Prostate RT May Up Survival in mHSPC

Radiation therapy directed at the primary prostate tumor reduced mortality risk by 31%, study shows

RADIATION therapy (RT) directed at the primary prostate tumor in patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC) is associated with a statistically and clinically significant improvement in overall survival (OS), according to a recent study.

Scott C. Morgan, MD, of The Ottawa Hospital Cancer Centre in Ottawa, Canada, and colleagues studied a cohort of 410 patients with newly diagnosed mHSPC referred to a comprehensive cancer center from 2005 to 2015. Of these, 128 received prostate RT in addition to androgen deprivation therapy (ADT) and 282 received ADT alone. The median age of the ADT-only group was significantly higher than that of the prostate RT plus ADT group (77.5 vs 70 years). The median followup duration was 61 months.

The median OS was 47.4 months for the prostate RT group compared with 26.3 months for patients who did not receive prostate RT. On multivariate analysis, prostate RT was significantly associated with a 31% decreased risk of death compared with no prostate RT, the investigators reported in Prostate Cancer and Prostatic Diseases.

In addition, among patients who received prostate RT, OS improved along with increases in the biologically effective radiation dose. Each 10 Gy increase was significantly associated with a 13% decreased risk of death, according to the investigators.

“To our knowledge, this cohort represents the largest single-institution experience with primary tumor-directed RT in mHSPC reported to date,” Dr Morgan’s team wrote. “Receipt of prostate RT in this cohort was associated with a clinically significant improvement in OS.”

The authors noted that their cohort predated the debut of docetaxel and potent androgen receptor pathway inhibitors for use in mHSPC. “Whether the benefit of prostate RT in mHSPC will persist when used in addition to these therapies—or indeed, be enhanced by co-administration with these therapies—awaits the results of trials in progress.”

The authors acknowledged that the study was limited by its retrospective and nonrandomized design. They noted that there were significant differences in the baseline characteristics of men who received prostate RT and those receiving ADT alone.

“Some of these differences reflect the treatment policy at our center at the time, with locally advanced primary tumors being favored for receipt of RT,” Dr Morgan and his collaborators wrote. “Our analysis has adjusted for differences in these known baseline prognostic factors.”

In addition, they noted that certain patient and disease characteristics could not be captured reliably from a retrospective review of records.

“Specifically, this analysis could not account for performance status, volume of metastatic disease, comorbidities, receipt of systemic therapies at time of castration resistance, and other potential confounders,” they wrote. “These results should therefore be interpreted with some caution; residual confounding is possible.” ■

Study compared prostate radiation therapy plus ADT with ADT alone.

COVID-19 Vaccine Hesitancy Common in Dialysis Population

ALTHOUGH PATIENTS on dialysis are at increased risk for severe COVID-19related complications, a substantial percentage are hesitant to obtain a SARS-CoV-2 vaccination, according to new nationwide survey results presented during the virtual 2021 National Kidney Foundation Spring Clinical Meetings.

A total of 943 patients from 135 facilities within a large dialysis network responded to an anonymized survey administered in English or Spanish via tablet or smartphone during January 8 to February 11, 2021. In all, 22% of respondents and 34% of those aged 18-44 years reported that they would likely not seek a COVID-19 vaccine even if the vaccine were proven safe and effective for the general population, Pablo Garcia, MD, of Stanford University in Palo Alto, California, and colleagues reported.

Half of vaccine-hesitant respondents expressed concerns about side effects and 19% indicated concern about vaccine efficacy.

Vaccine acceptability was lower among women, younger age groups (18-44 years), and patients identifying as Black, Native American, or Pacific Islander, the investigators found. Although older patients were more accepting, the team encouraged vaccination efforts toward this group because older patients are at higher risk for serious illness.

COVID-19 vaccine hesitancy declined to 18% of all respondents and 26% of respondents aged 18-44 years if the vaccine were offered at dialysis facilities. On March 25, the Biden administration announced that SARS-CoV-2 vaccines would indeed be made available to dialysis facilities for administration.

“We believe this action will facilitate access to vaccines—which seems to be the primary barrier in our population, rather than hesitancy,” Dr Garcia told Renal & Urology News. “However, outreach programs targeted to the groups with lower vaccine acceptability will be crucial to achieving levels of vaccinations high enough to reach ‘herd immunity.’” ■

Outcome Predictors in Pediatric LN

THE BEST PREDICTORS of poor renal outcomes in pediatric patients with lupus nephritis (LN) include male gender, requiring dialysis at the time of diagnosis, and failure to achieve remission within 1 year after induction therapy, recently reported data suggest.

The data are from a study that included 53 patients with childhood-onset systemic lupus erythematosus: 32 who were concurrently diagnosed with LN (median age 12.1 years) and 21 patients in whom LN developed later (median age 13.8 years). Patients with a concurrent LN diagnosis were significantly more likely to have arthritis (62.5% vs 33.3%) and a lower estimated glomerular filtration rate (eGFR; 110 vs 147 mL/min/1.73 m2) compared with patients who later developed LN. Renal biopsy results showed that 54.7% of patients with LN had class 4 and 22.6% had class 3 disease.

Among treated patients, 77.3% and 73% achieved complete or partial remission at 6 and 12months, respectively, Rezan Topalog˘lu, MD, PhD, of Hacettepe University in Ankara, Turkey, reported in Nephrology Dialysis Transplantation. Patients who attained complete response at 6 months after induction treatment had better renal survival than patients who did not respond to treatment. The risk for poor renal outcome, defined as GFR less than 60 mL/min/1.73 m2 or dialysis), was a significant 8.6- and 13.8-fold higher for patients who did not attain remission at 6 and 12 months, respectively.

In addition, male vs female gender was significantly associated with an 8.4fold increased risk for poor renal outcomes. Requiring dialysis at the time of LN diagnosis was significantly associated with a 6.5-fold increased risk.

The remission rate at 6 months was significantly higher among patients treated with mycophenolate mofetil (MMF) or cyclophosphamide (CYC) compared with other combination therapies. They observed no significant difference between the CYC and MMF groups’ response rates, although 79% of class 4 patients received CYC as induction therapy. By 12 months, response rates were comparable across treatment groups.

Renal survival rates at 5 and 10 years were 92% and 85.7%, respectively. In the proliferative LN group, renal survival rates were 90.5% and 75%, respectively.

According to Dr Topalog˘lu’s team, “prompt recognition and aggressive management of pediatric LN is essential to achieve and maintain remission.” ■