Systemic Chemotherapy for Metastatic Hormone-Sensitive Prostate Cancer
Traditionally, long-term androgen deprivation therapy (ADT) has been considered as the standard of care (SOC) for men with metastatic hormone-sensitive prostate cancer. But, unfortunately several months after the ADT, tumors become castration-resistant, and eventually all patients suffer from disease progression. In 2004, two randomized phase 3 trials demonstrated for the first time a survival benefit in patients with metastatic castration-resistant prostate cancer (mCRPC) utilizing docetaxel-based chemotherapy, setting a new standard of care for patients with mCRPC [1, 2]. The benefit of docetaxel-based chemotherapy in patients with mCRPC suggested that early chemotherapy might improve the prognosis of patients with metastatic hormone-sensitive prostate cancer (mHSPC). In bringing docetaxel into the hormone-sensitive setting, the rationale was to preemptively eradicate cancer cells inherently insensitive to ADT by acting on cellular targets outside of the androgen-signaling pathway, thus improving clinical outcomes. Recently, final results of three large, randomized, phase 3 trials (GETUG-AFU 15, CHAARTED, and STAMPEDE) evaluating the value of up-front docetaxel chemotherapy in mHSPC were reported.
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