Dong Nguyen, Medical Doctor at Binh Dan hospital, shared Jeff Ryckman’s, Associate Professor of Radiation Oncology at WVU Medicine Camden Clark Medical Center, post on X, adding:
“That’s (again) a misinformation from a RadioOnco, Jeff Ryckman.
The truth is PROTEUS study protocol only mandated the perioperative treatment phase – 6 cycles of apalutamide + ADT before RP and 6 cycles after RP.
However, the subsequence therapy (any additional treatments after completion of the study protocol, such as salvage RT or systemic therapy) was not mandated by the protocol. It was left to the discretion of the treating physicians based on each patient’s clinical status, reflecting real-world clinical practice.
Please note that even they don’t mandated in protocol the whole perioperative systemic intensification strategy but they still test the effectiveness the whole strategy .
That is the perioperative apalutamide + ADT arm still demonstrated clear benefits across the overall treatment strategy:
- Approximately 30% reduction in the need for postoperative radiation
- Longer time to first subsequent treatment: median 74.2 months vs. 41.5 months
- Better in MFS as one of the primary outcome compare in the whole strategy.”
Quoting Jeff Ryckman’s comment on Juan Gómez Rivas‘ post on PROTEUS Study:
“The OP captures much of the editorial’s caution, but misses what I think is the key comparator issue that the editorial explicitly raises.
PROTEUS did not test perioperative ADT/Apa vs modern SOC. The control arm was RP + perioperative ADT/placebo, not RP-first with early SRT/ADT as needed or upfront RT/ADT.
So the trial shows apalutamide improves outcomes when added to perioperative ADT around RP. It does not show that the whole perioperative systemic intensification strategy beats local-first care.”
Title: PROTEUS Trial the Day After: Practice Changing or Premature Escalation?
Authors: Isabel Heidegger, Chiara Mercinelli, Giulia Marvaso, Jean Cristophe Bernhard, Elena Castro, Tamás Fazekas, Giorgio Gandaglia, Juan Gomez-Rivas, Guillaume Ploussard, Maria Rosaria Raspollini, Lara Rodriguez-Sanchez, Francesco Sanguedolce, Roderick van den Bergh, Morgan Rouprêt, Alessandro Volpe, Gianluca Giannarini, Pierre Blanchard
Other articles featuring Dong Nguyen and Jeff Ryckman on OncoDaily.