Use of androgen deprivation therapy (ADT) in combination with docetaxel (Taxotere) or abiraterone (Zytiga) in newly diagnosed cases of metastatic noncastrate prostate cancer (mNCPC) is recommended in recently updated American Society of Clinical Oncology (ASCO) guidelines. Historically, mNCPC has been treated with ADT alone until progression; ASCO noted a survival benefit from adding docetaxel or abiraterone, based on a review of several trials.1
For patients with low-volume disease (according to CHAARTED) who are candidates for chemotherapy, the guidelines moderately recommend offering docetaxel (Table).
Table. Treatment Recommendations for De Novo Noncastrate Disease
The dosage of docetaxel alone or with prednisone is now listed as 6 doses at 75 mg/m2 administered every 3 weeks under a strong recommendation, based on both CHAARTED and STAMPEDE.1
The guidelines note that without randomized data comparing docetaxel with aberaterone, variables such as comorbidities, toxicity, quality of life, drug availability, and cost will need to be considered when choosing either treatment for a patient.
- Morris MJ, Rumble RB, Basch E, et al. Optimizing anticancer therapy in metastatic non-castrate prostate cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2018;36(15):1521-1539. doi: 10.1200/JCO.2018.78.0619.
- Sweeney CJ, Chen YH, Carducci M, et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med. 2015;373(8):737-746. doi: 10.1056/NEJMoa1503747.
- James ND, Sydes MR, Clarke NW, et al; STAMPEDE investigators. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet. 2016;387(10024):1163-1177. doi: 10.1016/S0140-6736(15)01037-5.
- Gravis G, Boher JM, Joly F, et al. Androgen deprivation therapy (ADT) plus docetaxel versus ADT alone in metastatic non castrate prostate cancer: impact of metastatic burden and long-term survival analysis of the randomized phase 3 GETUG-AFU15 trial. Eur Urol. 2016;70(2):256-262. doi: 10.1016/j.eururo.2015.11.005.
- Fizazi K, Tran N, Fein L, et al; LATITUDE investigators. Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med. 2017;377(4):352-360. doi: 10.1056/NEJMoa1704174.
- Zytiga® (abiraterone acetate) plus prednisone approved for treatment of earlier form of metastatic prostate cancer [press release]. Horsham, PA: Janssen Pharmaceutical Companies; February 8, 2018. janssen. com/zytiga-abiraterone-acetate-plus-prednisone-approved-treatment- earlier-form-metastatic-prostate. Accessed June 28, 2018.
- James ND, DeBono JS, Spears MR, et al. Adding abiraterone for men with high-risk prostate cancer (PCa) starting long-term androgen deprivation therapy (ADT): survival results from STAMPEDE (NCT00268476). J Clin Oncol. 2017;35 (suppl; abstr LBA5003). doi: 10.1200/JCO.2017.35.18_suppl.LBA5003.
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