New in the treatment of advanced prostate cancer

The annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago, United States has attracted greater clinical interest this time at the treatment of metastatic prostate cancer.

Undoubtedly, the results presented that have most impressed professionals who are dedicated to treating patients with these tumors are those obtained in the CHAARTED study.

So far, the usual clinical practice based on current scientific evidence established as optimal initial treatment of prostate cancer with tumor spread to other organs administering hormone therapy to block the production and activity of male androgens on tumor metastatic cells.

In this trial the survival of patients was compared with this type of cancer that began this hormonal blockade (standard treatment so far) with respect to which, in addition to hormonal blockade, received six cycles of docetaxel based chemotherapy and continued later with hormonal blockade exclusively.

This study showed a striking increase in survival of patients with this cancer receiving hormonal combination chemotherapy compared to those treated only with hormonal blockade. The difference in survival between the two groups of patients was almost a year and a half in favor of the combined treatment group in patients who had a higher number of metastatic sites in bone or visceral involvement, which is an improvement of survival without unprecedented in the field of oncology. In this clinical setting used to seeing increases survival of only two or three months are usually enough to make a new drug or combination thereof for the treatment of a particular tumor is approved, since we know that small increases but continuously just assuming significant successes in the battle against cancer.

It must however be noted that, despite these excellent results raise requiring a change in routine clinical practice, there are still aspects that this study has not clarified yet, including the possible toxicity of chemotherapy, especially in some patients with chronic lung or heart disease or the need to better clarify the subgroup of patients who benefit more with less toxicity is situated.

This trial has been a collaboration of different US hospitals included in the cooperative oncology group ECOG and is a clear example of that with good clinical hypotheses and thanks to the collaboration of different researchers and hospitals, it is possible to advance in increasing survival and quality of life of cancer patients.

Another important aspect of this study is that, from now on, collaboration between urologists and oncologists will be more necessary as they are usually urologists who begin hormone therapy in these patients but now must sit with medical oncologists to decide who need to offer the combination of chemotherapy with hormonal blockade and who it is not the best option.