Top Line: Is biochemical recurrence a good surrogate endpoint for overall survival in the treatment of prostate cancer?
The Study: Biochemical recurrence is a classic endpoint for prostate cancer trials and even in the clinic after treatment. That’s because it’s easy to observe and is often the first sign of recurrent disease. However, it is debated whether BCR is actually a good surrogate for survival in patients with prostate cancer. In fact, recent studies have shown that metastasis-free survival is a better surrogate for OS than BCR-based outcomes. This massive study from the MARCAP consortium sought to settle the matter using data from >10,000 individual patients treated in 11 trials of radiation dose escalation, ADT use, and ADT prolongation. They used multiple statistical approaches to determine if biochemical outcomes are prognostic of OS. Among these patients, interventions to escalate dose, add ADT, or prolong ADT all improved BCR outcomes. However, only the addition of ADT and prolongation of ADT were associated with improved OS. At best, BCR outcomes were only modestly associated with OS. Ultimately, the authors concluded that BCR and BCR-based outcomes are poor surrogates for OS outcomes in prostate cancer treatment.
TBL: This large analysis found that biochemical recurrence is a poor surrogate outcome for overall survival in trials of localized prostate cancer. | Roy, J Clin Oncol 2023
The Study: Biochemical recurrence is a classic endpoint for prostate cancer trials and even in the clinic after treatment. That’s because it’s easy to observe and is often the first sign of recurrent disease. However, it is debated whether BCR is actually a good surrogate for survival in patients with prostate cancer. In fact, recent studies have shown that metastasis-free survival is a better surrogate for OS than BCR-based outcomes. This massive study from the MARCAP consortium sought to settle the matter using data from >10,000 individual patients treated in 11 trials of radiation dose escalation, ADT use, and ADT prolongation. They used multiple statistical approaches to determine if biochemical outcomes are prognostic of OS. Among these patients, interventions to escalate dose, add ADT, or prolong ADT all improved BCR outcomes. However, only the addition of ADT and prolongation of ADT were associated with improved OS. At best, BCR outcomes were only modestly associated with OS. Ultimately, the authors concluded that BCR and BCR-based outcomes are poor surrogates for OS outcomes in prostate cancer treatment.
TBL: This large analysis found that biochemical recurrence is a poor surrogate outcome for overall survival in trials of localized prostate cancer. | Roy, J Clin Oncol 2023