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Does Earlier Chemo Offer Bigger Benefits to Prostate Cancer Patients?

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The mainstay of initial treatment for advanced prostate cancer is hormonal therapy, also called androgen deprivation therapy (ADT). Testosterone, the predominant male hormone (or androgen), stimulates growth of prostate cancer cells. But while lowering testosterone levels with ADT is highly effective, it does not offer a cure. In time, the effect of testosterone suppression wanes and the disease progresses. At this point, a man is considered to have castration-resistant, or castration-recurrent, prostate cancer (CRPC).

Traditionally, chemotherapy has been the next step for men whose prostate cancer is no longer controlled by ADT and has spread outside the prostate. Chemotherapy works by destroying cancerous cells as they replicate. But some researchers wondered what would happen if chemotherapy was initiated at the same time as ADT instead of waiting for ADT to fail. Could this help a man live longer? And if so, how long?

The CHAARTED (ChemoHormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer) study was launched in July 2006 to answer these important questions. The trial enrolled 790 men with metastatic prostate cancer who had not yet started androgen deprivation (or androgen ablation) therapy. The men (average age, 63) were randomly assigned to receive ADT alone or ADT plus the chemotherapy agent docetaxel (Taxotere).

The study was stopped prematurely in 2012 after an interim analysis showed that men who had received the chemo-hormonal therapy survived 57.6 months, on average, compared with 44 months for those who received hormone therapy only. Interestingly, the survival difference between the two groups was even greater in men with high-volume disease (four or more bone metastases, one of which is outside the spine or pelvis).

Findings from the CHAARTED study have proven to be game changing. Indeed, the National Comprehensive Cancer Network (NCCN) has revised its most recent prostate cancer treatment guidelines to include concurrent chemotherapy-hormone therapy as an option for some men with high-volume disease who have not been treated with ADT. Some doctors may also recommend this regimen to a man who lacks metastases to the bone if he has malignancies that have spread to the liver or lung, since they are associated with a particularly poor prognosis.

Laboratory studies have suggested that ADT plus cabazitaxel (Jevtana)—a newer chemotherapy drug in the same family as docetaxel—is an even more effective combination. Investigators have begun clinical trials to determine whether that finding may also hold true for humans. For now, however, Jevtana is currently approved only for use by men with metastatic CRPC who have already been treated with docetaxel. 

 

Posted in Prostate Disorders on April 12, 2016


Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Health After 50 Disclaimer


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Health After 50 Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the editors cannot be answered in this space.

The views expressed here do not constitute medical advice, and do not represent the position of Scientific American Health After 50 or Remedy Health Media, LLC, which has no responsibility for any comments posted on this site.


New survival data supporting more aggressive cancer treatment should be accompanied by whatever is known about how the new treatment affects quality of life, i.e. negative side effects. There is a severity of side effects beyond which at least some patients with advanced prostate or other cancers might decide to abstain from further treatment, electing palliative care instead. More than any other disease, cancer chemotherapies should include a discussion of the risk/benefit profile rather than just the benefit.

Posted by: AndyGpost | April 17, 2016 11:00 AM

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Prostate Disorders White Papers

H. Ballentine Carter, M.D.
Professor, Department of Urology and Oncology
Director, Adult Urology
Johns Hopkins University School of Medicine    

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