The first randomized pilot trial of metastasis-directed treatment in oligometastatic patients

It showed that ADT for polymetastases could be delayed by 8 months IF one is willing to accept only 80% confidence in the statistics in this pilot study (and IF one is willing to accept that ADT can be delayed until there are 4 simultaneous metastases). At the conventional 95% confidence, there was no statistically significant difference. But this begs the question of whether ADT should EVER be delayed when there are known metastases. When I mentioned that to Dr. Ost, he was appalled that his study would be abused for that purpose. He wrote, "MDT does not replace ADT and our results should not be interpreted in that way."

Importantly, this study does NOT address whether there is a survival advantage or disadvantage to metastasis-directed therapy, which is what we really want to know. We await other clinical trial to answer that question. What we know for a fact (from 4 major randomized trials) is that, among newly diagnosed patients, aggressive systemic therapy, as early as possible after metastases are discovered, provides significant survival advantage.

Here's an article about it:

/pcnrv.blogspot.com/2017/12/metastasis-directed-therapy-for.html

Hi Dan-

I could smell the fire when it hit BelAir and Westwood near the 405 that one time. Fortunately for the fires, it's a bone-chilling 52°F here in WeHo now.

The CORE RCT in the UK compares survival in patients randomized to standard-of-care vs. standard-of-care + SBRT to oligomets. Standard-of-care will include ADT.

/clinicaltrials.gov/ct2/show/NCT02759783

Dr Stephen Strum wrote in with some useful comments about the importance of ADT, and the importance of improving patient selection, which I totally agree with. Unfortunately, the best scan for finding lymph node mets (Combidex MRI) is not available in the US.

Bob-
He argues for better detection. Read it for yourself.

TA.......Bone chilling?????52F............well OK if YOU say so.
Gonna be 8F tonight and I think it is still BALMY. We will see -20 yest that was 20 below and could go lower this winter. Last winter we saw 26 below and a total of 69 inches of snow. Winter here starts in late Oct and doesn't finis until late april ( if we are lucky ).

Be well and thank you for all you do for all of us.

Roger