Many men with castrate-sensitive metastatic prostate cancer should not receive chemotherapy.
نویسندگان
چکیده
We wish to express our concern and disagreement with the (grade 1A) recommendation in the ESMO clinical practice guidelines for prostate cancer [1] that: ‘androgen deprivation therapy (ADT) plus docetaxel is recommended as first-line treatment of metastatic, hormone-naïve disease in men fit enough for chemotherapy’. The results of the GETUG-15 [2], CHAARTED [3] and (as yet unpublished) STAMPEDE trials [4] are important and should lead to change in practice for fit patients presenting with high-volume metastatic prostate cancer, but the guideline fails to recognize that metastatic prostate cancer is an extremely heterogeneous disease. In all three trials, at least 70% of the participants presented with de novo metastatic disease, and their results do not give useful information about men with lowvolume disease, or those who develop metastatic disease some years after diagnosis of localized prostate cancer. Such men present commonly in oncologic practice, and including them in this guideline has the potential to lead to substantial harm with minimal evidence of benefit. The authors state as justification: ‘the effect size (in the CHAARTED trial) was consistent across all subgroups. For example, the HR for overall survival was 0.63 (0.45–0.81) for men with high-volume disease, and 0.63 (0.34–1.17) for those with low-volume disease’ [1]. However, there are at least four reasons not to extend the guideline to men with low-volume disease or to those presenting with metastases at a long time after diagnosis of the primary.
منابع مشابه
Reply to the letter to the editor 'Many men with castrate-sensitive metastatic prostate cancer should not receive chemotherapy' by Tannock et al.
متن کامل
Overcoming docetaxel resistance in prostate cancer: a perspective review
The treatment of metastatic castrate-resistant prostate cancer has been historically challenging, with few therapeutic successes. Docetaxel was the first cytotoxic therapy associated with a survival benefit in castrate-resistant prostate cancer. Toxicity is typical of other cytotoxic agents, with myelosuppression being the dose-limiting toxicity and neurotoxicity also a notable side effect for ...
متن کاملMetastatic castrate-resistant prostate cancer with a late, complete and durable response to docetaxel chemotherapy: a case report
INTRODUCTION Although treatment options for men with metastatic castrate-resistant prostate cancer have improved in recent years, the outlook for patients remains poor, with overall survival in the region of 2 years. Response rates with chemotherapy are modest and disease progression is usually observed within months of stopping treatment. CASE PRESENTATION We present a case of a 72-year-old ...
متن کاملWhy Chemotherapy Should be Given Early for Men with Metastatic Prostate Cancer.
Metastatic hormone-sensitive prostate cancer (mHSPC) is an incurable disease, and despite a high response rate to androgen-deprivation therapy (ADT), outcomes have not significantly changed for many decades. Earlier attempts at multitargeted strategies with the addition of cytotoxic chemotherapy to ADT did not affect survival. As more effective therapies are emerging, including cytotoxic therap...
متن کاملWill chemotherapy change the management of prostate cancer?
Abstract Systemic therapy for metastatic prostate cancer has radically changed in the last 10 years with the introduction of several novel agents that have shown significant improvements in progression free and overall survival (see table 1). These have largely been studied in metastatic castrate-refractory prostate cancer (mCRPC) and have prolonged survival but in each case by less than 6 mont...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Annals of oncology : official journal of the European Society for Medical Oncology
دوره 27 3 شماره
صفحات -
تاریخ انتشار 2016