Role of systemic chemotherapy in metastatic hormone-sensitive prostate cancer

Niraj Shenoy, Manish Kohli

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: Patients with metastatic hormone sensitive prostate cancer (mHSPC) have traditionally been treated with androgen deprivation therapy (ADT). Recently, there has been a demonstration of a survival benefit with the addition of docetaxel to ADT from three large randomized controlled trials. This review summarizes these trials, draws comparisons between the trials, and attempts to provide critical evidence-based recommendation on the role of docetaxel in mHSPC. Methods: Of the two published (GETUG-AFU, Chemo-Hormonal therapy vs. Androgen Ablation Randomized Trial for Extensive Disease in prostate cancer [CHAARTED]) and one presented trial (STAMPEDE) an analysis of the study design, patient characteristics, outcomes, variables, and a critical comparison between the trials was performed for making practice recommendations. Results: All the three trials demonstrated statistically significant progression free survival with the addition of docetaxel to ADT in mHSPC. However, while CHAARTED trial demonstrated a significant survival benefit with addition of docetaxel to ADT in patients with high volume mHSPC, GETUG-AFU failed to demonstrate statistically significant survival benefit although there was an absolute difference in survival between the two arms, with lower sample size and statistical power compared to CHAARTED. The largest study, STAMPEDE, reported a 22 month survival benefit in patients with M1 disease with statistical significance; with subgroup analysis of high volume and low volume disease patients yet to be reported. Conclusion: After a careful comparison between the trials, we conclude that systemic docetaxel chemotherapy within 4 months of initiating ADT for metastatic, high-volume HSPC should be considered the standard of care for patients with good performance status.

Original languageEnglish (US)
Pages (from-to)257-261
Number of pages5
JournalIndian Journal of Urology
Volume32
Issue number4
DOIs
StatePublished - Oct 1 2016

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docetaxel
Androgens
Prostatic Neoplasms
Hormones
Drug Therapy
Survival
Therapeutics
Standard of Care
Sample Size
Disease-Free Survival
Randomized Controlled Trials

Keywords

  • Chemotherapy
  • hormones
  • prostate cancer

ASJC Scopus subject areas

  • Urology

Cite this

Role of systemic chemotherapy in metastatic hormone-sensitive prostate cancer. / Shenoy, Niraj; Kohli, Manish.

In: Indian Journal of Urology, Vol. 32, No. 4, 01.10.2016, p. 257-261.

Research output: Contribution to journalArticle

Shenoy, Niraj ; Kohli, Manish. / Role of systemic chemotherapy in metastatic hormone-sensitive prostate cancer. In: Indian Journal of Urology. 2016 ; Vol. 32, No. 4. pp. 257-261.
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