Stéphane Oudard, MD
DURING A DISCUSSION of Dr. Vale’s poster, Stéphane Oudard, MD, Professor of Oncology and Chief of the Oncology Clinical and Translational Research Unit at Georges Pompidou Hospital in Paris, France, said that although newer treatments have improved survival, there are still many challenges in prostate cancer.
“We still don’t know how to treat patients with clinically localized disease who have undergone curative treatment and have a rising prostate-specific antigen, especially for nonmetastatic castrate-resistant prostate cancer. Prostate cancer is a highly heterogeneous disease, with no validated biomarkers to identify aggressive disease and cross-resistance between androgen receptor–targeted therapies,” Dr. Oudard commented.
BOTH TREATMENTS extend survival, he continued. “The cost of treatment and the duration of treatment [median of 33 weeks with abiraterone acetate plus prednisone and 6 cycles with docetaxel], as well as the toxicity profiles of each drug, will determine selection. Will we be able to afford these drugs?” he asked.
“Perhaps the right question is not which of these two drugs to use, but whether we can combine them. Prostate cancer heterogeneity may be better addressed by a combination of abiraterone acetate plus prednisone and docetaxel to get rid of the androgen receptor–independent clones, which are responsible for death,” Dr. Oudard suggested.
Awaiting Possible Answers
HIS CRITICISM of the STOPCaP meta-analysis was that it did not take individual patient characteristics into account or consider tumor burden and the impact of subsequent therapies.
Dr. Vale was asked to respond to Dr. Oudard’s comments. She said: “We agree that individual participant data would enable us to gain a more thorough understanding of the picture with regard to these treatments. Indeed, we very much see this as a first step on the journey and are working toward conducting a full network meta-analysis based on the individual patient data as part of our planned program of work with STOPCaP collaborators. The individual patient data analysis will allow us to more fully explore some of the interesting questions that remain—such as the impact of patient characteristics or treatment on disease progression—on these overall results. We hope we can deliver more answers once that analysis is complete.” ■
DISCLOSURE: Dr. Oudard has received honoraria from Sanofi, Bayer, Astellas Pharma, and Janssen. Dr. Vale reported no conflicts of interest.
ABIRATERONE ACETATE (Zytiga) plus prednisone and docetaxel have moved up from the castrate-resistant metastatic setting to earlier in the course of disease as treatment of high-risk hormone-sensitive prostate cancer in men who are initiating androgen-deprivation therapy, based on level 1 evidence...
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...