Andy Hahn, MD, a resident at the University of Utah School of Medicine, discusses therapy for patients with prostate cancer whom neither docetaxel or abiraterone acetate (Zytiga) is an option.

The most recent advances in the field of metastatic hormone-sensitive prostate cancer have been the introduction of both abiraterone and docetaxel, says Hahn. In the STAMPEDE trial, the addition of abiraterone and prednisone to standard androgen deprivation therapy (ADT) lowered the relative risk of death by 37% and improved progression-free survival by 71% compared with ADT alone. The CHAARTED trial investigated docetaxel plus ADT versus ADT alone and showed a median overall survival of 57.6 months with ADT plus docetaxel versus 44.0 months with ADT alone after a median follow-up of 28.9 months.

However, there may be patients in whom neither therapy is appropriate. Both abiraterone and docetaxel have additional toxicities with treatment, explains Hahn. Therefore, elderly patients who strongly express that they have an interest in being treated but cannot handle a lot of toxicity may be treated with ADT alone. Hahn notes that younger patients with a good performance status who are looking to prolong their lives as long as possible should be offered either abiraterone or docetaxel.

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Dr. Hahn on Patients With Prostate Cancer Whom Neither Docetaxel or Abiraterone is an Option

Andy Hahn, MD, resident, University of Utah School of Medicine, discusses abiraterone acetate (Zytiga) versus docetaxel in the treatment of patients with prostate cancer.

Although there has not yet been a head-to-head trial comparing androgen deprivation therapy (ADT) plus abiraterone versus ADT plus docetaxel, STAMPEDE reported out data with these 2 combinations simultaneously. Data from this trial showed that when comparing abiraterone with docetaxel, there was no significant difference in overall survival or metastasis-free survival. There was a trend in favor of abiraterone regarding progression-free survival and failure-free survival, but these were surrogate endpoints, Hahn says.

The PEACE-1 trial, which will read out in the next few years, may offer an answer to the question of abiraterone versus docetaxel, Hahn says. This trial is evaluating a variety of combinations, including a head-to-head comparison of ADT plus docetaxel versus ADT plus abiraterone.

Andy Hahn, MD, resident, University of Utah School of Medicine, discusses abiraterone acetate (Zytiga) versus docetaxel in the treatment of patients with prostate cancer.
 

Dr. Hahn Discusses Abiraterone Versus Docetaxel in Prostate Cancer

Andy Hahn, MD, resident, University of Utah School of Medicine, discusses patient selection for abiraterone acetate (Zytiga) versus docetaxel in metastatic hormone-sensitive prostate cancer (mHSPC).

Older patients are better suited for abiraterone, as are those with poor performance status, says Hahn. Patients with low-volume disease are also better candidates for the agent. Though the definition of low-volume disease varies across cohorts, Hahn states that this means there is no evidence of visceral disease and patients have less than 5 bony metastases.

Patients who are better candidates for docetaxel are younger patients with good performance status and high-volume disease. Hahn cautions that the agent comes with significant toxicity. Therefore, patients with significant peripheral neuropathy, patients who may have trouble with myelosuppression, and patients who are at increased risk of infection from other co-morbidities should not receive docetaxel.

From the time patients on abiraterone start androgen-deprivation therapy (ADT) to the time they progress to castration-resistant prostate cancer, they will need to take abiraterone daily. Patients on docetaxel will get ADT plus docetaxel for about the first 4 months of treatment before continuing with ADT alone.

The PEACE1 study, which will compare ADT plus abiraterone versus docetaxel in patients with mHSPC, is anticipated to read out in 2020.

Andy Hahn, MD

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Dr. Hahn on Patients With Prostate Cancer Whom Neither Docetaxel or Abiraterone is an Option

Dr. Hahn Discusses Abiraterone Versus Docetaxel in Prostate Cancer

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