Chemohormonal Therapy Extends Metastatic Prostate Cancer Survival

Results of CHAARTED trial of docetaxel plus androgen ablation are “practice changing” for metastatic prostate cancer patients

  • Date: 03 Jun 2014
  • Author: Lynda Williams, Senior medwireNews Reporter
  • Topic: Prostate Cancer

medwireNews: Adding docetaxel to hormone therapy significantly prolongs overall survival in men with a new diagnosis of metastatic, hormone-sensitive prostate cancer, trial findings show.

The interim results of the phase III CHAARTED (Chemohormonal Therapy versus Androgen Ablation Randomized Trial For Extensive Disease in Prostate Cancer) trial were reported this week at the annual meeting of the American Society of Clinical Oncology, held in Chicago, Illinois, USA.

“The results of this study are practice-changing”, commented presenting author Christopher Sweeney, from the Dana-Farber Cancer Institute in Boston, Massachusetts, USA, in a press release.

“We have strong scientific evidence that patients with the most advanced metastatic prostate cancer benefit from the early addition of docetaxel to testosterone suppression and not waiting until the cancer has progressed with suppressed testosterone therapy.”

By January 2014, the patients had been followed up for a median of 29 months, by which time deaths were reported for 101 of the 397 men who were randomly assigned to begin docetaxel 75 mg/m2 every 3 weeks for six cycles within the first 4 months of androgen deprivation therapy (ADT). And 136 of the 393 men given ADT alone had also died.

Overall survival was significantly longer for patients given docetaxel plus ADT than those given ADT alone, at a median of 57.6 versus 44.0 months and hazard ratio (HR) of 0.61.

The early analysis demonstrated that chemohormonal therapy significantly increased overall survival by 17 months in men with a high volume of metastases, defined as visceral disease and/or four or more bone metastases. These men given combined therapy had a median overall survival of 49.2 versus 32.2 months with ADT alone (HR=0.60).

The median overall survival has not yet been reached for patients with low-volume disease in the two treatment arms.

Chemohormonal therapy was also associated with a better outcome in all treatment subgroups assessed, including patients aged younger and older than 70 years and patients of all races. Combined treatment was also associated with longer survival for patients regardless of whether or not they had previously received localised therapy, continuous androgen blockade or early treatment to prevent skeletal metastases.

Time to clinical progression was also significantly higher for chemohormonal therapy than ADT alone (32.7 vs 19.8 months, HR=0.49) as was time to castration-resistant disease (20.7 vs 14.7 months, HR=0.56).

Of the men given docetaxel plus ADT, 6% experienced febrile neutropaenia, 1% sensory and 1% motor nerve symptoms, and one patient died.

“This is one of the biggest improvements in survival we have seen in a trial involving patients with an adult metastatic solid tumor”, said Christopher Sweeney.

“The certainty of the data is strong for patients with a high volume of metastatic disease and clearly justifies the treatment burden.”

Reference

Abstract LBA2. American Society of Clinical Oncology 50th Annual Meeting; Chicago, Illinois, USA: 30 May to 3 June 2014.

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