Discussant of the abstract, Alejandro Berlin, MD, MSc, Assistant Professor at the Princess Margaret Cancer Centre, Toronto, called the study “thought-provoking” and applauded the data-sharing approach to answer a clinically relevant question. According to Dr. Berlin, this work resurfaces the long-standing need to better understand the biologic underpinnings behind the observed improvement in outcomes with the combinatorial approach.
Alejandro Berlin, MD, MSc
“Even though there is an obvious systemic benefit of androgen-deprivation therapy to local treatments, there is also evidence suggesting a local additive and synergistic effect,” he commented. “In prostate cancer, we have actually shown the complementary roles and bidirectional effects of both local radiotherapy and androgen-deprivation therapy systemic approaches in several randomized phase III trials.”
To contextualize these results, Dr. Berlin noted that prior studies exploring neoadjuvant hormonal therapy have shown nil effect of extending its duration, which is “fundamentally different from what we have seen in the adjuvant setting.”
“When patients are referred to us with already-started androgen-deprivation therapy, it poses a challenge to determine the optimal total overall duration of that therapy,” he explained. “However, I think it is important to highlight that this study is not suggesting neoadjuvant androgen-deprivation therapy should be avoided; most studies exploring the use of adjuvant hormonal therapy have had a component of neoadjuvant treatment.”
What Next?
In the future, said Dr. Berlin, researchers should move beyond exploring solely the local treatment effect of radiotherapy. What is done before, during, and after treatment has an impact as well.
“This seems to be a dynamic field, particularly in terms of radiotherapy response modulation,” he concluded. “There is a lot of room for differential effect for modulating agents such as androgen-deprivation therapy.”
Publisher's Note: This article was originally published in the December 10, 2020 issue of The ASCO Post.
DISCLOSURE: Dr. Berlin reported no conflicts of interest.
