ATHENSIn patients with advanced or inoperable prostate cancer,
intermittent androgen suppression shows promise as an equally
effective, less toxic, and cheaper alternative to continuous hormone
blockade, Dr. Sergio Bracarda, of Perugia University (Italy), said at
the 23rd Congress of the European Society for Medical Oncology (ESMO).
In an attempt to determine whether discontinuous treatment could
avoid or delay the emergence of hormone-refractory disease, Dr.
Bracarda and his colleagues used prostate-specific antigen (PSA)
measurements to guide the stopping and re-starting of androgen
They treated 88 consecutive patients with either a luteinizing
hormone releasing hormone (LHRH) analog plus a peripheral
antiandrogen (complete androgen blockade) or with an LHRH analog
alone and only 1 month of an antiandrogen to prevent flare-ups
(partial androgen blockade). Hormonal blockade was interrupted when a
patients PSA level fell to zero and was resumed when the PSA
level approached 10 ng/mL.
In his discussion of the results obtained on 73 of these patients,
Dr. Bracarda said that no instances of disease progression to a
hormone-refractory status have been observed during a median
follow-up of 29 months. In contrast, he noted, historical data
suggest that virtually all patients receiving continuous androgen
suppression develop resistance within 6 to 18 months.
Resumption of sexual activity was reported by 88.6% of patients
during the off-therapy period of the first cycle (mean duration, 6
months); by 68% of patients during the second off-therapy period
(mean duration, 3 months); and by 80% during the third drug hiatus.
Overall, study participants were able to spend more than half of the
follow-up period off therapy.
Cost savings were achieved with intermittent androgen suppression,
compared with continuous suppression. The cost of therapy averaged
about $2,300 per year with complete androgen blockade and about
$1,200 per year with partial androgen blockade.