Dr. Hahn on Patients With Prostate Cancer Whom Neither Docetaxel or Abiraterone is an Option

Andy Hahn, MD
Published: Tuesday, Sep 11, 2018



Andy Hahn, MD, a resident at the University of Utah School of Medicine, discusses therapy for patients with prostate cancer whom neither docetaxel or abiraterone acetate (Zytiga) is an option.

The most recent advances in the field of metastatic hormone-sensitive prostate cancer have been the introduction of both abiraterone and docetaxel, says Hahn. In the STAMPEDE trial, the addition of abiraterone and prednisone to standard androgen deprivation therapy (ADT) lowered the relative risk of death by 37% and improved progression-free survival by 71% compared with ADT alone. The CHAARTED trial investigated docetaxel plus ADT versus ADT alone and showed a median overall survival of 57.6 months with ADT plus docetaxel versus 44.0 months with ADT alone after a median follow-up of 28.9 months.

However, there may be patients in whom neither therapy is appropriate. Both abiraterone and docetaxel have additional toxicities with treatment, explains Hahn. Therefore, elderly patients who strongly express that they have an interest in being treated but cannot handle a lot of toxicity may be treated with ADT alone. Hahn notes that younger patients with a good performance status who are looking to prolong their lives as long as possible should be offered either abiraterone or docetaxel.
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Andy Hahn, MD, a resident at the University of Utah School of Medicine, discusses therapy for patients with prostate cancer whom neither docetaxel or abiraterone acetate (Zytiga) is an option.

The most recent advances in the field of metastatic hormone-sensitive prostate cancer have been the introduction of both abiraterone and docetaxel, says Hahn. In the STAMPEDE trial, the addition of abiraterone and prednisone to standard androgen deprivation therapy (ADT) lowered the relative risk of death by 37% and improved progression-free survival by 71% compared with ADT alone. The CHAARTED trial investigated docetaxel plus ADT versus ADT alone and showed a median overall survival of 57.6 months with ADT plus docetaxel versus 44.0 months with ADT alone after a median follow-up of 28.9 months.

However, there may be patients in whom neither therapy is appropriate. Both abiraterone and docetaxel have additional toxicities with treatment, explains Hahn. Therefore, elderly patients who strongly express that they have an interest in being treated but cannot handle a lot of toxicity may be treated with ADT alone. Hahn notes that younger patients with a good performance status who are looking to prolong their lives as long as possible should be offered either abiraterone or docetaxel.

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