Combining chemotherapy and hormone therapy early for metastatic prostate cancer

This study examined the safety and effectiveness of androgen deprivation therapy (ADT) plus docetaxel (Taxotere) compared to ADT alone for metastatic prostate cancer. Researchers reported increased progression-free survival and overall survival when ADT was combined with docetaxel.

ADT is a type of hormone therapy that targets androgens, the male sex hormones (such as testosterone). Reducing androgen levels can dramatically improve survival among prostate cancer patients. ADT is currently the standard of care for advanced prostate cancer, including cancer that has spread to distant parts of the body (metastatic).

Chemotherapy, such as docetaxel, is often added in patients with progressing cancer despite standard hormonal therapy. However, a number of studies have suggested that adding docetaxel to ADT to begin with, instead of waiting until cancer progresses, may increase survival.

This study aimed to compare the safety and effectiveness of ADT plus docetaxel with ADT alone. The results of 3 separate trials involving 2,264 men with metastatic prostate cancer were pooled into a single analysis. Men were randomly assigned to either undergo treatment with ADT plus docetaxel or ADT alone. All men were receiving hormone therapy for the first time. Treatment outcomes were followed for an average of 51.6 months.

The combination of docetaxel and ADT resulted in longer progression-free survival compared to ADT alone. Men receiving the combination therapy were 37% less likely to show disease progression (based on blood tests) than men receiving ADT alone. Men receiving combination therapy were 27% less likely to have a short overall survival (time from treatment until death from any cause) relative to ADT alone.

Men with large tumors (high-volume disease) showed a 33% benefit in overall survival with combination therapy. However, overall survival was similar for combination therapy and ADT alone for men with smaller tumors.

Side effects were more common among men undergoing ADT plus docetaxel compared to ADT alone. These included low white blood cell counts, with and without fever, and severe fatigue. 

Researchers concluded that men with metastatic prostate cancer who receive both chemotherapy and hormone therapy early had increased progression-free survival and overall survival. The benefit in overall survival was especially pronounced for men with high-volume disease.