Adding Docetaxel to Standard Treatment of Localized High-Risk Prostate Cancer
Posted: Monday, June 15, 2020
Seth A. Rosenthal, MD, of Sutter Cancer Centers, Sacramento, California, and colleagues reported that in men with localized high-risk nonmetastatic prostate cancer who are fit to receive chemotherapy, the addition of docetaxel to androgen suppression and radiotherapy may improve overall and disease-free survival outcomes as well as the rate of distant metastasis. However, the phase III NRG Oncology RTOG 0521 trial also demonstrated that the addition of docetaxel appeared to be associated with hematologic toxicity. The results were published in the Journal of Clinical Oncology.
The researchers randomly assigned 563 evaluable patients with localized high-risk nonmetastatic disease to receive standard long-term androgen suppression plus radiotherapy with or without adjuvant docetaxel. The median follow-up was 5.7 years.
The therapy was well tolerated in both treatment arms. The 4-year overall survival rate was 93% with docetaxel versus 89% without docetaxel (P = .034). Similarly, the 6-year disease-free survival rate was also significantly higher with docetaxel (65%) than without it (55%; P = .043). The 6-year rate of distant metastasis was higher among the patients who received docetaxel than in those who did not (14% vs. 9.1%; P = .044).
There were a higher number of overall deaths and prostate cancer-related deaths in the treatment group that did not receive docetaxel. Overall, there were 43 and 59 deaths in the docetaxel and nondocetaxel groups, respectively. Of them, 16 and 23 deaths, respectively, resulted from prostate cancer.
However, grade 3 and 4 adverse events were more frequent among patients who received chemotherapy, especially hematologic events. Grade 3 hematologic toxicity was 22.0% in the docetaxel arm versus 1.8% in the nondocetaxel arm. Grade 4 hematologic toxicity was 22.3% in the docetaxel arm and did not occur in any of the patients in the nondocetaxel arm.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.