Early Chemotherapy Offers No Survival Edge in mCRPC

Giving docetaxel before abiraterone does not improve progression-free and overall survival compared with the reverse sequence.
Giving docetaxel before abiraterone does not improve progression-free and overall survival compared with the reverse sequence.

Early use of chemotherapy in patients with metastatic castration-resistant prostate cancer (mCRPC) is not associated with significantly improved survival, new findings suggest.

In a retrospective study of 58 mCRPC patients, researchers found no significant difference in progression-free and overall survival between patients who received docetaxel chemotherapy followed by abiraterone hormonal therapy and patients who received the reverse sequence in propensity score-weighted multivariate analyses.

“Treatment sequencing should be determined by patient and disease characteristics, comorbidities and end-organ function, ability to tolerate side effects, and patient preferences,” Benjamin L. Maughan, MD, of Johns Hopkins Sidney Kimmel Comprehensive Cancer Center in Baltimore, and colleagues concluded in The Prostate (published online ahead of print).

Patients in the abiraterone-to-docetaxel group had greater metastatic burden in bone and higher median PSA levels compared with the docetaxel-to-abiraterone group, according to the investigators.

The authors said it is likely that choosing a treatment sequence based on molecular characteristics of the cancer, such as AR-V7 status, is more important that making treatment decisions based on clinical features alone.

Dr. Maughan's group noted that previous studies suggest that sequential hormonal therapy after chemotherapy is progressively less effective compared with initial hormone therapy. “Cross-resistance mechanisms between hormonal and chemotherapy are likely a major reason for this suggested incremental decrease in therapeutic efficacy,” they wrote.

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