Hot Topic

The Newsletter of ANZUP Cancer Trials Group Limited

AUTUMN 2015

Increased survival in men with metastatic prostate cancer who receive chemotherapy when starting hormone therapy

www.anzup.org.au

HOT TOPIC

At the plenary session of the ASCO Annual Meeting in 2014, Associate Professor Sweeney presented the results of the CHAARTED trial. This randomised phase III trial showed that men with hormone-sensitive metastatic prostate cancer who received docetaxel chemotherapy at the start of standard hormone therapy lived more than a year longer than patients who received hormone therapy alone1 .

Standard initial therapy for metastatic prostate cancer is by lowering testosterone levels with androgen deprivation therapy (ADT) as prostate cancer depends upon the male hormone testosterone for growth. Docetaxel chemotherapy has been shown to be beneficial for patients later in the disease when the cancer has started growing despite the suppression of testosterone. This study assessed the use of docetaxel earlier in the disease at the initiation of hormone therapy.

They enrolled 790 men with metastatic prostate cancer and randomised participants to ADT alone or ADT with docetaxel chemotherapy every three weeks over a period of 18 weeks. A significant improvement in overall survival was noted favoring the participants who received docetaxel chemotherapy plus ADT with a median overall survival of 57.6 months compared with a median overall survival of 44.0 months with ADT alone. Of note, participants with a high volume of metastatic disease (defined as visceral metastases and / or 4 or more bone metastases) accounted for most of the benefit with a median overall survival of 49.2 months with docetaxel plus ADT compared with 32.2 months with ADT alone.

Given the toxicities associated with chemotherapy, the authors commented that the use of early docetaxel in combination with ADT for patients who have high volume disease experienced the most benefit and appear the group where the benefits clearly justify the treatment burden . Subsequently an update of the French GETUG 15 study was reported in February 2015 which randomised 315 men with hormone sensitive prostate cancer to either ADT alone or in combination with docetaxel. In contrast to the CHAARTED trial, this study did not show a statistically significant difference in survival but did show a trend in favour of early docetaxel for those with high volume disease as well 2. It is of note this study was done in an earlier era prior to access to the new therapies for castration resistant disease – this may account for the differences in results .

Results just released from the UK STAMPEDE trial have also shown a survival benefit with docetaxel for patients with prostate cancer starting hormone therapy3. This trial enrolled 2,962 patients with either high-risk locally advanced or metastatic prostate cancer to four arms of treatment. The addition of docetaxel to ADT prolonged survival by 10 months (67 versus 77 months). In the subset of patients with metastatic disease the survival benefit was greater at 22 months (43 versus 65 months)4, confirming the role of docetaxel at the initiation of hormone therapy in metastatic prostate cancer.

References: 1. Sweeney, C. et al. Impact on overall survival (OS) with chemohormonal therapy versus hormonal therapy for hormone-sensitive newly metastatic prostate cancer (mPrCa): An

ECOG-led phase III randomized trial. J Clin Oncol 32:5s, 2014 (suppl; abstr LBA2) 2. Gravis, G. et al. Androgen deprivation therapy (ADT) plus docetaxel (D) versus ADT alone for hormone-naïve metastatic prostate cancer (PCa): Long-term analysis of the GETUG-AFU 15 phase III trial. J Clin Oncol 33, 2015 (suppl 7; abstr 140) 3. James, N. et al. Docetaxel and/or zoledronic acid for hormone-naïve prostate cancer: First overall survival results from STAMPEDE (NCT00268476). J Clin Oncol 33:5s, 2015 (suppl; abstr 5001) 4. The ASCO Post, 13th May 2014. http://www.ascopost.com/ViewNews.aspx?nid=27615&utm_ medium=Email&utm_source=ExactTarget&utm_campaign=&utm_term=4155600

REGISTER TO RIDE

RIDING FOR UROGENITAL CANCERS

EVENT OVERVIEW

Riding for 4 hours to defeat 4 cancers

Testicular, prostate, kidney & bladder cancers

Join us at:Join us at: SYDNEY MOTOR SYDNEY MOTOR SPORTS PARK, TUESDAY 1ST SEPTEMBER SPORTS PARK, TUESDAY 2015 1ST SEPTEMBER 2015

Whether you’re an avid cyclist, new to the sport or just looking for a challenge – the “Below the Belt Pedalthon” is the race for you. As the name suggests, teams of up to 6 are challenged to ride as many laps as possible within 4 hours. Testing true teamwork and strategy, riders may ride for as many or as few laps as possible. Have an industry rival? Looking for an excuse to challenge your peers? Bring it to the track! In 2014, 248 riders from 35 teams across several industries did more than 3,500 laps in the 4 hours. In the spirit of bygone corporate golf days, Pedalthon promises to provide a unique occasion to network with other enthusiastic cyclists from the business community, promote teamwork and bonding in the pit lane and to enjoy

track racing circuits. How are you helping? All funds raised in their efforts to improve treatments and outcomes for those affected by urogenital (prostate, testicular, kidney and bladder) cancers. These more common, but less glamorous “below the belt” cancers account for more than 27,500 cancers diagnosed in Australia every year. We need your help to fund more trials.

PACKAGE HIGHLIGHTS ● Regular training schedules and tips provided by Australian cycling icons Brad McGee and Ben Kersten ● Individual pit lane garage for your team available for the day ● Access to mechanic, masseuse, food and drink ● Charity contribution ● Finishers’ awards and cycling goody bag ● Post ride event and function ● Complimentary 2015 BTB jersey Cost Early Bird: $1,750 per team excl GST After 30 June: $2,000 per team excl GST

Event details Tuesday 1st September 2015 7:30am: Registration 8:30am: Event & Safety 9:00am: 3 Hour Team Challenge 12:00pm: Sprint Challenge 1:00pm: Lunch, Awards, Celebration

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