Dr. Sandler on Chemotherapy Combination Regimens in Prostate Cancer

Howard M. Sandler, MD, chair, Department of Radiation Oncology, professor of Radiation Oncology, Cedars-Sinai Medical Center, discusses potential combination regimens with chemotherapy as treatment for patients with prostate cancer.

The role of chemotherapy for men with localized high-risk prostate cancer is very interesting, Sandler explains. After all, he adds, chemotherapy is widely used in other tumor types. For example, adjuvant chemotherapy is standard treatment in breast cancer. In lung cancer and colon cancer, chemotherapy is also standard.

Prostate cancer has been an outlier, in that chemotherapy has not yet found a role for men without metastatic disease until recently, Sandler says. The treatment was established in men with metastatic castration-resistant prostate cancer, and docetaxel was shown to improve survival in very advanced patients.

A 2015 study that Sandler was involved in demonstrated the survival data for adjuvant docetaxel chemotherapy after radiation therapy for patients with high-risk localized prostate cancer. Researchers also observed a small but statistically significant improvement in overall survival.

This was at a 4-year endpoint, which is considered very early in prostate cancer. It is Sandler's expectation that the survival curves, which are already separating by 4 years, are going to separate more over time. Therefore, the impact of chemotherapy is measurable and is statistically significant. Additionally, chemotherapy has been listed in the NCCN guidelines as an option for men with high-risk localized prostate cancer.