Chemo plus androgen deprivation therapy recommended for extensive hormone-sensitive prostate cancer
A combination of chemotherapy and androgen deprivation therapy (ADT) is recommended for men with extensive hormone-sensitive prostate cancer, according to a presentation at the 14th Urological Association of Asia (UAA) Congress 2016 held in Singapore.
In the CHAARTED study, men with metastatic, hormone-sensitive prostate cancer who received six cycles of docetaxel in addition to ADT had significantly longer overall survival (OS) than those on ADT only (57.6 vs 44.0 months, hazard ratio [HR] for mortality in the combined therapy group, 0.61, 95 percent confidence interval [CI], 0.47-0.80; p<0.001). [N Engl J Med 2015;373:737-746]
However, in the randomized, open-label, phase III GETUG-AFU-15 study, docetaxel was not recommended as first-line treatment for patients with noncastrate, metastatic prostate cancer where the median OS was 58.9 months in patients given docetaxel and ADT compared with 54.2 months in those on ADT alone (HR, 1.01, 95 percent CI, 0.75-1.36). [Lancet Oncol 2013;14:149-158]
In the STAMPEDE trial, men given docetaxel at the initiation of long-term hormone therapy had improved survival compared to those on long-term hormone therapy only (HR, 0.78, 95 percent CI, 0.66-0.93; p=0.006), although the combination arm also had a higher incidence of adverse events. [Lancet 2016;387:1163-1177]
“Chemohormonal therapy in men with extensive disease castrate-sensitive metastatic prostate cancer improves overall survival,” said Associate Professor Glenn Liu from the University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, US, who presented these findings at UAA 2016.
“GETUG-AFU-15 showed a trend towards improvement in OS, but it was not statistically significant. CHAARTED showed improvement in overall survival in intent-to-treat, with predominant benefit seen in men with extensive disease,” said Liu.
“The addition of six cycles of docetaxel chemotherapy to ADT in hormone-sensitive prostate cancer should be recommended if there is extensive disease present and [the patient is] a candidate for docetaxel. Chemohormonal therapy may be considered in men with high functional burden of disease,” he said, citing men with rapidly rising prostate-specific antigen (PSA) levels, high-grade disease, large metastases, and de novo presentation as potential candidates.
According to Liu, targeting the androgen receptor remains the most effective strategy for treating advanced prostate cancer and suggested that improved understanding of the resistance mechanisms in castrate-resistant prostate cancer may help with selecting the optimal treatment for patients.