Relevant advances in the treatment of de novo hormone-sensitive prostate cancer have not been achieved for decades – in which the disease is already in a metastatic stage at the time of diagnosis -, but now a new study carried out by the consortium European PEACE, in which the Vall d’Hebron Institute of Oncology (VHIO) has participated, has found that a triple therapy that combines three drugs has important benefits for these patients and prolongs their survival.
The new therapeutic option is based on adding abiraterone – a second-generation androgen biosynthesis inhibitor – and prednisone (a corticosteroid) to the combined treatment of androgen suppression and docetaxel, a chemotherapy drug. This improves both radiographic progression-free survival and overall survival.
It is the first time that a triple systemic therapy has been tested in these patients, which has demonstrated its ability to obtain the aforementioned improvements and which has many possibilities of becoming a standard of care in these cases. The results of the study confirming the advantages of this treatment have been published in the prestigious journal The Lancet.
Combining the three drugs increases survival up to 60 months
The objective of the study led by Peace was to determine the efficacy and safety of incorporating abiraterone and prednisone into combined treatment of androgen suppression and ‘docetaxel’, a chemotherapy drug. Joan Carles, head of the VHIO Genitourinary, CNS and Sarcoma Tumors Group and one of the authors of the article, explained that “this is the first trial to show that a triple systemic therapy improves the outcomes of prostate cancer patients de novo metastatic. His findings, combined with evidence from other studies, support the idea that early intensification of treatment is more effective than the use of treatments that are used sequentially when the disease has become resistant.”
The risk of disease progression was reduced by 50% with this combination, from an average of 2.05 years without progression to 4.46, and the risk of mortality was also reduced by 25%.
The research has evaluated different treatments that were not new, since in other previous studies they had shown their efficacy in combating metastatic hormone-sensitive castration-resistant prostate cancer. The key difference is that now their use has been proposed from the beginning in a combined way and not sequentially as it had been done up to now.
“The combination that we have seen that has the best results is the one in which abiraterone is administered combined with prednisone together with androgen deprivation and docetaxel. It was possible to observe that the risk of disease progression was reduced by 50% with this combination, going from an average of 2.05 years without progression to 4.46, and that the risk of mortality was also reduced by 25%”, he points out. the specialist.
The researchers found that from the 36 months of survival achieved with androgen deprivation, it was passed at 42 months when chemotherapy was added, and at 53 months when the suppressive treatment was combined with abiraterone. “Now, with the triple combination, this has gone up to 60 months. A figure that is very good if one takes into account that 85% of the patients who progressed to castration resistance in the control arm were administered drugs that had been shown to increase survival in this situation, with which It is possible that these figures would have been even higher if this had not been the case”, Dr. Joan Carles continues explaining.
Regarding the application of this prostate cancer treatment in clinical practice, it is important to note that the three drugs are already approved to treat this type of cancer. “They could be implemented in our clinical practice immediately, since they are drugs that are separately approved for this therapeutic indication. The clearly positive results are encouraging and should encourage interaction between the different specialties in order to ultimately benefit patients with high-risk, hormone-sensitive, metastatic prostate cancer”, concludes Dr. Joan Carles.
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