Benefits Vary With Docetaxel and Abiraterone in High-Risk Prostate Cancer

Excerpt:

“The first head-to-head comparison of docetaxel and abiraterone acetate for high-risk prostate cancer patients starting long-term hormone therapy found benefit with both treatments when added to androgen deprivation therapy (ADT). Treatment decisions may come down to specific toxicities, which differ between the treatments.

“The large STAMPEDE trial previously found that both docetaxel and abiraterone improved outcomes when compared with placebo. “Right now, oncologists and urologists want to know which combination is preferable, which is why we conducted this analysis,” said study author Matthew Sydes, MSc, a statistician at University College London.”

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ESMO 2017 Press Release: Patients with High Risk Prostate Cancer May Benefit “Equally” From Two New Treatments

Excerpt:

“Patients with high risk prostate cancer starting long-term hormone therapy may benefit from two new treatments, according to late-breaking results from the STAMPEDE trial presented at the ESMO 2017 Congress in Madrid.

“Long-term hormone therapy alone has been the standard of care for patients with high risk locally advanced or metastatic prostate cancer since the 1940s.”

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Second-Generation AR-Targeting Agent Explored in High-Risk Prostate Cancer

Excerpt:

“Researchers are hoping the results of a late-stage efficacy and safety study of apalutamide (ARN-509) in patients with high-risk, localized, or locally advanced prostate cancer who are receiving primary radiation therapy will demonstrate an improvement in metastasis-free survival, according to global principal investigator, Howard M. Sandler, MD.

“ ‘The patient population that we’re studying are men who are at risk of dying of prostate cancer,’ Sandler, chair of the Department of Radiation Oncology at Cedars-Sinai Medical Center in Los Angeles, told OncologyLive. ‘If we can provide better upfront disease control, we’re hoping to reduce the number of men who enter into the castrate-resistant prostate cancer stage.’ “

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ASCO: Combo Tx Fails in Local High-Risk Prostate Ca

Excerpt:

“Neoadjuvant enzalutamide (ENZA) and abiraterone acetate (AA) plus 5 mg prednisone daily can be given safely for 6 months in men with localized high-risk prostate cancer prior to prostatectomy, a neoadjuvant study showed.

“However, the findings did not favor adding ENZA to augment AA plus leuprolide acetate (LHRHa) efficacy in localized high-risk prostate cancer, Eleni Efstathiou, MD, PhD, of the University of Texas MD Anderson Cancer Center, in Houston, said during a presentation at the American Society of Clinical Oncology.

“Pathologic downstaging (≤ pT2N0) occurred in 30% of patients treated with the combination therapy (AA+ENZA+ LHRHa) versus 52% of patients who received AA plus LHRHa alone (P=0.07), the study showed. Despite universal PSA depletion (≤ 0.1), a wide range of viable tumor was observed (volume 0-8.64 cc, cellularity 0-90%, and a tumor epithelial volume [TEV] 0-5.58 cc). TEV and stage were aligned.”

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Video: Dr. Matthew Cooperberg on Surgery for Aggressive Prostate Cancer

“Matthew Cooperberg, MD, genitourinary cancer specialist, University of California San Francisco, discusses the rise in aggressive management of men with high-risk prostate cancer. Cooperberg says the proportion of men who are receiving hormonal therapy alone had been rising consistently over the course of a 15 year period, up until 2010, to about 50%. Since then, Cooperberg says that number has dropped to about half of what it was, or 25%, which is attributed to more aggressive treatment.

“Cooperberg says local therapy for men with high-risk prostate cancer was normally radiotherapy, with surgery not being nearly as common. He adds that a growing body of evidence dictates that surgery in prostate cancer may be a more effective local therapy than radiation alone. According to the body of evidence, cancer-related survival and overall survival were normally boosted when surgery was involved for these patients.”

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Androgen Suppression Plus RT Improves DFS in Prostate Ca

“Adding 6 months of androgen suppression (AS) to radiation therapy improved biochemical disease-free survival in high-risk localized prostate cancer patients – even at radiation doses of 78 Gy – and it did so with acceptable adverse effects, according to a randomized European Organisation for Research and Treatment of Cancer trial reported in the Journal of Clinical Oncology.

“At 7.2 years’ median follow-up, the study found that combination therapy led to a 5-year biochemical disease-free survival of 82.6% (95% CI 78.4-86.1) versus 69.8% for radiation alone (95% CI 64.9-74.2) – translating to a hazard ratio of 0.52 (95% CI 0.41-0.66, P=0.001, 319 events). Adjuvant AS also improved clinical progression-free survival, for an HR of 0.63 (95% CI 0.48-0.84, P=0.001, 205 events).

“No statistically significant interaction between treatment effect and radiation dose emerged: heterogeneity P=0.79 and P=0.66, for biochemical disease-free survival and progression-free survival, respectively, according to Michel Bolla, MD, of Grenoble University Hospital in France, and colleagues.”


For Prostate Cancer Patients, Risk-Specific Therapies Now More the Norm

“After decades of overtreatment for low-risk prostate cancer and inadequate management of its more aggressive forms, patients are now more likely to receive medical care matched to level of risk, according to a study by researchers at UC San Francisco.

“In the first study to document updated treatment trends, researchers found that from 2010 to 2013, 40 percent of men with low-risk prostate cancer opted for active surveillance, in which the disease is monitored closely with blood tests, imaging studies and biopsies. Treatment is deferred unless these tests show evidence of progression.

“In contrast, less than 10 percent overall of low-risk prostate cancer patients pursued active surveillance in the years from 1990 through 2009. Rates for radiation therapy for this low-risk group have also slipped since 1995, the authors noted in the study published in JAMA earlier this month.”


Increased Radiation Dose Offers No Survival Benefit for Patients with Low-Risk Prostate Cancer, Penn Study Finds

“Increased radiation dose is associated with higher survival rates in men with medium- and high-risk prostate cancer, but not men with low-risk prostate cancer, according to a new study from Penn Medicine published this week in JAMA Oncology. Already-high survival rates for men with low-risk prostate cancer were unaffected by higher radiation dosages compared to lower radiation dosages.

“In 2014, low-risk prostate cancer was the most common type of prostate cancer diagnosed in the United States, affecting about 150,000 patients, many of whom undergo aggressive treatment, either complete removal of the prostate or radiation.

“ ‘Our study raises the provocative question of whether radiation dose reduction for patients with low-risk prostate cancer could achieve similar cure rates while avoiding the increased risk of side effects associated with higher radiation doses,’ said the study’s lead author, Anusha Kalbasi, MD, a resident in the department of Radiation Oncology at the Perelman School of Medicine at the University of Pennsylvania.”


ASCO 2015: Notable Reports on Prostate Cancer Treatment


This year’s American Society of Clinical Oncology (ASCO) annual meeting was short on any truly exciting developments in prostate cancer treatment. In stark contrast to other cancers, such as lung, breast, kidney, and melanoma, there were no reports of note on targeted and immunotherapies in prostate cancer. The two presentations summarized here offered new strategies in chemotherapy. Continue reading…