WS-1-2 - Pros and cons of docetaxel used to treat metastatic hormone-sensitive prostate cancer: The cons

Abstract

Recent advances in treatments for castration-resistant prostate cancer (CRPC) have proven to be effective. Clinical trials using novel agents targeting the androgen axis, and chemotherapeutic agents including docetaxel and cabazitaxel, have shown that such agents significantly prolong survival. Emerging trends in terms of the use of such agents include up-front prescription in settings of hormone-sensitive prostate cancer. Three landmark studies on first-line docetaxel combined with androgen deprivation therapy (ADT) have appeared. The CHAARTED study the STAMPEDE study, significant prolongation of overall survival was evident when docetaxel was combined with ADT (compared to ADT alone). Based on these results, the first-line use of docetaxel combined with ADT in patients with metastatic prostate cancer has become a standard of care recognized in both the NCCN and ESMO guidelines. The research findings are robust, and it is thus necessary to reconsider the optimal treatment strategy for hormone-sensitive metastatic prostate cancer occurring in Japanese patients. Study of a large-scale Japanese database detailing patient outcomes after hormone treatment (the J-CAP database) reveals that the overall survival rates were excellent. The clinical outcomes after ADT vary by race; Japanese patients enjoy better outcomes than do Caucasians. A response to first-line ADT was a strong predictor of clinical outcome in patients with metastatic hormone-sensitive prostate cancer. Considering such findings, initiation of up-front docetaxel would be controversial in Japanese populations. It is necessary to define biomarkers indicating that the early use of docetaxel would be warranted, or other predictors of optimal results after such treatment. For example, predictors of early recurrence after primary ADT would certainly support a decision to prescribe docetaxel up-front when treating hormone-sensitive metastatic prostate cancers in Japanese populations.