I remember when I was first diagnosed with a prostate cancer recurrence, when I was told that I had advanced prostate cancer. More than any other times that I have been told I have cancer (I have melanoma, thyroid cancer, renal cancer and advanced prostate cancer) I felt the world stopped and my life was now going to be limited. I asked my wonderful oncologist, Dr. Daniel Petrylak, if perhaps I should immediately jump to chemotherapy (with docetaxel) either instead of or along with hormone therapy. Without missing a beat he recommended strongly against it.
From a logical, but very informed standpoint, it seemed to me to be a great idea. Why not just immediately move to the heavy guns and knock out this cancer and be done with it. Fortunately, I listened to Dr. Petrylak’s recommendation and just started hormone therapy (ADT). Now, it is seven years later and I continue to be successful on intermittent ADT and I am still feeling as healthy today as I was when I faced the diagnosis.
Not withstanding this, I do admit to occasionally wondering what if I had immediately moved to chemotherapy. Of course there is no way to ever answer this question. Perhaps I would be in even better shape today, but it is also clear to me that perhaps I would be worse, maybe even dead. Who knows and the reality is what is the difference. What is important is that I am still here today, seven years later and feeling great.
It turns out (no great surprise) that many men and doctors have asked the same question, will the early use of chemotherapy (while still hormone reactive) extend life? There have been many attempts to answer this question, but the trials have historically not been able to enroll adequate numbers of men to answer this question, that is until now. Just published are the results of a clinical trial known as GET-AFU 15. This trial was a randomized Phase III study that used men who were still hormone responsive and who were metastatic. The trial was conducted at institutions located in France and Belgium from October 2004, to December 2008.
The trial, with overall survival being the primary endpoint) compared two groups of treatments. The first group (n= 193) received hormone therapy, either by surgical means or by medication LHRH therapy combined with a non-steroidal antiandrogen such as flutamide or bicalutamide. The second group (n=192) also had hormone therapy along with docetaxel (75 mg/m2) given intravenously on the first day of each 21-day cycle for up to nine cycles.
The trial showed that the median survival in the first group (no chemotherapy) was 54.2 months and the median survival in the chemotherapy group was 58.9 months. The hormone therapy group had no adverse significant side effects while the chemotherapy group had 72 serious side effects. In addition, there were four (4) treatment deaths reported in the chemotherapy group.
In response to the deaths the data monitoring committee recommended treatment with granulocyte colony-stimulating factor among the men being treated with chemotherapy. Once this was added there were no further treatment-related deaths in the chemotherapy group.
The trial authors came to the strong conclusion that chemotherapy (docetaxel) should not be used as a first line treatment for men with hormone responsive advanced prostate cancer.
The Lancet Oncology, Early Online Publication, 8 January 2013
Joel T. Nowak, M.A., M.S.W.
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