ASCO Issues New Guidelines for Optimizing Anticancer Therapy in Metastatic Non-Castrate Prostate Cancer

04/04/18

The American Society of Clinical Oncology (ASCO) has released new guidelines to address abiraterone or docetaxel with androgen-deprivation therapy (ADT) for metastatic prostate cancer that has not been treated with testosterone-lowering agents.

The standard therapy for newly diagnosed metastatic prostate cancer has traditionally been ADT alone.

An expert panel led by Michael J Morris, MD, Memorial Sloan Kettering Cancer Center (New York, NY) and Weill Cornell Medicine (New York, NY), examined a total of three prior studies (GETUG-AFU 15, STAMPEDE, and CHAARTED) that compared ADT alone vs ADT plus docetaxel, as well as two prior studies (LATITUDE and STAMPEDE) for ADT alone vs ADT plus abiraterone.

The panel found that both STAMPEDE and CHAARTED favored ADT plus docetaxel to improve overall survival in patients with metastatic non-castrate prostate cancer. LATITUDE and STAMPEDE favored ADT plus abiraterone (with prednisone or prednisolone) in this same population.

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After examining the results of these studies, the panel developed clinical practice guideline recommendations (published online in the Journal of Clinical Oncology April 2, 2018; doi:10.1200/JCO.2018.78.0619). The key suggestions include:

  • Docetaxel and abiraterone are two separate standards of care for metastatic non-castrate prostate cancer. The use of both standards in combination or in series has not been assessed and therefore cannot be recommended.
  • For men with metastatic non-castrate prostate cancer with high-volume disease who are candidates for chemotherapy, the addition of docetaxel to ADT should be offered.
  • For patients with low-volume disease who are candidates for chemotherapy, docetaxel plus ADT may be offered.
  • The appropriate regimen of docetaxel is six doses of docetaxel administered every 3 weeks at 75 mg/m2 either alone or with prednisolone.
  • For men with high-risk de novo metastatic non-castrate prostate cancer, the addition of abiraterone to ADT should be offered.
  • For men with lower-risk de novo metastatic non-castrate prostate cancer, abiraterone may be offered.
  • The appropriate regimen of abiraterone is 1,000 mg with either prednisolone or prednisone 5 mg once daily until treatment(s) for metastatic castration-resistant disease are initiated.

The panel noted that ADT plus docetaxel vs ADT plus abiraterone have not been compared, and it is unknown if some patients benefit more from one regimen as opposed to another. “Fitness for chemotherapy, patient comorbidities, toxicity profiles, quality of life, drug availability, and cost should be considered in this decision,” they noted.—Zachary Bessette