Adding docetaxel chemotherapy to frontline hormone therapy improves quality of life (QOL) and may reduce the need for subsequent treatment, according to an analysis from the ongoing phase I/II STAMPEDE trial.
“For those men with prostate cancer that had not metastasized, adding docetaxel to hormone therapy reduced the risk of recurrence by 40%, which improves QOL and saves cost for treating cancer recurrence,” reported lead study author Nicholas James, MD, PhD, of the University of Birmingham in the United Kingdom, who presented the data at a press briefing ahead of the 2018 Genitourinary Cancers Symposium, held February 8–10 in San Francisco.
“We already knew that docetaxel prolongs survival for men with metastatic prostate cancer, but this improvement in QOL and reduction in subsequent treatment—and therefore, costs—in nonmetastatic disease is somewhat surprising and may cause clinicians to rethink how and when they use docetaxel to treat prostate cancer,” Dr. James said.
STAMPEDE (Systemic Therapy in Advanced or Metastatic Prostate Cancer: Evaluation of Drug Efficacy) has enrolled more than 9,000 men with advanced and metastatic prostate cancer since 2005, 592 of whom received docetaxel. A 2016 analysis had demonstrated that patients receiving docetaxel lived 10 months longer, on average, compared to those treated with hormone therapy alone. The new QOL analysis utilized the five-point-scale European EuroQol EQ-5D patient self-reporting instrument to rate their mobility, self-care, daily activities, pain and discomfort, and anxiety and depression levels.
Using the patient-reported data, the authors created statistical models that predict patients’ survival time, quality-adjusted life years (QALYs), and incremental cost-effectiveness.
The model predicted a 0.89-year survival gain for men receiving docetaxel over those receiving only hormone therapy. QOL was also preserved for a half-year (0.51 year) longer. In the docetaxel group, men with advanced prostate cancer but no metastatic disease had a 0.78-year survival advantage and saw their QOL preserved for an additional 0.39 years, Dr. James reported.
The long-term QOL benefit appears to outweigh the acute side-effects of chemotherapy, such as chemotherapy-induced nausea and fatigue.
Net cost savings accrued for docetaxel therapy because of delayed disease recurrence and hence, shorter periods of time spent in relapse, Dr. James said. Overall, the model suggested that docetaxel is cost-effective for men with nonmetastatic and metastatic advanced prostate cancer, with an estimated annual cost in the United Kingdom of £5,000—or approximately $6,750—per additional QALY in benefit.
Upfront docetaxel results in a gain in QALYs in all subgroups, Dr. James concluded. “Our analysis suggests a high degree of certainty about the QALY gain. Results suggest use of docetaxel in selected nonmetastatic patients should be considered.”
Although docetaxel is mandated by the UK National Health Service, orally administered abiraterone is an available alternative in the United States.