In an individual patient data meta-analysis (WOLVERINE) reported in The Lancet Oncology, Tang et al found that the addition of metastasis-directed therapy (MDT) to standard of care (SOC) was associated with benefits in patients with oligometastatic prostate cancer.
Study Details
A systematic review of the literature identified six phase II trials that included randomization of a total of 472 patients to receive MDT-SOC (n = 248) vs SOC (n = 224) in this setting. Primary outcome measures in the current analysis were progression-free survival, radiographic progression–free survival, castration resistance–free survival, and overall survival. The primary analysis included a trial-level analysis using a random effects model and a patient-level analysis stratifying by trial.
Key Findings
Median follow-up in the six trials included in the analysis was 40.7 months (interquartile range = 25.6–53.7 months).
Compared with patients receiving SOC alone, those receiving MDT-SOC had improved: progression-free survival at the trial level (hazard ratio [HR] = 0.44, 95% confidence interval [CI] = 0.35–0.56, P < .0001) and at the individual patient level (HR = 0.45, 95% CI = 0.35–0.57, P < .0001); radiographic progression-free survival at the trial level (HR = 0.60, 95% CI = 0.42–0.85, P = .0039) and at the patient level (HR = 0.59, 95% CI = 0.46–0.76, P < .0001); and castration resistance–free survival at the trial level (HR = 0.58, 95% CI = 0.37–0.92, P = .019) and patient level (HR = 0.58, 95% CI = 0.37–0.91, P = .017). Hazard ratios for overall survival favored patients receiving MDT-SOC at the trial level (0.63, 95% CI = 0.39–1.00, P = .051) and the patient level (0.64, 95% CI = 0.40–1.01, P = .057).
The investigators concluded: “WOLVERINE showed a benefit with MDT for oligometastatic prostate cancer in progression-free survival, radiological progression–free survival, and castration resistance–free survival. Overall survival benefit was not significant and further research is needed.”
Chad Tang, MD, of the Department of Genitourinary Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, is the corresponding author for The Lancet Oncology article.
DISCLOSURE: The study was funded by the National Cancer Institute and others. For full disclosures of the study authors, visit thelancet.com.
