Docetaxel Does Not Improve Metastasis-Free Survival in Men With Nonmetastatic Prostate Cancer

Docetaxel chemotherapy added to standard of care in patients with nonmetastatic prostate cancer and showed good evidence for improving failure-free and progression-free survival but not metastatic progression-free survival or overall survival. Researchers published the most recent findings from the STAMPEDE trial in JNCI Cancer Spectrum.

“Our analysis confirms the failure-free survival benefit associated with this approach, with

clear evidence that patients treated with upfront docetaxel lived longer without their disease

relapsing,” wrote researchers. “This would also mean that men could continue their lives for a longer period without the need for additional therapeutic intervention.”

Earlier results from the randomized controlled STAMPEDE trial showed that adding upfront docetaxel improved overall survival for patients starting long-term androgen deprivation therapy for prostate cancer. In the current study, which included a median 6.5 years of follow up, researchers reported long-term survival outcomes for patients with nonmetastatic prostate cancer. The analysis included 460 men who received standard-of-care androgen deprivation therapy, and 230 men who received docetaxel in addition to standard-of-care androgen deprivation therapy.

Researchers found no advantage with added docetaxel for metastatic progression-free survival, the study’s primary outcome.

According to findings, rates of 5-year metastatic progression-free survival were 77% with standard-of-care treatment and 82% with docetaxel plus standard-of-care treatment.

Overall survival, failure-free survival, and progression-free survival were investigated as secondary outcomes. Analyses showed evidence that docetaxel plus standard-of-care treatment improved failure-free survival and progression-free survival, reported researchers, “but no good evidence of overall survival benefit.”

Additionally, the study found no evidence that added docetaxel increased late toxicity.

“There is robust evidence that standard-of-care plus docetaxel improved failure-free survival and progression-free survival (previously shown to increase quality-adjusted-life-years), without excess late toxicity, which did not translate into benefit for longer-term outcomes,” concluded researchers. “This may influence patient management in individual cases.”

Reference:
James ND, Ingleby FC, Clarke NW, et al. Docetaxel for nonmetastatic prostate cancer: long-term survival outcomes in the STAMPEDE randomized controlled trial. JNCI Cancer Spectr. 2022;6(4):pkac043. doi:10.1093/jncics/pkac043.