Cora Sternberg, MD
FORMAL DISCUSSANT of the STAMPEDE trial, Cora Sternberg, MD, Chief of the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, commended the study design. “This multiarm, multistage design is very innovative. The investigators plan up to 10 trials over 20 years. The first results showed that docetaxel could be added to androgen-deprivation therapy in high-risk prostate cancer, and the second comparison showed the same thing for abiraterone. But the study populations were slightly different,” she said.
“The landscape [for hormone-sensitive high-risk prostate cancer] has changed considerably in terms of docetaxel. Patients with M1 disease have an improvement in overall survival from 40% to 50% at 4 years with the addition of docetaxel. Now comes the new kid on the block—abiraterone acetate (Zytiga), with a 37% risk reduction in death favoring the drug in a mixed population of metastatic and nonmetastatic high-risk prostate cancer,” Dr. Sternberg continued.
The risk reduction is similar to the 38% seen in the LATITUDE trial, which included all patients with metastatic disease, newly diagnosed hormone-sensitive prostate cancer.
Choosing Between Therapies
“THE QUESTION IS which drug is better for hormone-naive patients starting hormonal therapy? Abiraterone or docetaxel? The presentation by Mr. Sydes offers the only head-to-head data we have at the moment. Two different drug-based therapies improve survival compared to the previous standard of care for hormone-sensitive prostate,” Dr. Sternberg continued.
“Both STAMPEDE randomized trials support staring hormonal therapy plus either abiraterone acetate plus prednisone or six cycles of docetaxel. At 1 and 2 years, the percentage of patients with grade 3 or 4 [severe] toxicities was low and similar among the two groups. Toxicities associated with chemotherapy for six cycles will dominate decisions about upfront docetaxel. Toxicities associated with abiraterone acetate plus prednisone are also likely to influence decisions. Physicians will base their choice of therapy on availability and patient characteristics and preferences,” Dr. Sternberg stated in an official ESMO press release. ■
DISCLOSURE: Dr. Sternberg has received honoraria and research support from Sanofi-Aventis and Janssen.
