"A major game-changer" for men with metastatic prostatic cancer
New study proves early treatment with both chemotherapy and hormonal therapy has a major impact
Eisenberger and Carducci: Giving chemotherapy sooner rather than later prolongs life.
It used to be that men with metastatic prostate cancer were started on hormonal therapy, and when cancer escaped the hormones they moved on to chemotherapy. By then, there was so much cancer, and the disease had evolved into something so difficult to kill, that the response to this treatment was usually short-lived. A decade ago, investigators from the Eastern Cooperative Oncology Group Genitourinary Group (ECOG), chaired by Hopkins oncologist Michael Carducci, decided that it was time to shake things up. What if, they wondered, instead of waiting for the disease to come to us, we go after it sooner, rather than later?
Results of a new study called CHAARTED, sponsored by the National Cancer Institute, have proven that early treatment with chemotherapy in addition to hormonal therapy has a major impact on quality and quantity of life.
This study showed that in men with more than three metastatic lesions on bone scan, when chemotherapy is given at the same time as hormonal therapy is started, survival improved by nearly a year and a half. "This has the potential to be a major game-changer," says Carducci. He and Eisenberger were co-authors of this study, led by Christopher Sweeny of the Dana Farber Cancer Institute/Harvard Cancer Center. "Based on these results, it seems now that men diagnosed with metastatic disease will do well to include a medical oncologist in their care team to seek the advisability of early chemotherapy, in addition to hormonal therapy."
This work, presented during the plenary session of the 2014 American Society of Clinical Oncology, found that six cycles of chemotherapy with docetaxel given together with standard hormonal therapy extended the lives of men with newly diagnosed metastatic prostate cancer by nearly 18 months, with manageable side effects. "We saw the benefits mainly in men with high-volume metastasis," says Eisenberger, "men with more than three lesions seen on a bone scan, and/or liver and lung involvement." It is well known that prostate cancer cells are sensitive to hormonal therapy, says Carducci, "but in the vast majority of men, for many reasons, the cancer continues to grow." In fact, scientists speculate that even at the time of diagnosis, some cancer cells are already hormone-resistant. "The idea behind CHAARTED," adds Eisenberger, "was that if docetaxel is effective against cells that no longer respond to hormones at late stages, then it could be even more effective if we gave it early, when there are far fewer hormone-insensitive cells around. The results strongly support this hypothesis." Interestingly, 10 years ago, Eisenberger co-chaired the global study of docetaxel, which found that the drug extended life in men with advanced cancer – after they had already become resistant to hormonal therapy. Given earlier, the drug shows even more promise now, he believes.
"Based on these results,
it seems now that men
diagnosed with metastatic
disease will do
well to seek the advisability of early chemotherapy, in addition to hormonal therapy."
Giving chemotherapy sooner, rather than later, prolongs life for men with metastatic disease.