD.

Conclusions: IAD is non-inferior to CAD in terms of OS and cancer-specific survival, and is at least non-inferior in terms of time to progression. This meta-analysis confirms IAD as a valid standard of care for managing prostate cancer patients.Prostate Cancer and Prostatic Disease advance online publication, 1 April 2014; doi:10.1038/pcan.2014.10.

Intermittent versus continuous androgen deprivation for locally advanced, recurrent or metastatic prostate cancer: a systematic review and meta-analysis.

2014 Jan 25;14:9. doi: 10.1186/1471-2490-14-9.

Botrel TE¹, Clark O, dos Reis RB, Pompeo AC, Ferreira U, Sadi MV, Bretas FF.

Author information

¹Evidencias Scientific Credibility, Campinas, São Paulo, Brazil. tobias.engel@evidencias.com.br.

Abstract

BACKGROUND:

Prostate cancer is the most common cancer in older men in the United States (USA) and Western Europe. Androgen deprivation (AD) constitutes, in most cases, the first-line of treatment for these cases. The negative impact of CAD in quality of life, secondary to the adverse events of sustained hormone deprivation, plus the costs of this therapy, motivated the intermittent treatment approach. The objective of this study is to to perform a systematic review and meta-analysis of all randomized controlled trials that compared the efficacy and adverse events profile of intermittent versus continuous androgen deprivation for locally advanced, recurrent or metastatic hormone-sensitive prostate cancer.

METHODS:

Several databases were searched, including MEDLINE, EMBASE, LILACS, and CENTRAL. The endpoints were overall survival (OS), cancer-specific survival (CSS), time to progression (TTP) and adverse events. We performed a meta-analysis (MA) of the published data. The results were expressed as Hazard Ratio (HR) or Risk Ratio (RR), with their corresponding 95% Confidence Intervals (CI 95%).

RESULTS:

The final analysis included 13 trials comprising 6,419 patients with hormone-sensitive prostate cancer. TTP was similar in patients who received intermittent androgen deprivation (IAD) or continuous androgen deprivation (CAD) (fixed effect: HR = 1.04; CI 95% = 0.96 to 1.14; p = 0.3). OS and CSS were also similar in patients treated with IAD or CAD (OS: fixed effect: HR = 1.02; CI 95% = 0.95 to 1.09; p = 0.56 and CSS: fixed effect: HR = 1.06; CI 95% = 0.96 to 1.18; p = 0.26).

CONCLUSION:

Overall survival was similar between IAD and CAD in patients with locally advanced, recurrent or metastatic hormone-sensitive prostate cancer. Data on CSS are weak and the benefits of IAD on this outcome remain uncertain. Impact in QoL was similar for both groups, however, sexual activity scores were higher and the incidence of hot flushes was lower in patients treated with IAD.