Intermittent Hormone Therapy: What Is Its Place in Clinical Practice?☆

Context

Intermittent hormone therapy (IHT) for prostate cancer (PCa) has been garnering interest in the urologic community. IHT aims to minimise treatment-related side-effects, to improve overall quality of life (QoL), to reduce the cost of care, and possibly to delay progression to castration-resistant PCa (CRPC). But questions remain as to whether its use is supported by scientific evidence and how it should be applied in clinical practice.

Objective

To discuss the current scientific evidence on IHT and to offer recommendations on how to implement IHT in clinical practice.

Evidence acquisition

This paper was based on a presentation given at a satellite symposium on PCa that was held at the 2009 annual meeting of the European Association of Urology (EAU) in Stockholm, Sweden. Data were retrieved from recent review articles, original articles, and abstracts on IHT.

Evidence synthesis

Several phase 2 and 3 clinical trials have evaluated IHT; however, the phase 2 trials were generally small and used different methodologies, and most of the randomised controlled phase 3 trials are not mature yet. While considering these limitations, it can be concluded that IHT appears to have a beneficial effect on the incidence of side-effects, on QoL, and on cost. Additionally, IHT appears to have no negative impact on overall survival or progression-free survival compared to continuous hormone therapy. It could not yet be demonstrated that IHT prolongs the time to CRPC; therefore, further research is needed, also to provide guidance on how IHT should be applied in clinical practice.

Conclusions

IHT appears to have a beneficial effect on treatment-related side-effects and QoL and no negative impact on survival. Final data from phase 3 studies, however, are awaited, also to determine selection criteria for patients.

The scientific evidence on intermittent hormone therapy (IHT) in prostate cancer and its implementation in clinical practice is discussed. Although final data from phase 3 trials are awaited, IHT appears to have a beneficial effect on side-effects and no negative impact on survival.