Combining therapies early for metastatic cancer

This study determined the benefit of combined hormone-chemotherapy in the treatment of metastatic prostate cancer.

Researchers concluded that combination therapy resulted in significantly longer overall survival.

Androgen deprivation therapy (ADT) is a type of hormone therapy that targets androgens, the male sex hormones (such as testosterone). Reducing androgen levels has dramatically improved survival among prostate cancer patients, and ADT is currently the standard of care for advanced prostate cancer.

Chemotherapy, such as docetaxel (Taxotere), is often added in patients with progressing cancer despite hormonal therapy. However, many believe that adding chemotherapy to ADT to begin with, instead of waiting until cancer progresses, may increase survival.

790 men with metastatic prostate cancer (cancer that has spread to distant organs) were randomly assigned to receive either ADT combined with docetaxel, or ADT alone.

Overall survival was significantly improved with combined ADT and docetaxel. Average survival was almost 14 months longer with combination therapy (averaged almost 58 months) compared to ADT alone (averaged 44 months). Men receiving treatment with ADT and docetaxel were 39% more likely to survive during the study follow-up (average 2.5 years), when compared to men receiving treatment with ADT alone. The benefit of combination therapy was even more pronounced in men with more advanced metastasis.

In addition to longer overall survival, combination therapy also resulted in better overall cancer control. Imaging and blood tests of cancer progressions, as well as the time to the development of drug resistance, were all reduced with combination therapy.

Combination therapy was, however, associated with an increased rate of side-effects. Serious febrile neutropenia (fever associated with a low white blood-cell count) was noted among 6.2% of men receiving combination therapy. Serious infections were noted among 2.3% of men, and chemotherapy related nerve damage was noted among 0.5% of men.

The researchers concluded that combined chemo-hormonal therapy (ADT with docetaxel) significantly improves survival in men with with metastatic prostate cancer.