Optimal Chemo-Hormonal Sequencing for MCRPC Maybe Taxotere - Zytiga - Jevtana - Xtandi

[JoelT]

In a retrospective study presented at the Society for Urologic Oncology 2020 meeting, researchers from the Mayo Clinic reported a small 112 patient cohort with metastatic castration-resistant prostate cancer (mCRPC). The study included two different groups:

Group A (80 men) were given docetaxel chemotherapy (Taxotere) followed by one of the second-line hormonal therapies: either abiraterone (Zytiga) or enzalutamide (Xtandi)

Group B (32 men) were given a second-line hormonal therapy then followed by Taxotere. It was noted that bone metastases were more common in Group B (87%) than Group A (58%)

Three-year survival was:

· cancer-specific survival: 87% Group A vs. 64% Group B

· overall survival: 82% Group A vs. 61% Group B

· these results were similar for men who had a high-volume of metastases, excluding those with lymph node-only disease

This study was not a prospective randomized clinical trial; it was a retrospective trial. However, it comes to a different conclusion than from a couple of earlier retrospective analyses.

Sonpavde et al. reported from an analysis of 1445 men at VA hospitals that there was no difference in overall survival among those who started with taxanes vs. those that began with second-line hormonal therapy.

In a study at Johns Hopkins, Maughan et al. reported no statistically significant differences in total progression-free survival related to the order in which Taxotere or Zytiga were given. Both studies adjusted for disease characteristics.

In the STAMPEDE trial of newly diagnosed men with metastatic hormone-sensitive prostate cancer (mHSPC), there was no difference in survival among men who were randomized to get Taxotere or Zytiga first (see this link). The Mayo study's difference may be due to "selection bias" in the retrospective study - Group A may have received Taxotere first because they were healthier and more likely to survive.

But even if the survival difference is an artifact of the study methodology, there are other reasons to do Taxotere first:

SEE THE REST OF THIS POST ON THE NEW ADVANCED PROSTATE CANCER BLOG PUBLISHED BY CancerABCs.org at:

cancerabcs.org/advanced-pro...

Joel T Nowak

[Hidden]

Joel, to be clear am I reading that treatment sequence can be Taxotere , Zytiga, Jevtana and Xtandi in that order? I'm wondering because during my last in clinic visit with my Mo, she mentioned that the latest trend was to start Jevtana when Zytiga failed as opposed to using Xtandi next.

[NPfisherman]

STAMPEDE is the major trial for PCa, and continues to evolve with metformin being evaluated currently... Using smaller trials lacks the patient numbers that STAMPEDE has in determining treatments. Here is an article on abiraterone vs. docetaxel from STAMPEDE:

ascopost.com/issues/october...

It would seem based on the article that abiraterone is the treatment of choice, but PEACE V will be out in 2023 or so. The real concern that I have from chemo is that there seems to be decreased treatment response from CPI's for those that used chemo versus chemo naive--CHECKPOINT 650...

Don Pescado

[NPfisherman]

Why do you not respond to replies on your posts?? Are you just trying to direct traffic to your blog?? Are you really interested in optimal chemo hormonal sequencing and if so, why do people who get chemo first have a lower response rate to Lu-177 and immunotherapy-CHECKMATE 650 than chemo naive patients??

Don Pescado

[6357axbz in reply to NPfisherman]

Good questions all!

[NPfisherman in reply to 6357axbz]

The question I have is why does HU allow people to post questons or respond to questions using their blog as an answer?? Isn't this spamming ?? Why should people have to read someone's blog to interpret their answer to a question?? Using a blog as an answer and forcing someone to read it for a response is an inconvenience that cancer patients should not have to undergo. Give a straight answer and do not use a blog for an answer--all IMHO !!!!

Fish

[6357axbz in reply to NPfisherman]

Agreed