Prostate cancer is the most frequently seen type of
cancer in men. It is the second most frequent cause of
mortality.[
In the GETUG-AFU 15, study patients with metastatic
prostate adenocarcinoma have been divided into
two arms. One arm received ADT, and the other arm
received 9 cycles of docetaxel therapy in addition to
ADT. During a 50 years of median follow-up overall
survival (OS) in the ADT-docetaxel arm was 58.9
months, and in the ADT arm, 54.2 months (HR 1.01,
p=0.955). Biochemical progression-free survival (PFS)
was 22.9 months in the ADT-docetaxel arm (p=0.005)
arm, and 12.9 months in the ADT arm. Clinical PFS
was 23.5 months in the ADT ? docetaxel arm, and 15.4
months in the ADT arm (p=0.015). During 80 months
of median follow-up OS was 60.9 months in the ADTdocetaxel
arm, and 35.1 months in the ADT arm which
was significantly different between groups. However in
high-volume disease (visceral metastases or ?4 bone
lesions with ?1 beyond the vertebral bodies and pelvis)
any difference was not detected. Adverse effects as neutropenia,
and neutropenic fever (8%), nausea, vomiting,
and neuropathy were more frequently seen in the
ADT ? docetaxel arm.[
In the CHAARTED study, patients with metastatic
prostate cancer were divided into 2 arms. One arm received
6 cycles of docetaxel together with ADT, and
the other arm received ADT. During 28.9 months of
median follow-up period OS was 57.6 months in the
ADT-docetaxel arm, and 44 months in the ADT arm
(HR 0.61, p<0.001). OS was detected as 49.2 months in
the high-volume disease in the combination arm, and
32.2 months in the ADT arm (HR 0.60, p<0.001) Time
to clinical progression was 33 months in the combination
arm, and 19.8 months in the ADT arm (HR 0.61,
p<0.001). Neutropenic fever was more frequently seen
(6.2%) in the combination arm.[
However STAMPEDE study was more heterogenous
when compared with other studies.Not only patients
with metastatic prostate cancer, but those with locallyadvanced
disease were also included in the study. Sixtytwo
percent of the patients had metastatic disease. The
patients were divided into 4 arms as follows: ADT, ADT
? Zolendronic acid, ADT ? Docetaxel, and ADT ? Zolendronic
acid ? Docetaxel. During median follow-up
period of 43 months, OS was 67 months in the ADT ?
docetaxel arm, and 77 months in ADT arm (p=0.003).
However PFS was 37 months in the ADT ? docetaxel
arm, and 21 months in the ADT arm (p=0.0001). However
in the metastatic subgroup OS was 43 months in
the ADT arm, and 65 months in the ADT-docetaxel arm
(p=0.002). As detected in subgroup analysis,patients
aged <70 years with metastatic disease, and Gleason
score of ?7 benefited more in the combination arm. In
this study neutropenic fever was more frequently seen
(15%) in the docetaxel containing arms.[
In a meta-analysis encompassing these three studies,
docetaxel given with ADT created a significant difference
in OS, and PFS rates. A significant difference
was not detected between high (HR 0.67), and low-volume
(HR 0.80) diseases (p=0.53). Addition of docetaxel
to ADT decreased mortality risk 27% in metastatic
(HR 0.73), and 33% in high-volume metastatic disease
(HR 0.67).[
