Chemotherapy with ADT Prolongs Survival in Patients with Prostate Cancer

Addition of docetaxel had the greatest benefit in patients with a high burden of metastatic disease.

Men with certain types of metastatic prostate cancer can look forward to better treatment after a recent study revealed giving chemotherapy along with hormone therapy can prolong the lives of patients with this disease.

Prostate cancer is the second most common cancer among men in the United States after skin cancer. More than half of prostate cancers remain in the area of origin and do not pose a threat to patients’ lives. They can be treated with surgery or radiation, but in some cases they do not need treatment.

Prostate cancer that has metastasized is treated with radiation or surgery along with drugs that block the hormones the tumors rely on to grow and spread. Androgen deprivation therapy (ADT) uses medications to block the action of hormones like testosterone that promotes male sex characteristics.

Chemotherapy is not given to those who have metastatic prostate cancer that is sensitive to hormone therapy. Chemotherapy only becomes an option when hormone therapy is no longer controlling the disease. Researchers led by Christopher Sweeney, MBBS, of the Dana-Farber Cancer Institute performed a clinical trial to test whether adding the chemotherapy drug docetaxel at the start of ADT treatment would improve overall survival.

The study observed nearly 800 men with metastatic, hormone-sensitive prostate cancer. The men were randomly assigned to receive ADT alone or ADT plus 6 cycles of docetaxel. The median follow-up time was approximately 29 months.

The study showed that those who had ADT treatment along with chemotherapy had a longer survival rate than those who did not receive chemotherapy. Adding docetaxel benefitted all the subgroups analyzed, but had the greatest effect in those with a high burden of metastatic disease.

Men in the combination group also showed improvement in the prostate-specific antigen (PSA) test. More patients in the combination group had lower levels of PSA than did those in the ADT-only group.

Side effects of the combination therapy were mild, including fatigue and allergic reaction. Further research is still needed to determine which prostate cancer patients would benefit from adding chemotherapy to ADT.

“This trial is the first to identify a strategy that prolongs survival compared with ADT alone in men newly diagnosed with metastatic, hormone-sensitive prostate cancer,” Dr. Sweeney said.