ORLANDO—In 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 Institute.
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 patients.
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(Drug information on megestrol) (Megace), antiandrogen withdrawal with or without ketoconazole(Drug information on ketoconazole), hydrocortisone(Drug information on hydrocortisone) with or without mitoxantrone(Drug information on 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).
