Advanced prostate cancer - combining ADT with chemotherapy

[alanbarlee]

The following current Medscape article (extract) will be of interest to all our members:

"The survival of men with metastatic disease who progress following ADT (androgen deprivation therapy) continues to improve. Before 2004, the median survival was less than 36 months, but it is now more than 5 years, thanks to new therapies approved by the US Food and Drug Administration (FDA). The standard of care for nearly 10 years has been to initiate ADT for men with metastatic disease followed by docetaxel when the disease became castration-resistant.

That may change soon for men with more extensive metastases, however, following the results of the CHAARTED study. This randomized controlled trial compared standard ADT vs ADT plus docetaxel every 3 weeks for 6 cycles. The results were made public because the interim analysis found a significantly longer 3-year overall survival rate in men who received the combined therapy (63.4% for ADT and docetaxel-based chemotherapy vs 43.9% for ADT alone). This is a game changer that will require urologists to interact more closely with oncologists when starting ADT to ensure that the combination treatment is delivered.

Despite disease progression in many men following standard ADT with surgical or medical castration, the hormonal axis continues to offer therapeutic opportunities for men with metastatic disease. Abiraterone acetate combined with prednisone was previously approved to treat metastatic castration-resistant prostate cancer (mCRPC) after docetaxel. This year the combination gained approval for use before chemotherapy in asymptomatic or minimally symptomatic men with mCRPC after an updated interim analysis of a phase 3 clinical trial.[9]

The study was stopped when a planned interim analysis showed a median radiographic progression-free survival of 16.5 months with abiraterone vs 8.3 months with prednisone alone. Median overall survival was 35.3 months in the abiraterone arm and 30.1 months in the placebo arm (hazard ratio

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, 0.79; P = .0151). This marks the second FDA-approved therapy available for men with mCRPC before chemotherapy; sipuleucel-T (immunotherapy) was previously approved in this clinical setting".

[DavidAbrahams]

Very interesting, I think I will pass a copy to my Medical Oncologist as he believes I've moved into the CRPC stage  and has indicated that I should start Chemo sooner rather than later. Towards end of 1st quarter of 2014. The conundrum is that he sent me for a second opinion and I was advised that it would be at least another 12 months at the earliest before I would have to consider chemo.

Where is the Crystal Ball!