For about 70 years, the standard treatment for patients with advanced prostate cancer was drugs that blocked male hormones feeding the tumor. If that stopped working and the disease progressed, oncologists turned to chemotherapy to kill the cancer cells.
This timetable is about to change. Results of a clinical trial led by a Dana-Farber researcher revealed that such patients lived longer if started on both a hormone blocker and a chemotherapy drug at the same time. The government-sponsored trial found that 69 percent of men receiving both treatments were alive at three years, compared with 52.5 percent of men who initially got just the hormone blocker. The advantage was so striking – especially for patients with greater degrees of cancer spread – that the National Cancer Institute publicized the findings ahead of schedule to alert doctors and patients.
“The results of this study are practice-changing for some patients,” says Christopher Sweeney, MBBS, clinical director of Dana-Farber’s Lank Center for Genitourinary Cancer, who headed the trial. We asked him to explain:
Q. Who were the patients in the study?
A. The study involved 790 men diagnosed with metastatic cancer that had spread beyond the prostate gland to the bones, liver or lungs. The cancer was typically detected on an imaging scan. Some had disease that recurred after prostate surgery, while others had been treated with prior radiation to the prostate gland, and the remaining patients were first diagnosed with cancer when it was seen on the scans.
Q. How were they treated?
A. All patients received ADT (androgen deprivation therapy) after diagnosis. In addition, some randomly selected men were started on chemotherapy infusions with docetaxel (Taxotere) every three weeks for 18 weeks.
Q. Who benefited most from the dual therapy?
A. About two-thirds of the men already had a lot of disease spread to the bones, liver or lungs when treatment started, and they had the greatest benefit. Researchers are continuing the study to determine the outcomes in patients with less-extensive metastases.
Q. What about side effects?
A. Docetaxel has some toxic side effects that are generally well-tolerated, but may be prohibitive for older, frailer patients.
Q. What should I do if I’m a patient like those in the clinical trial?
A. If your doctor says you have a significant spread of cancer beyond the prostate gland, speak with him or her about adding docetaxel chemotherapy at the beginning, instead of waiting until the hormone blockers stop working. It’s a one-two punch that works for some.