Recent randomized phase III trials data presented at the European Society for Medical Oncology (ESMO) Meeting 2014, showed how patients with prostate cancer exhibit an increase in overall survival upon new treatment strategies.
Androgen deprivation therapy (ADT) is currently the treatment of choice for patients with prostate cancer, both for high-risk non-metastatic and metastatic prostate cancer. However, despite positive results, many men eventually exhibit disease again following ADT, a condition termed castrate-resistant prostate cancer (CRPC).
The findings from three different phase III trials showed how the combination of ADT with other therapeutical agents resulted in significant increase in overall survival among these patients.
Randomized CHAARTED study
Presented by Dr. Christopher Sweeney from the Dana-Farber Cancer Institute, Boston, MA, USA, the results showed that adding docetaxel to ADT significantly increased overall survival by 17 months (32.2 to 49.2 months) in untreated newly diagnosed, high-volume metastatic prostate cancer patients.
Professor Giuseppe Curigliano from the European Institute of Oncology, Milan, Italy, commented in an ESMO press release, “The investigators demonstrated that patients with ‘high-volume,’ castration-sensitive metabolic disease benefit from upfront docetaxel and it appears to confer a survival benefit that is superior to docetaxel given for metastatic castration-resistant disease. However, there is a need to develop better models to determine who ‘high-’ and ‘low-’ volume disease groups should include to avoid, for example, discrimination between a patient with several small lesions and one with a single large lesion.”
Randomized COU-AA-302 study
Presented by Dr. Charles Ryan from the University of California, San Francisco, the results showed CYP17 (key enzyme for androgen biosynthesis) inhibitor, Abiraterone acetate, combined with prednisone (a synthetic corticosteroid, that works as an immunosuppressant) increased overall survival when compared with prednisone alone in chemotherapy-naïve metastatic CRPC.
Professor Giuseppe Curigliano commented, “In future trials it will be important to select patients responsive versus resistant to abiraterone or other anti-androgen agents.”
Randomized STAMPEDE trial
Presented by Dr. Nicholas James from the University of Warwick, Coventry, UK, the results showed combining radiotherapy with ADP in patients with newly diagnosed non-metastatic (M0) and node-positive non-metastatic (N+M0) prostate cancer improved overall survival and failure-free survival.
Dr. Eleni Efstathiou, MD Anderson Cancer Center, Houston, TX, USA, noted in the same press release, “This confirms previously reported trials on locally advanced disease. Importantly, data suggest that lymph node-positive, non-metastatic disease may warrant more aggressive combinatorial strategies incorporating radiotherapy and systemic treatment. Data will need to mature and a confirmatory trial is likely warranted for current practice to be altered. Importantly, safety of such an approach is of the essence, given the involved field and diversity in radiation treatment rendered based on availability. Undoubtedly, the data presented is in line with the biology of the disease.”
