Oncology
Prostate Cancer
In the Crosshairs: Hormone-Sensitive Oligometastatic Disease
Overview
Hellman and Weichselbaum are often credited for being first to suggest that patients with oligometastatic disease – when metastases are limited in number and location – would benefit from effective local therapy in addition to systemic therapy. Today, investigators are pursuing such treatment of oligometastatic prostate cancer as they also seek to refine the working definition for and scientific understanding of this disease state. The ORIOLE trial, a phase 2 randomized trial of observation vs stereotactic ablative radiation for oligometastatic prostate cancer, will assess the safety and efficacy of stereotactic ablative radiotherapy (SABR) for hormone-sensitive oligometastatic prostate cancer. The ORIOLE trial also promises to explore the biology of oligometastatic disease, as revealed through immunologic, cellular, molecular, and functional imaging correlates. Investigators hypothesize that SABR to all metastases will delay progression by disrupting the metastatic process. Whether or not such an aggressive approach can achieve cure in this setting is unknown.
Expert Commentary
Glen Gejerman, MD
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I would agree that there has been a shift toward more aggressive treatment in the setting of oligometastatic disease, but I think an important distinction is whether the patients have hormone-sensitive or castration-resistant disease. It is clear that patients can be treated for years when they have hormone-sensitive disease, and that different therapeutic modalities are effective. One can truly achieve a very nice, long, disease-free interval. |
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“I would agree that there has been a shift toward more aggressive treatment in the setting of oligometastatic disease, but I think an important distinction is whether the patients have hormone-sensitive or castration-resistant disease.”
Once patients shift into the castration-resistant category, however, the malignancy becomes much more difficult to manage. I think that, if we want to speak about cure, treatment advances specifically for that more resistant phase of the disease are needed. Certainly, for patients who have hormone-sensitive oligometastatic disease, a very aggressive approach with the hope of cure is, I think, reasonable.
“Certainly, for patients who have hormone-sensitive oligometastatic disease, a very aggressive approach with the hope of cure is, I think, reasonable.”
References
Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13(1):8-10.
Radwan N, Phillips R, Ross A, et al. A phase II randomized trial of Observation versus stereotactic ablative RadiatIon for OLigometastatic prostate CancEr (ORIOLE) [ NCT02680587). BMC Cancer. 2017;17:453.
