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The CHAARTED trial was a landmark study investigating the impact of chemotherapy with androgen deprivation therapy (ADT) on the treatment of patients with hormone-naïve metastatic prostate cancer, states Ganesh S. Palapattu, MD. In the study, the combination of ADT and docetaxel was compared with ADT alone in 790 patients. The combination resulted in a median overall survival (OS) of 57.6 months compared with 44 months in the ADT-alone arm (HR = 0.61; P = .0003).
Intriguingly, patients with high-volume disease (n = 520), defined as 4 or more bone metastases, liver or lung metastases, who received ADT plus docetaxel concurrently had even better relative outcomes than those treated with ADT alone. In this population, the median OS was 49.2 months with the combination versus 32.2 months with ADT alone.
These findings are potential game changers for patients who present with metastatic disease in the chemo-naïve setting, explains Palapattu. CHAARTED showed that patients benefit from giving chemotherapy upfront concurrently with ADT. Still, Palapattu questions how these data can be utilized and incorporated into urology practices, many of which are not equipped to administer chemotherapy.
These data are powerful enough to modify practices; however, the study began enrollment in 2006, and the whole world of advanced prostate cancer has changed throughout the duration of the study, explains Brian Mehlhaff, MD. Advanced therapeutics for prostate cancer that didn’t exist during study enrollment are available now, he notes. With this in mind, it could be informative to conduct a similar trial in the context of the newer agents.