clinical trials, black men with metastatic hormone-refractory prostate cancer
have the same and possibly longer survival, compared with whites, according to
a pooled analysis of nearly 1,000 patients in four separate randomized phase
III Cancer and Leukemia Group B (CALGB) trials.
"The important finding is not the trend toward benefit
in African Americans, but the absence of advantage in whites," said
Timothy D. Gilligan, MD, a genitourinary oncologist with Dana-Farber Cancer
It is unclear how far the results can be interpreted, Dr.
Gilligan said at the 38th Annual Meeting of the American Society of Clinical
Oncology (abstract 725). He added that the data do argue against the disease
being inherently more aggressive in black men, at least in this select group of
The finding was unexpected, given the number of studies that
suggest black men in the United States have a higher prostate cancer in-cidence,
mortality, younger age at diagnosis, and more advanced disease at diagnosis
than men who belong to other racial or ethnic groups.
Dr. Gilligan and his colleagues reported on a pooled outcome
analysis including 144 black men and 844 whites with hormone-refractory
prostate cancer (median age 71, 57% with Gleason sum of 8 or more) enrolled in
four different CALGB trials between 1992 and 2000.
The trials evaluated different regimens, including low- vs
high-dose megestrol (Megace), antiandrogen withdrawal with or without
ketoconazole, hydrocortisone with or without mitoxantrone (Novan-trone), and
varying doses of suramin.
Median survival was 15 months for the black patients vs 14
months for whites (P = .425). In addition, the unadjusted hazard ratio
for blacks compared with whites was 0.95 (95% CI 0.77-1.12).