ASCO Clinical Practice Guidelines for Metastatic Noncastrate Prostate Cancer
Posted: Wednesday, July 11, 2018
Androgen-deprivation therapy (ADT) plus docetaxel or abiraterone offers survival benefits compared with ADT alone for patients with newly diagnosed metastatic noncastrate prostate cancer. This recommendation is part of the clinical practice guidelines created by the American Society of Clinical Oncology (ASCO) and published in the Journal of Clinical Oncology. The guidelines utilized prospective randomized studies to evaluate overall survival with the addition of docetaxel to ADT and were authored by Michael J. Morris, MD, of the Memorial Sloan Kettering Cancer Center, New York. They emphasized that fitness for chemotherapy, patient comorbidities, toxicity profiles, quality of life, drug availability, and cost should be factored into the treatment decision.
For the guidelines, ASCO authors performed a systematic review of three phase III randomized controlled trials—GETUG-AFU 15, STAMPEDE, and CHAARTED—comparing ADT and ADT with docetaxel. The investigators also used two studies reviewing ADT versus ADT with abiraterone (LATITUDE and STAMPEDE).
Both STAMPEDE and CHAARTED favored the addition of docetaxel, with hazard ratios of 0.78 and 0.73, respectively, whereas GETUG-AFU 15 did not. Meanwhile, both LATITUDE and STAMPEDE supported the use of abiraterone, with hazard ratios of 0.62 and 0.63, respectively.
Dr. Morris and colleagues found that men with de novo high-volume metastatic disease had the strongest benefits with docetaxel (per CHAARTED), with similar benefits found for high-risk patients using abiraterone acetate (per LATITUDE) and in the metastatic population in STAMPEDE. The research team concluded that ADT plus abiraterone and ADT plus docetaxel have not been compared, and it is unknown whether patients would benefit from one regimen over the other.