Updated CHAARTED results confirm docetaxel benefit for metastatic prostate cancer
medwireNews: Long-term analysis of the CHAARTED trial confirms the survival benefit conferred by the addition of docetaxel to androgen deprivation therapy (ADT) in men with metastatic hormone-sensitive prostate cancer.
The longer follow-up also confirmed the clinical benefit with chemohormonal therapy for patients with high-volume disease, but the initial promising – albeit nonsignificant – hazard ratio (HR) favoring docetaxel in men with low-volume disease did not translate into a significant gain in the current analysis, the researchers report in the Journal of Clinical Oncology.
At a median follow-up of 53.7 months, overall survival (OS) remained significantly longer for the 397 participants who were randomly assigned to receive ADT plus docetaxel 75 mg/m2 every 3 weeks for up to six cycles than for their 393 counterparts given ADT alone, at a median of 57.6 versus 47.2 months, and an HR of 0.72.
This was also the case for the subgroup of patients with high-volume disease, defined by the presence of visceral metastases and/or four or more bone lesions, of which at least one had to be located outside of the vertebral column or pelvis. Specifically, OS was a median of 51.2 months for the ADT plus docetaxel group and 34.4 months for the ADT alone group, giving a significant HR of 0.63.
By contrast, median OS did not differ significantly between the treatment arms for men with low-volume disease, at 63.5 months for the ADT plus docetaxel arm and unreached for the ADT alone.
The addition of docetaxel also led to significant improvements in secondary endpoints, such as the time to development of castration-resistant prostate cancer and time to clinical progression, with the benefit more pronounced in all cases among patients with high- rather than low-volume disease.
Christopher Sweeney (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) and co-investigators note that these findings need to be interpreted in light of the recent LATITUDE and STAMPEDE trials showing significantly improved outcomes with the addition of abiraterone acetate to ADT.
They write that future research will need to address whether docetaxel should be added to the combination of ADT and newer androgen receptor targeting agents, such as abiraterone.
“Fortunately, three studies have or have nearly completed accrual and are stratified by docetaxel use and will allow an analysis of ADT plus docetaxel with or without abiraterone, enzalutamide, or apalutamide.”
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