I just find out about this report, and I find it incredibly important.
Intermittent androgen deprivation (IAD) therapy until now (see http://theoncologist.alphamedpress.org/cgi/content/full/9/3/295 ) suffers from a progressive decline in the duration of the off-therapy phase and an increase in the duration of the on-therapy phase in subsequent cycles. Patients spent an average of 45% of the time not receiving therapy.
The most important question is the potential impact on survival of IAD in comparison with continuous androgen deprivation CAD. There was no statistically significant difference in time to progression between the two arms of a particular study. However, in the off-treatment phase of IAD, greater than 90% of patients recovered normal testosterone levels and that allows the body to recover from the treatment and has psychological and physiological advantage to the patients.
So there remain at least 2 advantages to giving breaks off of the hormone therapy instead of staying on it continuously: quality of life in the off-period is better and money is saved. These facts seem not of much importance to the medical society, because CAD is still there.
And now this study from Figg, et al. proves that the off-period can be made longer and the progressive decline in the duration of it can actually be halted by using thalidomide !
Using it in the 1st cycle increased the off-period from 9.6 (for the placebo) to 15 months for using thalidomide. Because of the wide range of participating patients (with on-study PSA's avg. 5.1, range 0.9–311.8, and Gleason avg. 5.1, range 3 -10), the accuracy obtained was not good enough to call this a significant difference (there were a total of 159 patients involved).
But in the 2nd cycle, where traditionally you would expect the off-period to become shorter, the results were that the off-period of 17.1 months for thalidomide increased compared to that in the 1st cycle, but it declined to 6.6 months for the placebo. That was certainly significant. It must be said that the gruop that got thalidomide during this cycle's off-period was the group that had a placebo in the 1st cycle.
Am I correct in thinking that the results had been even better when they had gotten thalidomide twice ?
So it looks that, with thalidomide, the IAD cycle can be repeated many more times, maybe indefinitely ?
Should not everybody on hormone therapy demand that he gets thalidomide ?
(Thalidomide was an over the counter sleeping pil from 1957 till 1961, when it was forbidden because of serious birth defects when used by pregnant women).
March'06: PSA 3.6
Diagnosed at age 63 Sep'09: PSA 575, GS 7 (4+3)
3 positive cores in 6
Bone scan: as a fully lit christmas tree
With Zoladex+150mg Casodex PSA <0.1
Additionally 4-weekly Zometa (zoledronin acid)
Post Edited (Arno) : 8/10/2010 5:52:20 AM (GMT-6)