Drug combination extends survival by more than a year in metastatic prostate cancer

June 2, 2014

Men with newly diagnosed metastatic, hormone-sensitive prostate cancer lived more than a year longer when they received a chemotherapy drug as initial treatment instead of waiting to for the disease to become resistant to hormone-blockers, report scientists from Dana-Farber Cancer Institute and the Eastern Co-operative Oncology Group.

The dramatic results in a multi-center phase III trial should change the way physicians have routinely treated such patients since the 1950s, they said.

"This is the first study to identify a strategy that prolongs survival in newly diagnosed, metastatic ," said Christopher J. Sweeney, M.B.B.S, of Dana-Farber's Lank Center for Genitourinary Oncology. He presented the results of the trial Sunday, June 1, 2014 at the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago.

"The benefit is substantial and warrants this being a new standard treatment for men who have high-extent disease and are fit for chemotherapy," added Sweeney, principal investigator of the E3805 National Cancer Institute-funded study.

"The prolongation in survival seen in the prostate cancer patients participating in Dr. Sweeney's study is very impressive, dramatically longer than the typical 2-6 month prolongation typically observed in successful studies of other metastatic adult solid tumors," said Bruce E. Johnson, MD, Dana-Farber's chief clinical research officer.

In current practice, men newly diagnosed with prostate cancer that has spread widely, and whose cancer depends on male hormones to grow, are started on hormone-blocking medications – androgen deprivation therapy (ADT). Most tumors eventually outgrow their need for hormones and the cancer progresses. Only then do patients begin chemotherapy.

The video will load shortly
Dr. Christopher Sweeney talks about his new study showing a drug combination extends survival by more than a year in metastatic prostate cancer. Credit: Dana-Farber Cancer Institute

The new trial tested Sweeney's hypothesis that immediately hitting the cancer with chemotherapy in addition to hormone treatment would impair the tumor cells' ability to repair damage, delaying the development of resistance.

The study enrolled 790 men newly diagnosed with metastatic disease; they were randomized to receive ADT alone or ADT with docetaxel (brand name Taxotere®) over 18 weeks. In the ADT-only group, 124 patients were given docetaxel when their cancer worsened. In the ADT-plus-docetaxel group, 45 patients whose disease progressed received additional docetaxel.

At a median follow-up of 29 months, 136 patients in the ADT-only group had died versus 101 in the group that received both drugs. This translated into a median overall survival of 57.6 months for men who received early chemotherapy compared with 44 months in the group given ADT as the only initial treatment – more than a year of additional life.

In the 520 patients who had high-extent disease (whose cancer had spread to major organs and/or the bones), treatment with ADT plus docetaxel had an even greater benefit: these men had a median overall survival of 49.2 months versus 32.2 in the ADT-only group – a difference of 17 months.

Earlier results of the trial were made public by the NCI in December 2013 because of the strong positive findings. Sweeney's presentation at ASCO covers updated and more detailed results.

Most of the striking survival benefit with early use of docetaxel was found in men with a high burden of . Sweeney said more time is needed to assess the benefit of the drug combination in the men with lesser burdens of disease, as their median survival has not yet been reached.

The most serious side effects were neutropenic fever and neuropathy; one patient died as a result of treatment.

The addition of docetaxel not only lengthened survival but delayed disease progression as measured by an increase in prostate-specific antigen (PSA), the appearance of new metastases, or worsening symptoms. The receiving had an average of 32.7 months before the cancer progressed by worsening scan results or symptoms, compared to 19.8 months for hormone therapy alone.

"This study shows that early chemotherapy increases the chances that certain patients with have a longer time without symptoms from , and also live longer," Sweeney said.

Explore further: Treatment extends life for men with prostate cancer

Related Stories

Treatment extends life for men with prostate cancer

June 1, 2014
A new treatment has been shown to extend the lifespans of men with advanced prostate cancer by as much as one year, researchers said Sunday.

Study shows benefits for men with metastatic prostate cancer who receive chemotherapy when starting hormone therapy

December 6, 2013
Men with hormone-sensitive metastatic prostate cancer who received the chemotherapy drug docetaxel given at the start of standard hormone therapy lived longer than patients who received hormone therapy alone, according to ...

ASCO: No benefit for immediate ADT after PSA-only relapse

May 22, 2014
(HealthDay)—For men with a prostate-specific antigen (PSA)-only-based relapse after prostate surgery or radiation therapy, there seems to be little or no survival benefit for immediate initiation of androgen deprivation ...

Liver metastases and its prognostic significance in men with metastatic prostate cancer

May 31, 2012
Liver metastases predicts shorter overall survival in men with metastatic castration-refractory prostate cancer (mCRPC), according to data being presented at the 2012 American Society of Clinical Oncology Annual Meeting in ...

Radiation for prostate cancer linked to secondary cancers, study finds

May 30, 2014
Among men treated for prostate cancer, those who received radiation therapy were more likely to develop bladder or rectal cancer, according to a new study from the University of Michigan Comprehensive Cancer Center.

Prostate cancer drug delivers benefits before chemotherapy

June 2, 2014
A drug used to treat men with late-stage prostate cancer proved effective in stemming progression of the disease in research participants who had not yet received chemotherapy and extended their survival, according to results ...

Recommended for you

No dye: Cancer patients' gray hair darkened on immune drugs

July 21, 2017
Cancer patients' gray hair unexpectedly turned youthfully dark while taking novel drugs, and it has doctors scratching their heads.

Shooting the achilles heel of nervous system cancers

July 20, 2017
Virtually all cancer treatments used today also damage normal cells, causing the toxic side effects associated with cancer treatment. A cooperative research team led by researchers at Dartmouth's Norris Cotton Cancer Center ...

Molecular changes with age in normal breast tissue are linked to cancer-related changes

July 20, 2017
Several known factors are associated with a higher risk of breast cancer including increasing age, being overweight after menopause, alcohol intake, and family history. However, the underlying biologic mechanisms through ...

Immune-cell numbers predict response to combination immunotherapy in melanoma

July 20, 2017
Whether a melanoma patient will better respond to a single immunotherapy drug or two in combination depends on the abundance of certain white blood cells within their tumors, according to a new study conducted by UC San Francisco ...

Discovery could lead to better results for patients undergoing radiation

July 19, 2017
More than half of cancer patients undergo radiotherapy, in which high doses of radiation are aimed at diseased tissue to kill cancer cells. But due to a phenomenon known as radiation-induced bystander effect (RIBE), in which ...

Definitive genomic study reveals alterations driving most medulloblastoma brain tumors

July 19, 2017
The most comprehensive analysis yet of medulloblastoma has identified genomic changes responsible for more than 75 percent of the brain tumors, including two new suspected cancer genes that were found exclusively in the least ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.