Intense Androgen-Deprivation Therapy With Abiraterone Acetate Plus Leuprolide Acetate in Patients With Localized High-Risk Prostate Cancer: Results of a Randomized Phase II Neoadjuvant Study. By Taplin et al. 2014
Key sentence from the paper: “Prostatectomy alone is inadequate therapy for many patients with high-risk localized [prostate cancer], and neoadjuvant systemic therapy provides an opportunity to improve cure rates…extremely low levels of prostate tissue and androgens are achieved with [luteinizing hormone-releasing hormone agonists (LHRHa)] plus [abiraterone acetate] compared with LHRHa alone.”
For the full abstract, see: http://www.ncbi.nlm.nih.gov/pubmed/25311217
Commentary: Because ADT in the neoadjuvant mode (i.e. used before a primary medical treatment) can enhance survival for many prostate cancer patients treated with external beam radiotherapy, a related question is whether starting ADT prior to radical prostatectomy may be of similar benefit. That study was, in effect, done over a decade ago [See: Klotz et al., 2003; J Urol. 170(3):791-794.] and showed no particular benefit for patients assessed over the following six years.
This paper resurrects the topic. Here, 58 prostate cancer patients were given not just an LHRH agonist drug for ADT (like Eligard or Lupron), but were also given abiraterone. All the patients were recruited for the study between 2009 and 2011. It is thus too soon to tell whether the two-drug combination used before their prostatectomy improved their long term survival or quality of life. We hope to see a follow-up paper on these patients in a few years time.
Meanwhile the authors demonstrate here that the two drug combination shows a definite positive impact on the surgically removed prostate tissue. The drugs are designed to decrease androgen not just in the blood, but also in the tissue of the tumor. The combination of drugs appears to do a better job of reducing the androgen there, than using the LHRH agonist alone.
Taplin ME, Montgomery B, Logothetis CJ, Bubley GJ, Richie JP, Dalkin BL, Sanda MG, Davis JW, Loda M, True LD, Troncoso P, Ye H, Lis RT, Marck BT, Matsumoto AM, Balk SP, Mostaghel EA, Penning TM, Nelson PS, Xie W, Jiang Z, Haqq CM, Tamae D, Tran N, Peng W, Kheoh T, Molina A, Kantoff PW. 2014. Intense Androgen-Deprivation Therapy With Abiraterone Acetate Plus Leuprolide Acetate in Patients With Localized High-Risk Prostate Cancer: Results of a Randomized Phase II Neoadjuvant Study. Journal of Clinical Oncology.