🚨⭐🔵 #ESMO26 | Abstract 2215O | PEACE-1

Long-term overall survival with abiraterone acetate plus prednisone in the PEACE-1 phase 3 trial for de novo metastatic castration-sensitive prostate cancer (mCSPC)

🎤 Presented by Prof. Karim Fizazi 🇫🇷
@OncoAlert @myESMO

🔬 7.7 years of follow-up: Does upfront treatment intensification translate into durable survival?

PEACE-1 provides a compelling answer!

📊 PHASE III | N=1,173

Randomized 2×2 factorial design evaluating abiraterone + prednisone and/or prostate radiotherapy added to standard of care (ADT ± docetaxel).

Median follow-up: 7.7 years.

📈 1️⃣ OVERALL POPULATION

✅ OS HR 0.75 (95% CI 0.65–0.87)
✅ p=0.0001

Median OS:
🔹 With abiraterone: 6.1 years
🔹 Without abiraterone: 4.6 years

➡️ A sustained 25% relative reduction in the hazard of death.

💥 2️⃣ TRIPLET THERAPY | N=710

ADT + docetaxel + abiraterone vs ADT + docetaxel:

✅ Median OS: 6.2 vs 4.4 years
✅ HR 0.68 (95% CI 0.56–0.82)

⭐ 1.8 additional years in median survival!

📊 8-YEAR OVERALL SURVIVAL

✅ Triplet: 40.3%
🔹 Doublet: 27.1%

➡️ Absolute difference: +13.2 percentage points.

These are clinically meaningful long-term outcomes, beyond early response rates or surrogate endpoints.

🔬 3️⃣ DOES METASTATIC VOLUME MATTER?

🔵 HIGH-VOLUME DISEASE

✅ Median OS: 4.6 vs 3.5 years
✅ HR approximately 0.68

A clear and durable survival advantage.

🔵 LOW-VOLUME DISEASE

📈 Median OS: 7.8 vs 6.2 years
HR 0.74 (95% CI 0.52–1.05)

Numerically favorable, although the subgroup CI crossed 1.

📌 No significant interaction by disease volume (p=0.56).

⚠️ This does not establish identical treatment benefit in both subgroups.

⭐ MY POINT OF VIEW | CLINICAL PEARL

Long-term follow-up is where a treatment strategy proves its true value.

Unlike early response signals, PEACE-1 provides mature evidence that upfront systemic intensification can translate into substantially longer survival.

💡 In appropriately selected patients with de novo mCSPC who are candidates for docetaxel, these findings strongly reinforce the role of upfront triplet therapy.

The clinical question is increasingly not simply whether to intensify, but which patients should receive a triplet, how best to integrate local treatment, and how to preserve quality of life.

🎯 Precision matters—but so does acting early when a proven survival advantage is available.

👏 Congratulations to Prof. Karim Fizazi and the entire PEACE-1 team for this important long-term contribution to prostate cancer care!

@urologysummit @gbanna74 @ravikanesvaran @Uromigos @LosUromigos

@neerajaiims @Silke_Gillessen @EfstathiouEleni @AOmlin @declangmurphy @cdanicas @montypal @DrScottTagawa

@ecancer @UrologyTimes @urotoday @wearemedsir @OpenMedicineHQ

#ProstateCancer #mCSPC #mHSPC #GUOncology #PEACE1 #TripletTherapy