STAMPEDE provides further insight into treating prostate cancer

30 Sep 2019

Further results from the STAMPEDE trial have been presented at European Society for Medical Oncology Congress 2019 over the last few days, providing additional insight into how best to treat men with advanced or high risk prostate cancer.

On Friday, Noel Clarke, Consultant Urologist at The Christie and Salford Royal NHS Foundation Trusts, Manchester, presented long-term follow-up results looking at the effect of the chemotherapy drug docetaxel in men who started treatment with disease that had already spread. Previous results from STAMPEDE showed that upfront docetaxel improved how long men starting hormone therapy for prostate cancer lived. Since those results were published, there has been some debate on whether all men whose disease has spread benefit from docetaxel, or whether it is just those men with high burden disease (disease which had spread more). The longer-term results from STAMPEDE presented at ESMO show that men with both high and low burden disease that has spread benefit from upfront docetaxel. Overall, men who received upfront docetaxel lived for an extra 16 months, on average, compared to those who had hormone therapy alone. There was no evidence that docetaxel had a different effect depending on how much the disease had spread at the time of treatment. The STAMPEDE team recommend that upfront docetaxel is considered both for men with high and low burden disease that has spread beyond the prostate.

On Sunday, Nick James, Chief Investigator of the STAMPEDE trial, presented long-term follow-up results looking at the effect of docetaxel in men whose disease had not spread at the time they started treatment. The results showed no good evidence that adding docetaxel to standard treatment delayed the disease spreading to other parts of the body in this group of patients. There was also no evidence that it improved how long men lived for. However, it did improve the time until the cancer became more active, which is usually detected by a blood test. The results also showed that docetaxel did not lead to more side-effects after one year compared to standard treatment.

Adnan Ali from the Genito-Urinary Cancer Research Group of the Manchester Cancer Research Centre presented exploratory analyses of whether the benefit of radiotherapy for men whose disease had already spread varies depending on where the disease had spread. Previous results from STAMPEDE showed that men with low-burden disease benefited from radiotherapy. However, it was not clear exactly how ‘low-burden disease’ should be defined. The results from this analysis show that patients whose disease has spread only to distant lymph nodes or to three or fewer parts of the bone benefit from adding radiotherapy to standard therapy. However, it is unclear if patients whose disease has spread to other sites or to four or more parts of the bone benefit from radiotherapy. Patients whose disease has spread to other internal organs do not seem to benefit from radiotherapy.

On Monday, Janet Brown, Clinical Lead in Bone Oncology at the University of Sheffield, presented results looking at the bone health of men in the STAMPEDE trial. The analysis found that around one in three men starting hormone therapy for prostate cancer should have a bone mineral density assessment to decide whether they need to take additional drugs to protect their bones.

Hattie Mintz, PhD student at University of Warwick, presented results looking at whether men who had upfront docetaxel were at higher risk of neutropenic sepsis than men who have docetaxel once their hormone therapy has stopped working. Her analysis found that using docetaxel at the same time as starting hormone therapy did not lead to a higher risk of neutropenic sepsis than does using docetaxel after hormone therapy has stopped working for the first time.

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