There is a paradigm shift happening around us in the clinical care of men with metastatic hormone-sensitive prostate cancer. We now know that survival is better when docetaxel chemotherapy is added to androgen-deprivation therapy (ADT), but there have been and still remains concerns about the toxicity of the docetaxel.
Recent findings from a new study, however, show that the adverse events experienced by men who have chemotherapy at this stage tends to be are short-lived and that, overall, men treated with ADT and docetaxel continue to enjoy a high quality of life as well as an extension of their life.
However, this seems to be the case. According to a study presented at the recent ASCO GU Conference, the lead researcher, Linda J. Patrick-Miller, PhD, from the University of Chicago Medical Center said, “Many patients fear chemotherapy and think they are going to be sick for months and months but at about 6 months, patients felt almost ‘back to normal,’ and by 12 months, they felt as they did before treatment.” She also said that by 12 months after receiving the chemotherapy in combination with ADT men reported a better quality of life than those who had only ADT.
Dr. Patrick-Miller’s study was presented at the Genitourinary Cancers Symposium 2016 in San Francisco. She did confirm that men, while receiving the combination therapies of ADT and docetaxel, did experience increased symptoms. However, she added that, “It did not have a long-term impact on overall quality of life or on their emotional well-being.”
She added that this chemotherapy regime isn’t like some other cancer therapies, which might only confer a modest benefit. She made it clear that adding docetaxel to hormone therapy has a significant impact on survival.
In their quality-of-life analysis, Dr. Patrick-Miller and her colleagues utilized data from the pivotal ECOG E3805 CHAARTED trial presented at the ASCO 2014 Annual Meeting. When the CHAARTED results were presented the survival findings were hailed as “practice-changing” and “transformative.” In the trial there were fewer deaths with ADT plus docetaxel (chemotherapy) than with ADT alone (104 vs 137), and median overall survival was better with the combination than with ADT alone (57.6 vs 44.0 months; hazard ratio, 0.47; P = .0003).
The use of the combination of the two therapies did lead to an increase of toxicities, including fever with suppressed white cell count in 6% of the men as well as “a significant impact on nerve function.” In addition, 1% of 397 men in the combination group died as a result of the combination treatment.
The researchers used a separate sub-scale to measure specific chemotherapy related quality of life issues. The researchers found that, “As expected, it was lower in the group that received docetaxel”
In the quality-of-life analysis, the Functional Assessment of Cancer Therapy–Prostate (FACT-P) and the Functional Assessment of Cancer Therapy–Taxane (FACT-Taxane) were administered at baseline and at 3, 6, 9, and 12 months after randomization.
They reported that there was a significant difference between the chemotherapy combination group and the ADT only groups in FACT-P scores at 3 months (P = .02) and at 12 months (P = .04). At 3 months, scores in the combination group were lower than those in the ADT only group, but at 12 months, scores in the combination group were higher!
Now we have a shift in clinical practice that could both extend life and also increase the quality of our life. The price would be a few months of a decreased quality, but in most instances we are already healthier and happier while we are still hormone sensitive as our disease has not yet had the opportunity to take a realty significant toll on our bodies and our spirits.
Genitourinary Cancers Symposium (GUCS) 2016: Abstract 286. Presented January 7, 2016.