The impact of progression‐directed therapy on survival in metastatic castration‐refractory prostate cancer: MEDCARE phase 3 trial

• Published in: BJU international 2025-01, Vol.135 (1), p.63-70
• Main Authors: Rans, Kato, Goffin, Karolien, Joniau, Steven, Daugaard, Gedske, Hartog, Julie, Van Wynsberge, Lodewijk, De Meerleer, Gert
• Format: Article
• Language: English
• Subjects: Androgen receptors; Androgens; Castration; Clinical Trials, Phase III as Topic; Disease Progression; Humans; Male; metastasectomy; Metastases; Metastasis; metastasis‐directed therapy; metastatic castration‐refractory prostate cancer; metastatic prostate cancer; oligoprogressive prostate cancer; Prospective Studies; Prostate cancer; Prostatic Neoplasms, Castration-Resistant - drug therapy; Prostatic Neoplasms, Castration-Resistant - mortality; Prostatic Neoplasms, Castration-Resistant - pathology; Prostatic Neoplasms, Castration-Resistant - therapy; Quality of life; Radiation therapy; stereotactic body radiotherapy; Survival; Toxicity
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/bju.16574

Background Metastatic castration‐refractory prostate cancer (mCRPC) presents a therapeutic challenge despite advancements in treatment. Once mCRPC is attained, patients face limited survival prospects. Next‐line systemic treatment (NEST) is the standard of care for progressive mCRPC, encompassing various therapeutic options with associated toxicity and costs. In patients with oligoprogressive mCRPC, data suggest that progression‐directed therapy (PDT), such as metastasectomy or stereotactic body radiotherapy, delays the initiation of NEST. Methods and Design The MEDCARE phase III trial aims to assess the impact of PDT on overall survival (OS) in oligoprogressive mCRPC. In this multicentric, randomised, prospective trial, we aim to randomise 246 patients in 1:1 allocation ratio between the standard‐of‐care therapy (surveillance or NEST) or PDT while continuing the current systemic treatment. Patients will be stratified based on number of progressive lesions (one vs ≥one), location of progressive lesions (local recurrence, N or M1a vs M1b or M1c) and previous systemic therapy (palliative androgen‐deprivation therapy [pADT] vs pADT + androgen receptor‐targeted agent or patients who received docetaxel in the past). The primary endpoint is OS, and the secondary endpoints include quality of life, radiographic progression‐free survival (PFS), modified PFS, prostate cancer‐specific survival and PDT‐induced toxicity. Discussion This is the first randomised phase 3 trial in the setting of PDT in patients with oligoprogressive mCRPC with OS as the primary endpoint.