Here's the PEACE1 data proving the survival benefit of "triplet therapy" combining ADT, docetaxel, and abiraterone in newly-diagnosed men with metastases. The survival benefit (and the improvement in radiographic progression-free survival, prostate cancer-specific survival, and the time to castration resistance) was seen in the total patient population. Although the benefit was similar regardless of metastatic burden, the benefit only reached statistical significance in those with a high burden of metastases. We have to wait for proof that it is true too if there is a low burden of metastases. Interestingly, docetaxel did not add to the incidence of severe or fatal adverse events. Triplet therapy is now the new standard of care for newly diagnosed metastatic patients.
"While comparison is complicated, the extension of progression-free survival by 2.5 years by adding abiraterone to docetaxel alone is impressive."
" Docetaxel adds 1 - 1.5 years to progression-free survival over ADT alone. "
"Abiraterone adds 1 - 1.5 years to progression-free survival over ADT alone."
Got it. Thanks.
So it would seem that doing all three concurrently, instead of just one of them, is good for an extra 1 - 1.5 years of progression -free survival, maybe more... but who's counting? LoL
And I think?... (perhaps more importantly depending on your personal view) without it generating much more in the way of side effects?
Adding "… Docetaxel (or Abiratrone) adds 1 - 1.5 years to progression-free survival over ADT alone. "
And:
“..,the extension of progression-free survival by 2.5 years by adding abiraterone to docetaxel alone”…presumably you meant that either way ADT was also included.
But then you say:
“So it would seem that doing all three concurrently, instead of just one of them, is good for an extra 1 - 1.5 years of progression -free survival..”
Wouldn’t it seem that doing all vs one of them (presumably the one being ADT alone) would add 3.5 to 4 years to progression free survival being the 1 to 1.5 added via docetaxel or abiratrone to ADT plus the 2.5 years added by doing all three vs just two? …not 1 to 1.5 years you say?
I am no expert but the way I see it, the study proved its actually cumulative. The key language is ““..,the extension of progression-free survival by 2.5 years by adding abiraterone to docetaxel alone”…and presumably they meant that either way ADT was also included since no one does abiraterone or docetaxel without ADT. So they were comparing progression feee survival between two drugs ( abiraterone and ADT or docetaxel and ADT with a placebo) to the three drug cocktail. And the three drug cocktail extended PFS by 2.5 years. So we know the two drug cocktail patients were going to have 1 to 1.5 years extended PFS but the 3 drug cocktail ones had another 2.5 years of PFS beyond that. Total is 3.5 to 4 years.
My math was to determine the extra PFS between all 3 (docetaxel/Abi/ADT) vs that of ADT alone. That would seem to me to be the determined by added the benefit of Abi and ADT vs ADT alone (1.4 years) plus the benefit of adding docetaxel to Abi plus ADT (2.5 years). Wouldn’t that total be the cumulative 3.9 years? Or I’d my thinking once again skewed ?
Hey TA. Please See below the exchange between my self and Cesces discussing whether this new study proved a cumulative PFS survival of 3.5 to 4 years for the 3 drug cocktail vs ADT alone. We’d love your take. Thanks.
As a recipient of triple therapy I of course hope for the best result, whether it’s a added year, 2 years more, whatever.
I also certainly hope as a low metastatic burden guy (Oligometastatic in fact) that it had a positive effect, even if the only positive data so far seems to be in high metastatic burden patients.
Strictly from my view, the abi and the docetaxel (and the radiation for that matter) were easy to tolerate in every way. The ADT inconvenient but not that tough. I feel blessed and lucky for that, but I’m pretty convinced my overall health played a large role.
The influence of diet and exercise on the efficacy of all the treatments almost have to be greater than is currently ‘known’.
I’m well aware my habits-past, present and (hopefully) future- may do little to enhance PFS, DFS, OS, or the effectiveness of my triple therapy.
Yet if not, no regrets. Exercise induced QOL, of any length, is truly a superior benefit, blissfully impossible to measure accurately.
Thanks for that link and info Allen. Just wondering for myself not newly diagnosed,dx back in 2012 with St 4 , 3 cores 4+3, 6 or 7 mets, currently on zytiga 8 years. This study is nice , but is it not applicable to me? I had Lupton 4 years and never had doxtaxel
It's not applicable to your situation as far as we know. While on Zytiga, your prostate cancer cells that are not killed by it, escape destruction by going dormant. In this state of dormancy, they are protected from being killed by chemo. Chemo only kills rapidly replicating cells.
Eventually, those cells will emerge from dormancy and start replicating again. At that point, PSA, bone ALP, and the size and number of metastases will increase. Then docetaxel may kill many of them.
As yet, we don't have any artificial way to wake up those cells from dormancy.
Thanks again TA, still learning from you 9 years after DX. Also, since CTCA got taken over by City of Hope, I have an appointment with Dr. Tanya Dorf there in June to learn learn even more.
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Father,56, metastatic prostate ca, completed triplet therapy just now but experiencing pain
Apalutamide for Metastatic Castration-Sensitive Prostate Cancer
ADT duration data measures
