Adding docetaxel-based chemotherapy early to hormone therapy can improve survival

This study examined the benefit of adding chemotherapy to androgen deprivation therapy (ADT) early to treat metastatic hormone-sensitive prostate cancer. Researchers reported a survival benefit when chemotherapy was added to ADT. This benefit was only detected with chemotherapy involving docetaxel (Taxotere).

ADT is a type of hormone therapy that targets male hormones (such as testosterone) active in cancer growth. Reducing androgen levels can dramatically improve survival among prostate cancer patients. ADT is currently the standard of care for prostate cancer that has spread to distant organs (metastatic).

Many patients, however, stop responding to hormone therapy over time. This is known as hormone-resistant prostate cancer. Chemotherapy, such as docetaxel, is often added to ADT in cases of hormone-resistant prostate cancer. However, recent evidence is suggesting that adding chemotherapy to ADT early for hormone-sensitive prostate cancer may increase survival. This is in contrast to waiting until cancer progresses and becomes hormone-resistant.

This study aimed to examine the benefit of adding chemotherapy to ADT early to treat metastatic hormone-sensitive prostate cancer.

The results of 6 separate trials were included in analysis. A total of 2,675 men with metastatic hormone-sensitive prostate cancer were randomly assigned to undergo ADT alone or ADT plus chemotherapy. 3 trials applied the chemotherapy drug docetaxel. 2 trials used estramustine (Emcyt). 1 trial used estramustine in combination with other chemotherapy drugs. Patients were followed for an average of 26 to 82.9 months.

Docetaxel administered with ADT was associated with improved overall survival (time from treatment until death from any cause). Men receiving ADT plus docetaxel were 25% more likely to survive the study period compared to ADT alone. They also showed a 36% reduced risk of cancer progression compared to ADT alone. No significant survival benefit was observed with estramustine-based chemotherapy.

Estramustine-based chemotherapy plus ADT and ADT alone were associated with a similar rate of side effects. Men undergoing ADT plus docetaxel reported a higher rate of side effects compared to ADT alone. Low white blood cell counts were observed in 12 to 32% of men receiving docetaxel.

Researchers concluded that adding docetaxel-based chemotherapy to ADT can offer a survival benefit in men with metastatic hormone-sensitive prostate cancer. This benefit was not detected with other chemotherapy drugs.