Docetaxel Improves Long-Term Survival in Metastatic Prostate Cancer
NEW YORK (Reuters Health) - Docetaxel improves long-term survival in men with metastatic hormone-sensitive prostate cancer (mHSPC) regardless of their metastatic burden, according to findings from the STAMPEDE trial.
STAMPEDE investigators previously reported that upfront docetaxel improved overall survival in patients with metastatic hormone-naive prostate cancer (mHNPC) who start long-term androgen-deprivation therapy (ADT).
In the current study, Dr. Noel W. Clarke from The Christie and Salford Royal NHS Foundation Trusts, in Manchester, U.K., and colleagues examined long-term outcomes stratified by metastatic burden in 1,086 men with newly diagnosed metastatic prostate cancer randomized to standard of care or standard of care plus docetaxel treatment.
After a median follow-up of 78.2 months, patients receiving docetaxel had a median survival of 59.1 months versus 43.1 months among controls. Their estimated five-year survival was 49% versus 37%, the researchers reported in the Annals of Oncology, online September 27.
Docetaxel yielded a significant survival benefit in both metastatic-burden subgroups. Median survival with docetaxel was 93.2 months versus 76.7 months among controls in the low-burden subgroup and 39.9 months versus 35.2 months in the high-burden subgroup.
The estimated five-year survival with docetaxel was 72% versus 57% among controls in the low-burden subgroup and 34% versus 24% in the high-burden subgroup.
Addition of docetaxel to standard of care also produced significant improvements in failure-free, progression-free, metastatic progression-free survival and prostate-cancer-specific survival.
During the first year of follow-up, grade 3-5 toxicity rates were higher with docetaxel (42%) than with standard of care (24%), but toxicity reports were balanced across groups after the initial year.
"This reinforces the principle that ADT and docetaxel can be considered as an effective first-line treatment option for men with mHNPC regardless of metastatic burden," the authors conclude.
Dr. Carlo Cattrini from the Spanish National Cancer Research Center's Prostate Cancer Clinical Research Unit, in Madrid, told Reuters Health by email, "The results of STAMPEDE support the notion that chemotherapy in mHSPC can be used irrespective of disease volume in all patients fit enough to receive it. The choice between chemotherapy and novel hormonal agents remains challenging in mHSPC patients, but now there is no evidence to choose one rather than the other based on disease volume."
"In the treatment decisions, now we consider all mHSPC patients as a unique group," said Dr. Cattrini, who was not involved in the study. "However, we know that the behavior of de novo mHSPC is completely different from that of men relapsing after primary procedures, and currently we don't know if the survival benefit observed in these trials (which mostly enrolled patients with de novo mHSPC) would be also observed in a population with relapsing patients only."
Several drug companies supported the research.
Dr. Clarke did not respond to a request for comments.
Ann Oncol 2019.