Radiotherapy in Oligometastatic, Oligorecurrent and Oligoprogressive Prostate Cancer: A Mini-Review

Yaney, Alexander; Stevens, Andrew; Monk, Paul; Martin, Douglas D.; Diaz, Dayssy Alexandra; Wang, Shang–Jui

doi:10.3389/fonc.2022.932637

Cited by 8 publications

(4 citation statements)

References 48 publications

(49 reference statements)

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“…Immune checkpoint inhibitor therapies were also examined with limited success 67 , 68 . Ongoing studies examine these therapies in combination with radiotherapy 69 – 71 .…”

Section: Resultsmentioning

confidence: 99%

The SGLT2 inhibitor canagliflozin suppresses growth and enhances prostate cancer response to radiotherapy

Ali,

Mekhaeil,

Biziotis

et al. 2023

Commun Biol

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Radiotherapy is a non-invasive standard treatment for prostate cancer (PC). However, PC develops radio-resistance, highlighting a need for agents to improve radiotherapy response. Canagliflozin, an inhibitor of sodium-glucose co-transporter-2, is approved for use in diabetes and heart failure, but is also shown to inhibit PC growth. However, whether canagliflozin can improve radiotherapy response in PC remains unknown. Here, we show that well-tolerated doses of canagliflozin suppress proliferation and survival of androgen-sensitive and insensitive human PC cells and tumors and sensitize them to radiotherapy. Canagliflozin blocks mitochondrial respiration, promotes AMPK activity, inhibits the MAPK and mTOR-p70S6k/4EBP1 pathways, activates cell cycle checkpoints, and inhibits proliferation in part through HIF-1α suppression. Canagliflozin mediates transcriptional reprogramming of several metabolic and survival pathways known to be regulated by ETS and E2F family transcription factors. Genes downregulated by canagliflozin are associated with poor PC prognosis. This study lays the groundwork for clinical investigation of canagliflozin in PC prevention and treatment in combination with radiotherapy.

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“…Immune checkpoint inhibitor therapies were also examined with limited success 67 , 68 . Ongoing studies examine these therapies in combination with radiotherapy 69 – 71 .…”

Section: Resultsmentioning

confidence: 99%

The SGLT2 inhibitor canagliflozin suppresses growth and enhances prostate cancer response to radiotherapy

Ali,

Mekhaeil,

Biziotis

et al. 2023

Commun Biol

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“…The adrenal gland is a common site of metastases from many malignancies [ 103 ] and the indications have been increasing for a definitive treatment in metastatic adrenal lesions [ 104 , 105 ]. There was insufficient evidence to determine the best local treatment modality for isolated and limited adrenal metastases [ 106 ].…”

Section: Smart Clinical Applicationsmentioning

confidence: 99%

Stereotactic Magnetic Resonance-Guided Adaptive and Non-Adaptive Radiotherapy on Combination MR-Linear Accelerators: Current Practice and Future Directions

Bryant

Weygand

Keit

et al. 2023

Cancers

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Stereotactic body radiotherapy (SBRT) is an effective radiation therapy technique that has allowed for shorter treatment courses, as compared to conventionally dosed radiation therapy. As its name implies, SBRT relies on daily image guidance to ensure that each fraction targets a tumor, instead of healthy tissue. Magnetic resonance imaging (MRI) offers improved soft-tissue visualization, allowing for better tumor and normal tissue delineation. MR-guided RT (MRgRT) has traditionally been defined by the use of offline MRI to aid in defining the RT volumes during the initial planning stages in order to ensure accurate tumor targeting while sparing critical normal tissues. However, the ViewRay MRIdian and Elekta Unity have improved upon and revolutionized the MRgRT by creating a combined MRI and linear accelerator (MRL), allowing MRgRT to incorporate online MRI in RT. MRL-based MR-guided SBRT (MRgSBRT) represents a novel solution to deliver higher doses to larger volumes of gross disease, regardless of the proximity of at-risk organs due to the (1) superior soft-tissue visualization for patient positioning, (2) real-time continuous intrafraction assessment of internal structures, and (3) daily online adaptive replanning. Stereotactic MR-guided adaptive radiation therapy (SMART) has enabled the safe delivery of ablative doses to tumors adjacent to radiosensitive tissues throughout the body. Although it is still a relatively new RT technique, SMART has demonstrated significant opportunities to improve disease control and reduce toxicity. In this review, we included the current clinical applications and the active prospective trials related to SMART. We highlighted the most impactful clinical studies at various tumor sites. In addition, we explored how MRL-based multiparametric MRI could potentially synergize with SMART to significantly change the current treatment paradigm and to improve personalized cancer care.

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“…SBRT for oligoprogression has been evaluated in a limited number of settings. In prostate cancer, retrospective cohort studies have demonstrated that radiotherapy can prolong next-line systemic therapy-free survival (NEST-FS) and progression-free survival (PFS) among at least a subset of patients with oligoprogression [5]. A retrospective analysis similarly found that SBRT may have the potential to extend the duration of current systemic therapies among patients with renal cell carcinoma [6].…”

Section: Introductionmentioning

confidence: 99%

“…This could preserve subsequent treatments for later administration and, therefore, enable a longer total duration of treatment and possibly even a longer survival time [6]. However, even among disease sites that have been investigated, there remains a paucity of prospective data on the effectiveness of radiotherapy in treating oligoprogression [5,6]. Recently, a prospective phase II trial was carried out among patients with renal cell cancer receiving SBRT and tyrosine kinase inhibitor (TKI) therapy [7].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness and Safety of Stereotactic Body Radiation Therapy (SBRT) in the Treatment of Oligoprogressive Breast Cancer: A Systematic Review

et al. 2023

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Stereotactic body radiotherapy (SBRT) has emerged as a technique to treat oligoprogressive sites among patients with breast cancer who are otherwise doing well on systemic therapy. This study systematically reviewed the efficacy and safety of SBRT in the setting of oligoprogressive breast cancer. A literature search was conducted in the MEDLINE database. Studies regarding SBRT and oligoprogressive breast cancer were included. Key outcomes of interest were toxicity, local control, progression, and overall survival. From 863 references, five retrospective single-center cohort studies were identified. All studies included patients with both oligometastatic and oligoprogressive disease; 112 patients with oligoprogressive breast cancer were identified across these studies. Patient age ranged from 22 to 84, with a median of 55 years of age. Most patients had hormone-receptor-positive and HER2-negative disease. SBRT doses varied from 24 to 60 Gy in 1–10 fractions based on the location/size of the lesion. Forty toxicity events were reported, of which the majority (n = 25, 62.5%) were grade 1–2 events. Among 15 patients who received SBRT concurrently with a CDK4/6 inhibitor, 37.5% of patients experienced grade 3–5 toxicities. Progression-free and overall survival ranged from 17 to 57% and 62 to 91%, respectively. There are limited data on the role of SBRT in oligoprogressive breast cancer, and prospective evaluation of this strategy is awaited to inform its safety and efficacy.

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Radiotherapy in Oligometastatic, Oligorecurrent and Oligoprogressive Prostate Cancer: A Mini-Review

Cited by 8 publications

References 48 publications

The SGLT2 inhibitor canagliflozin suppresses growth and enhances prostate cancer response to radiotherapy

The SGLT2 inhibitor canagliflozin suppresses growth and enhances prostate cancer response to radiotherapy

Stereotactic Magnetic Resonance-Guided Adaptive and Non-Adaptive Radiotherapy on Combination MR-Linear Accelerators: Current Practice and Future Directions

The Effectiveness and Safety of Stereotactic Body Radiation Therapy (SBRT) in the Treatment of Oligoprogressive Breast Cancer: A Systematic Review

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