Adding Docetaxel or Zoledronic Acid to ADT for Advanced Prostate Cancer?

Summary and Comment |
January 7, 2016

Adding Docetaxel or Zoledronic Acid to ADT for Advanced Prostate Cancer?

  1. Robert Dreicer, MD, MS, FACP, FASCO

Docetaxel improved survival; zoledronic acid did not.

  1. Robert Dreicer, MD, MS, FACP, FASCO

Evidence from a recent U.S. intergroup study (CHAARTED; NEJM JW Oncol Hematol Apr 2013 and N Engl J Med 2015;

373:737) provides compelling evidence supporting the use of docetaxel at initiation of androgen deprivation therapy (ADT) in men with high-volume metastatic prostate cancer.

To examine this approach further, investigators in Europe conducted an industry-funded, randomized, controlled phase II/III study involving 2962 patients with newly diagnosed, metastatic, node-positive, or high-risk locally advanced disease. Patients who were previously treated with radical surgery, radiotherapy, or both and had relapsed with high-risk features were also eligible. Most patients (94%) were newly diagnosed; of these, 62% had metastatic disease. Patients were randomized 2:1:1:1 to standard of care (SOC; typically ADT and radiotherapy), SOC plus zoledronic acid, SOC plus docetaxel (with prednisolone), or SOC plus zoledronic acid and docetaxel.

At median follow-up of 43 months, overall survival (OS; the primary endpoint) was similar with SOC and SOC plus zoledronic acid (45 and 46 months, respectively). In contrast, median OS was improved with SOC plus docetaxel versus SOC (60 vs. 45 months; hazard ratio, 0.76; P=0.005) and with SOC plus docetaxel and zoledronic acid versus SOC (55 vs. 45 months; HR, 0.79; P=0.015).

Comment

Adding docetaxel to SOC significantly improved survival. When these data are considered along with the findings of the CHAARTED study, the addition of docetaxel to ADT in men with previously untreated metastatic prostate cancer should now be considered the standard of care.

Editor Disclosures at Time of Publication

  • Disclosures for Robert Dreicer, MD, MS, FACP, FASCO at time of publication Consultant / Advisory board Medivation; Genetech/Roche; Bind Pharmaceuticals; Astellas Editorial boards Urology; Clinical Genitourinary Cancer; Current Urology Reports Leadership positions in professional societies National Cancer Institute (Co-Chair, GU Oncology Steering Committee); American Board of Internal Medicine (member, Medical Oncology Test Writing Committee); Bladder Cancer Advocacy Network (member, scientific advisory board)

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.