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Chemotherapy + Hormone Therapy in newly diagnosed men with metastatic prostate cancer


Paul Edwards

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Paul Edwards

Doctors have been starting to use the newer drugs such as Xtandi (enzalutamide) and Zytiga (abiraterone) before docetaxel. This has moved chemotherapy further back in the sequence of treatment.

 

Now there is evidence for a role for earlier chemotherapy for some men.  By moving docetaxel from the castration-resistant stage, when men were not responding to testosterone-lowering agents, to the castration-sensitive state, when they were, the survival benefits were amplified.

 

The evidence comes from a clinical trial, “Chemohormonal Therapy versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer (CHAARTED)”.  The results were presented at the 2014 annual general meeting of the American Society of Clinical Oncology (ASCO).

 

The trial compared “upfront” docetaxel plus hormone therapy with hormone therapy alone in men with metastatic prostate cancer.  When patients enrolled in the trial, they were classified by the extent of their metastatic disease as high-volume or low-volume.  High volume was defined as visceral metastasis or 4+ bone metastases or both.

 

In men with high volume metastatic prostate cancer, the trial found that docetaxel plus hormone therapy improved survival over hormone therapy alone.  Longer follow-up was needed for men with low volume metastatic prostate cancer.

 

Dr Christopher Sweeney, the lead investigator of the trial, said: “This is one of the biggest improvements in survival we have seen in a trial involving patients with an adult metastatic solid tumour.”   Dr Michael J. Morris of Memorial Sloan Kettering Cancer Centre commented: “The best therapies reported previously have less than a third of the benefit seen in these patients.”

 

This study will not change the sequence of treatment for all patients.  This treatment applies only to men who had high volume metastatic cancer when first diagnosed.  Only about 4% of men with prostate cancer have metastatic cancer when first diagnosed.  Of that 4% the number of men with high-volume disease is even smaller.  Also to receive this treatment, patients must be well enough to receive docetaxel therapy.

 

Dr Sweeney is now involved in a clinical trial looking at the “upfront” treatment of newly diagnosed prostate cancer patients with docetaxel plus hormone therapy plus Xtandi (enzalutamide).

 

There are 2 talks on the internet about “upfront” docetaxel plus hormone therapy.

 

One is by Dr Snuffy Myers on his blog.  This talk is designed for patients with prostate cancer.  Here is the link to the video by Dr Myers:

 

http://askdrmyers.wordpress.com/2014/06/05/taxotere-lupron-before-adt/

 

The second is an interview on the Uro Today website with Dr Sweeney.  This interview is intended for urologists.  It is not suitable for general listeners.  Unless you have a detailed knowledge of clinical trials and of the statistical methods used in these trials, you should not listen to this interview.

 

Further information about the CHAARTED trial (including a link to the abstract of the trial) is available on the ASCO website.

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