Friday, December 12, 2014

A New Treatment CHAARTED for Men with Metastatic Prostate Cancer

Men with metastatic prostate cancer are traditionally treated with hormonal treatment, otherwise known as androgen deprivation treatment (ADT). Prostate cancer is a male cancer, and cutting male hormones (i.e. androgens) can cause the cancer to regress. Unfortunately, all prostate cancers will eventually learn to grow without androgens – a state called castration-resistant prostate cancer (CRPC). Once a man developed CRPC, they were often given chemotherapy. However, CRPC is an aggressive, hard to kill cancer and the effects of chemotherapy were often short-lived. Through research done greater than a decade prior, researchers found that docetaxel chemotherapy could prolong the life of men with advanced cancer. Mario Eisenberger, MD, Professor of Oncology and Urology at Johns Hopkins, was part of the prior docetaxel studies demonstrating a small benefit.

Nearly 10 years ago, investigators from the Eastern Cooperative Oncology Group (ECOG) decided to try a different paradigm – treating metastatic prostate cancer with chemotherapy much in earlier in the course of disease. The CHAARTED trial, was a phase III, randomized study enrolling 790 from 2006-2012 with metastatic prostate cancer. Dr. Eisenberger explains, "The idea behind CHAARTED was that if docetaxel is effective against cells that no longer respond to hormones at late stages, then it could be even more effective if we gavit it early, when there are far fewer hormone-insensitive cells around."

The CHAARTED trial was sponsored by the National Cancer Institute and led by Christopher Sweeny, MBBS of the Dana Farber Cancer Institute/Harvard Cancer Center and Johns Hopkins participated in the study. Patients were randomized to either receive (1) ADT or (2) ADT with docetaxel chemotherapy. This work was presented at the 2014 ASCO (American Society of Clinical Oncology) Meeting, demonstrating that six cycles of docetaxel with standard ADT extended the lives of newly diagnosed men with metastatic prostate cancer by nearly 18 months. The median overall survival for patients receiving ADT alone was 44 months and 58 months for men receiving ADT and docetaxel (P=0.003) – a major improvement in survival. The biggest benefit was seen in men with high-volume metastatic disease (more than three metastatic lesions on bone scan). Importantly, the side effects were minimal and manageable.

Michael Carducci, MD, Professor of Oncology and Urology at Johns Hopkins and Chairman of the ECOG Genitourinary Group stated, "This has the potential to be a major game-changer. Based on these results, it seems now that men diagnosed with metastatic disease will do well to include a medical oncologist in their care team to seek the advisability of early chemotherapy, in addition to hormone therapy."

Drs. Mario Eisenberger, MD and Michael Carducci, MD

Read more about CHAARTED at:

Quotations are extracted from DISCOVERY: Special Centennial Edition, Volume 11, Winter 2015, by the Patrick C. Walsh Prostate Cancer Research Fund.



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