ASTRO recommends moderate hypofractionation over conventional radiotherapy for localised prostate cancer of every risk group

The edition in brief

An ASTRO clinical practice guideline, published on 27 October, recommends moderate hypofractionation over conventional fractionation for localised prostate cancer across all risk groups, citing randomised evidence of equivalent cancer control, toxicity and quality of life with fewer visits. Ultrahypofractionation is a standard option for low and intermediate risk and may be considered in selected high-risk patients, preferably in trials. Age, comorbidity and androgen deprivation should not generally drive the choice, though moderate schedules may suit men with significant urinary symptoms. The evERA trial in NEJM randomised 373 patients with ER-positive, HER2-negative advanced breast cancer after a CDK4/6 inhibitor to oral giredestrant plus everolimus or standard endocrine therapy plus everolimus; progression-free survival was 10.0 against 5.5 months in ESR1-mutated disease (HR 0.38). KEYLYNK-001 found pembrolizumab with chemotherapy then pembrolizumab-olaparib maintenance improved progression-free survival in BRCA non-mutated advanced ovarian cancer (final ITT HR 0.71), with more serious toxicity. A TALAPRO-2 biomarker analysis found detectable ctDNA at baseline strongly predicted shorter radiographic progression-free survival. The pearl covers ESR1 testing on progression.