Chemohormonal Therapy versus Hormonal Therapy Alone in Men with Metastatic Prostate Cancer
Although the majority of patients with metastatic castrate-resistant prostate cancer (mCRPC) respond to androgen-deprivation therapy (ADT), prostate cancer will recur in many patients undergoing ADT. Because docetaxel has been shown to prolong overall survival (OS) in men with CRPC, Sweeney and colleagues reported on their trial that evaluated whether adding docetaxel to the treatment regimen improves OS when given at the time of starting ADT (Sweeney C, et al. ESMO 2014: Abstract 756O).
A total of 790 men with CRPC were randomized in a 1:1 ratio to receive ADT alone or ADT plus docetaxel 75 mg/m2 every 3 weeks for 6 cycles within 4 months of initiating ADT. Patients were stratified based on high-volume versus low-volume disease, where high-volume disease included those with visceral metastases and/or ?4 bone metastases, with at least 1 outside the vertebral column and pelvis.
The Table shows the results of ADT versus ADT plus docetaxel for the patients with high-volume disease. Decrease in prostate-specific antigen (PSA) to <0.2 ng/mL at 12 months, the time to PSA progression or to clinically progressive disease, and median OS were all significantly superior in the group receiving ADT plus docetaxel compared with the group receiving ADT alone. Grade 3 or 4 treatment-related adverse events were comparable in the 2 groups.
These data indicate that ADT plus docetaxel significantly improves disease control and OS compared with ADT alone in men with high-volume mCRPC.