Phase 2 trial of intermittent hormone therapy with or without metastasis-directed therapy for oligometastatic prostate cancer

The addition of metastasis-directed therapy (MDT) to intermittent hormone therapy (IHT) for oligometastatic prostate cancer has not been evaluated in a randomized trial. The phase 2 EXTEND trial randomized prostate cancer patients with 5 or fewer metastases to MDT + IHT or IHT only. Median progression-free survival (primary end point) was not reached in the MDT + IHT group versus 15 months in the IHT group (HR 0.25; p<0.001). Median progression free survival after achieving an eugonadal testosterone level of 150 ng/dl was not reached in the MDT + IHT group versus 6.1 months in the IHT group (HR 0.32; p=0,03). The authors conclude that addition of MDT to IHT for oligometastatic prostate cancer was associated with improved PFS and eugonadal PFS (visual abstract).