Earlier chemotherapy may extend patient survival in multiple prostate cancer settings

Whether a prostate cancer patient is just presenting with localized high risk prostate cancer, presenting with metastatic prostate cancer, or experiencing a metastatic recurrence, earlier treatment with taxane chemotherapy may prolong survival.

June 19, 2015 — Chemotherapy with docetaxel® (taxotere) has traditionally been used to treat prostate cancer patients only after they have developed resistance to hormone therapy. However, two new studies presented at the 2015 American Society for Clinical Oncology (ASCO) Annual Meeting found that the addition of taxane chemotherapy extended survival in several groups of patients initiating hormone therapy: in patients with primary metastatic disease or relapse with metastases after definitive local treatment, and as a first-line therapy in previously untreated patients with localized high-risk prostate cancer.

Upfront Therapy with Docetaxel® Prolongs Overall Survival in Men with Hormone-Naïve Metastatic Prostate Cancer Commencing Hormone Therapy

Prostate cancer patients who present with primary metastatic disease or relapse with metastases after definitive local treatment with prostatectomy or radiotherapy (RT) typically receive androgen deprivation therapy (ADT) with or without RT as the standard of care. Taxane chemotherapy or 2nd generation anti-androgen medications are only prescribed following the onset of ADT resistance. However, it is hypothesized that earlier administration of these therapies may extend patient lives.

Dr. Nicholas James of the University of Warwick and Queen Elizabeth Hospital Birmingham presented the first survival results released from the STAMPEDE CLINICAL TRIAL, the largest randomized clinical trial ever conducted in prostate cancer patients. This study tested the outcome of adding various therapies to the standard of care—ADT with or without RT—in hormone-naïve patients either presenting with metastatic disease or relapsing after prostatectomy or RT. The addition of docetaxel + prednisolone to standard of care treatment extended the median failure-free survival time from 21 months to 37 months, and extended the median overall survival time from 67 months to 77 months.

These results support previous results from the CHAARTED trial, presented at the 2014 ASCO annual meeting, where the addition of docetaxel® to ADT improved median overall survival from 44 to 57.6 months in a cohort of hormone-sensitive metastatic prostate cancer patients.  Collectively, these results support a paradigm change in clinical practice. Docetaxel® in combination with ADT should now be considered much earlier in the treatment regimen for men with hormone-naïve metastatic prostate cancer. 

The 2015 ASCO Annual Meeting was held from May 29 – June 2, in Chicago, IL. The preceding article was adapted from the July 2, 2015 issue of the Prostate Cancer Foundation Publication, NewsPulse.

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