The evolving landscape of metastatic hormone-sensitive prostate cancer: a critical review of the evidence for adding docetaxel or abiraterone to androgen deprivation.

BACKGROUND

Until 2015, androgen deprivation therapy (ADT) alone was the standard-of-care for metastatic hormone-sensitive prostate cancer (mHSPC). In 2015, the CHAARTED and STAMPEDE-Docetaxel studies demonstrated marked survival benefit with the addition of docetaxel to ADT in the mHSPC setting, leading to a change in the standard-of-care for mHSPC. The recent LATITUDE and STAMPEDE-Abiraterone trials showed similar substantial improvement in survival with the addition of abiraterone plus prednisone to ADT in this space.

METHODS

We conducted a review of the randomized phase III studies that have investigated either the addition of docetaxel or abiraterone to ADT in patients with mHSPC.

RESULTS

We describe the study designs, key eligibility criteria, and key results for the CHAARTED, STAMPEDE-Docetaxel, GETUG-AFU 15, LATITUDE, and STAMPEDE-Abiraterone clinical trials. We compare the data for abiraterone/prednisone plus ADT in mHSPC with the evidence for docetaxel plus ADT in these patients. Finally, we discuss several factors that should be considered when choosing between docetaxel/ADT or abiraterone/prednisone/ADT in mHSPC.

CONCLUSIONS

The management of mHSPC is evolving. Abiraterone plus prednisone in addition to ADT has emerged as an alternative standard-of-care to docetaxel plus ADT, and ongoing trials should clarify whether combination vs. sequential approaches with AR-targeting agents and taxane chemotherapy are preferred for initial management in the hormone-sensitive setting.