Chad Tang, Radiation Oncologist at the MD Anderson Cancer Center, shared a post on X:
“Extremely excited to share our latest article published The Lancet Oncology a few hours ago. The WOLVERINE individual patient meta-analysis was an international collaboration and part of X-MET collaboration. Goal was to evaluate MDT in oligomet prostate ca.
We first conducted a systematic review to identify all studies investigating MDT across prostate cancer, including prostate specific studies and multi-histology studies. Seven available randomized phase II studies were identified. The primary analysis evaluated the benefit of MDT across endpoints. For this analysis we identified 6 phase 2 studies randomizing oligomet prostate ca patients to +/- MDT: EXTEND (intermittent/continuous HT), STOMP, ORIOLE, COMET-SABR, and ARTO.
Using individual patient data we found strong evidence of benefit across endpoints: PFS, radiographic PFS (rPFS), and castration resistance free survival (CRFS). Overall survival (OS) barely missed significance with P=0.051 in the mixed effect model. As pre-specified we also analyzed the benefit utilizing a cox regression model stratified by trial identity. These results were extremely similar to the trial level analysis.
Given the nature of studies there were significant heterogeneity regarding castration sensitivity, hormone use, imaging, and sites of disease allowed. We created a long appendix analyzing the benefit of MDT across these cohorts and found a consistent benefit across cohorts.
Finally we added one additional study, RADIOSA (for 7 studies total), which randomized to MDT +/- hormones and conducted a prognostic analysis limited to patients receiving MDT. Several factors including ADT use and lower baseline PSA were associated with better outcomes.
This was an amazing team effort from an incredible group of highly collaborative trialists from several countries. The X-MET collaboration is adding more trials as they are published and we plan to evaluate other questions in prostate and other solid malignancies.
Title: Metastasis-directed therapy and standard of care versus standard of care for oligometastatic prostate cancer (WOLVERINE): a systematic review and individual patient data meta-analysis from the X-MET collaboration
Authors: Chad Tang, Alex D. Sherry, Hyunsoo Hwang, David P. Farris, Giulio Francolini, Vanessa Di Cataldo, Lorenzo Livi, Phuoc Tran, Paul G. Corn, Ana Aparicio, Gabriele Simontacchi, Ana P. Kiess, Jarey H. Wang, Valerie Fonteyne, Renee Bultijnck, Ryan Phillips, Matthew P. Deek, Robert Olson, Stephen Harrow, Giulia Marvaso, Chiara Lorubbio, Barbara A. Jereczek-Fossa, Ethan B. Ludmir, Pierre Blanchard, Andrew Warner, Ryan Sun, David A. Palma, Piet Ost
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