onc brain

Retrospective real-world analysis of commercial and Medicare claims databases, indexed at the date ADT was prescribed. Data cutoff May 2024. Presented at ASCO GU 2026 and discussed in a UroToday interview, not a full paper.

~17,000 pts with prostate cancer receiving ADT. ~90% GnRH agonist, ~10% GnRH antagonist (degarelix ~two-thirds, relugolix ~a third). Agonist pts were older, more likely on Medicare, and had longer median f/u.

Primary: two- and three-point MACE. Secondary: MACE before vs after 2021, the year HERO and PRONOUNCE reported.

Overall MACE ~four per 100 person-yrs. Antagonist pts had ~37% numerically lower MACE than agonist pts. Preexisting CVD carried ~11 per 100 person-yrs, about threefold. Post-2021 showed a modest reduction vs pre-2021.

Direction matches HERO, which the presenter cited for lower MACE with relugolix vs agonist. PRONOUNCE was cited for the value of cardiologist involvement, which frames the preexisting-CVD finding as a referral question, not only a drug-choice question.

Baseline age, payer and f/u imbalances bias the crude class comparison. MACE misses earlier cardiometabolic harm (diabetes, metabolic syndrome, renal dysfunction), as the interviewer pointed out. The pre/post-2021 shift is a secular trend with no causal link to the trials.

The more robust signal is the preexisting-CVD rate, which identifies who needs cardiovascular co-management whatever the ADT class. A PCF consensus statement on risk-tiered cardiology referral is described as forthcoming.

Retrospective claims comparison, 'numerically lower' with no CI or adjustment reported; agonist group older, more Medicare, longer f/u. Antagonist group mostly degarelix.

Retrospective SEER-Medicare claims analysis of localized prostate cancer diagnosed 2010-2017. 797 focal therapy patients Mahalanobis matched 2:1 to 1,594 IMRT patients on demographics, Medicaid eligibility, comorbidity, flu vaccination, primary care access, year, cancer characteristics and ADT. Logistic regression at 6, 12 and 24 months.

Fee-for-service Medicare beneficiaries with localized PCa as first and only cancer, continuously enrolled parts A and B from 12 months pre-diagnosis through 24 months post-treatment. New York, Idaho and Massachusetts registries excluded for missing AJCC staging. Patients who died within 24 months of treatment were excluded.

IMRT defined as external beam with no surgery plus ≥20 IMRT fractions and an IMRT planning code; a gap of ≥30 days between radiation dates counted as a separate course. SBRT and proton patients were excluded, as were patients with rectal hydrogel spacer, so the IMRT arm is conventional fractionation without a rectal spacer.

Presence of claims indicative of a GI or GU complication within 6, 12 and 24 months of treatment, assessed both as combined diagnosis and procedure codes and as procedure codes only. No patient-reported outcomes and no graded toxicity scale.

Direction reversed by organ system: GI favored focal therapy from 12 months onward, GU favored IMRT at every window measured. The 0-6 month GI comparison was null (OR 1.06, P=.81).

GU excess with focal therapy was driven by incontinence therapy (17.4% vs 7.5%) and erectile dysfunction (18.2% vs 13.1%), both P<.01. GI events with IMRT were predominantly rectal bleeding and colitis; the authors note related procedures were rare and not significantly different.

Focal therapy patients were disproportionately rural (6.4% vs 1.9%) and lower-income (51.5% vs 38.7% in the lowest two quintiles) before matching, so claim-generating behavior may differ by arm independent of toxicity. Baseline continence and erectile function were unmeasured, which matters most for the two endpoints driving the GU result.

The GI result is fragile in a specific way the abstract does not foreground: it collapses to one diagnosis subcategory and disappears in the procedure-only analysis. The GU result is the more robust half, and it runs against the premise that ablation is the lower-toxicity option.

Claims-based retrospective matching, not randomised; toxicity defined by diagnosis codes, and the GI difference vanished when restricted to procedure codes. No PROs, no baseline function.

Territory-wide retrospective cohort from the Hong Kong Hospital Authority CDARS database (more than 90% population coverage), NSCLC diagnosed 2010 to 2021. Overlap weighting was the primary propensity method, IPTW the sensitivity analysis; RMST was specified where proportional hazards failed.

Of 3522 ICI-treated pts, 335 received RT: 155 newly diagnosed advanced and 180 refractory NSCLC. 247 (73.7%) male, median age 64 (range 34-90).

RT dose, fractionation, modality, target site and the interval separating sequential from concurrent delivery are not reported in source text.

Primary: real-world OS after landmark, via weighted Kaplan-Meier and Cox models. Exposures: sequential vs concurrent RT+ICI (newly diagnosed), RT with vs without ICI maintenance (refractory), and receipt of chemotherapy.

Chemotherapy tracked with longer rwOS in newly diagnosed disease but not in refractory disease; no chemotherapy effect size in source text. IPTW estimates were similar to the primary analysis.

The source notes randomized data on RT+ICI sequencing are limited. PEMBRO-RT tested SBRT before pembrolizumab in advanced NSCLC, and PACIFIC placed ICI after concurrent chemoRT in unresectable locally advanced disease; neither randomized timing as this cohort compares it.

Undefined timing window and unreported RT parameters make the exposure heterogeneous, possibly mixing consolidative and palliative courses. The 2010 to 2021 window spans shifting first-line ICI practice, and any RMST estimates are not reported in source text.

A sequential advantage cuts against the common assumption that overlap maximises RT-ICI interaction, but urgent symptomatic RT given during ICI could explain it equally well. Whether continuing ICI after RT helps refractory disease remains open.

Retrospective propensity-weighted registry cohort; residual confounding by indication likely, upper CI bound 0.99 in n=155, and authors frame it as hypothesis generating.