Intermittent versus Continuous Androgen Deprivation in Prostate Cancer
In a randomized trial, researchers assigned some 1500 patients with newly diagnosed hormone-sensitive, metastatic disease either to continuous or intermittent androgen-deprivation therapy. By a median follow-up of almost 10 years, the hazard ratio for death with intermittent therapy was 1.10, but it was not statistically significant. Quality-of-life measures favored intermittent therapy after 3 months' therapy, but not after that point.
"Our findings were statistically inconclusive. In patients with metastatic hormone-sensitive prostate cancer, the confidence interval for survival exceeded the upper boundary for noninferiority, suggesting that we cannot rule out a 20% greater risk of death with intermittent therapy than with continuous therapy, but too few events occurred to rule out significant inferiority of intermittent therapy. Intermittent therapy resulted in small improvements in quality of life. Robert Dreicer writes in Journal Watch Oncology and Hematology: "For physicians and patients considering intermittent therapy for metastatic disease, these findings provide a cautionary note. However, as in all choices, an individual's own assessment of risks versus benefits will likely drive the final decision."