Treatment of Metastatic Disease
The management of men with metastatic prostate cancer has improved substantially during the past few years because of the availability of new drugs, but this has also presented new challenges. This year, the US Food and Drug Administration approved the use of enzalutamide before chemotherapy. Approval was based on results of the PREVAIL trial. Updated results demonstrate that the drug improved overall survival by 29% and radiographic progression-free survival by 81% compared with placebo.
Other prechemotherapy treatments already approved include abiraterone plus prednisone, sipuleucel-T, and radium-223. Important studies are needed to identify which patients do or do not benefit from these therapies and what is the best way to sequence the drugs.
Another trial, the CHAARTED study, compared ADT alone or in combination with docetaxel and found that chemotherapy improved median survival from 42.3 months to 52.7 months. In the men defined as having high-volume metastases (at least four bone or soft-tissue metastases), the improvement in survival was 17 months.
The study was well done, but because it began before the approval of the newer therapies, no standard approach was used to address progression in men in the control group. Therefore, we do not know whether using docetaxel along with ADT and delaying the use of these other options until the disease progresses would really be better than beginning with ADT, following with some sequence of these new treatments and then instituting docetaxel. The bottom line is that patients with metastases should be informed of the results from the CHAARTED study and the availability of the other therapies.
In summary, important studies were reported in 2014 that have significant implications for counseling men faced with detection or treatment of prostate cancer. We look forward to even more progress in the year ahead.
Medscape Urology © 2014 WebMD, LLC
Cite this: Gerald Chodak. Advances in Prostate Cancer: 2014 - Medscape - Dec 11, 2014.