What data support the use of continuing GnRH therapy "backbone" in metastatic castration resistant prostate cancer (mCRPC) receiving additional therapies?
Long-term ADT is deleterious to multiple organ systems (bone/sexual/psychiatric) and increases the risk of MACE. What level 1 evidence do we have to continue GnRH therapy in metastatic prostate cancer after progression to castration resistant disease? In selected cases, can ADT be safely withdrawn with close monitoring for PD in the mCRPC setting?
2 Answers
Mednet MemberInvited Expert
Medical Oncology · Duke University School of Medicine
Answered on
The short answer is that ALL phase 3 trials of life-prolonging therapies now approved in mCRPC required ongoing ADT (medical or surgical) and there is not a single positive life-prolonging phase 3 trial that did not do this. Until then our strongest evidence is to follow how these trials were conducted. Bipolar androgen therapy and allowing T recovery remains experimental and may do some harm by allowing androgen receptor dependent clones to progress more quickly. While BAT is very interesting and results in responses in about 1/3 of patients, it does not improve survival.
Mednet MemberInvited Expert
Medical Oncology · University of Minnesota-Masonic Cancer Center
Answered on
The best paper that has tackled this question recently is this one (it's a good read):