Prostate Cancer - Metastatic

A New Standard of Care?

For years the first line therapy for metastatic prostate cancer was hormone deprivation.  While there was debate as to whether this should be combined androgen blockade (using an androgen receptor blocker with a LHRH agonist (like Lupron) or LHRH alone, continuous or intermittent therapy this was the standard of care.

This may have changed after Dr. Christopher Sweeney presented findings from the ECOG E3805 CHAARTED trial in June, 2014 at the American Society of Clinical Oncology (ASCO).

The initial results presented December, 2013 were not as impressive.  The updated results have a median follow-up of 29 months and looked at almost 800 men.  The groups were randomized to either get hormone deprivation alone or hormone deprivation and chemotherapy (docetaxel).

The overall survival (OS) was 14 months longer in the group that received both vs hormonal deprivation alone.

 

It was even more impressive at 17 month OS advantage in the group who started with high volume disease.  The combination also increased time to PSA elevation by 6 months and clinical progression by 13 months.

 

There are increased risks with this combination including suppressed white cell count and decreased nerve function along with other risks of chemotherapy.

 

It is still unclear if patients with small volume, metastatic disease will have this great of a response and further studies will be needed. For now this may be the biggest news in years for treatment of metastatic prostate cancer.

Taken from an article I originally wrote on about.com

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