The following article is part of conference coverage from the 2018 Genitourinary Cancers Symposium in San Francisco. Renal and Urology News’ staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from GU 2018.

SAN FRANCISCO—New study findings support upfront use of docetaxel in men with metastatic and non-metastatic advanced prostate cancer (PCa), investigators concluded in a presentation at the 2018 Genitourinary Cancers Symposium.

Results from an analysis of men in the STAMPEDE trial—which enrolled men with advanced PCa starting first-line hormone therapy—show that adding docetaxel to standard of care (SOC) hormone therapy is a cost-effective approach to delaying disease progression and improving health-related quality of life.

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The analysis demonstrated that docetaxel recipients spend more time in the hormone-sensitive state (without treatment failure) and less time with castration-resistant prostate cancer (CRPC), especially those with non-metastatic disease, the investigators noted.

In addition, first-line use of docetaxel added to SOC was associated with a 24% decreased risk of death overall compared with SOC alone, with the protective effect observed mainly in the men with metastatic disease. Compared with SOC alone, docetaxel had no significant effect on survival among men with non-metastatic disease, but a significant 27% decreased risk of death among those with metastatic disease. Docetaxel also was associated with a significant 40% decreased risk of skeletal events.

In the STAMPEDE trial, SOC consisted of hormone therapy for 2 or more years as well as radiotherapy in some patients. Docetaxel at a dose of 75 mg/m2 was administered along with SOC for 6 3-week cycles with prednisolone 10 mg daily. The latest findings were presented by the STAMPEDE Chief Investigator, Nicholas James, MBBS, Professor of Clinical Oncology at the Institute of Cancer and Genomic Sciences, University of Birmingham, UK.

Dr James and his collaborators estimated that first-line docetaxel added to SOC prolonged predicted survival by an average of 0.89 years among patients with metastatic disease and 0.78 years for those with non-metastatic cancer compared with SOC alone. In addition, they estimated that docetaxel extended discounted quality of life years (QALYs) by 0.51 years and 0.39 years in patients with metastatic and non-metastatic disease, respectively. According to the investigators, QALY improvements in men with non-metastatic disease were driven by the beneficial effect of delayed and reduced relapse.

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Further, first-line use of docetaxel in men with advanced PCa was cost-effective for those with metastatic and non-metastatic disease. Docetaxel use resulted in a savings of £5,514 ($7626 US) per QALY vs SOC in the men with metastatic disease and higher QALYs and lower costs vs SOC among men with non-metastatic disease.

The financial savings is due in part to shorter periods of time spent with castration-resistant prostate cancer (CRPC) as a result of first-line docetaxel treatment, especially among men with non-metastatic disease.

Docetaxel remained cost effective in the men with non-metastatic disease even when no survival advantage was assumed because of reductions and delays in relapse, Dr James’ group reported.

According to Dr James, clinicians should consider whether the evidence is sufficiently compelling to support docetaxel use in men with non-metastatic disease.

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James N, Woods B, Sideris E, et al. Addition of docetaxel to first-line long-term hormone therapy in prostate cancer (STAMPEDE): Long-term survival, quality-adjusted survival, and cost-effectiveness analysis. Presented at the 2018 Genitourinary Cancers Symposium, held in San Francisco from Feb. 8-10. Abstract 162.