This article is more than 5 years old. Information may no longer be current.
Docetaxel improves quality of life for men with prostate cancer
Click Here to Manage Email Alerts
The addition of docetaxel to hormone therapy improved health-related quality of life among patients with metastatic and nonmetastaic prostate cancer, according to results from a new analysis of the STAMPEDE clinical trial scheduled for presentation at the Genitourinary Cancers Symposium.
Adding docetaxel also reduced the need for subsequent therapy and appeared cost-effective.
“We already knew that docetaxel prolongs survival for men with metastatic prostate cancer, but this improvement in quality of life 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,” Nicholas D. James, MD, PhD, professor of clinical oncology at University of Birmingham in the United Kingdom, said in a press release.
Previous research has shown docetaxel improves failure-free survival by 40% and OS by 25% among patients with metastatic disease.
“In high-risk nonmetastatic disease, docetaxel also improves failure-free survival by 40%, but [there is] no fully powered mature data on effect on OS [among] patients without metastatic disease, although [there is a] trend on meta-analysis,” James said during a press cast.
James and colleagues sought to determine the impact of docetaxel on health-related quality of life, resource use and cost-effectiveness among men enrolled in the STAMPEDE trial.
The STAMPEDE trial included approximately 2,000 men with advanced prostate cancer starting first-line hormone therapy. Standard treatment included hormone therapy for minimum of 2 years and radiotherapy for some patients. Researchers administered 75 mg/m2 docetaxel alongside standard treatment for six 3-weekly cycles with 10 mg daily prednisolone.
Researchers measured lifetime predictions of costs, changes in predicted survival duration, quality-adjusted life-years and incremental cost-effectiveness ratios. Patients completed the EuroQol EQ-5D to rate their mobility, how well they could care for themselves, ability to perform daily activities, pain and discomfort levels, and anxiety and depression.
Docetaxel extended predicted survival by an average of 0.89 years for patients with metastatic disease and 0.78 years for patients without metastatic disease.
Docetaxel also extended discounted QALYs by 0.51 years for patients with metastatic disease and by 0.39 years for patients without metastatic disease. For patients without metastatic disease, QALY increases appeared driven by beneficial effect of delayed and reduced relapse.
“What was interesting is, in nonmetastatic patients, we see there is a quality-of-life gain almost the same in magnitude [as for the metastatic patients],” James said. “We think this is an extremely important new finding.”
The incremental cost-effectiveness ratio of docetaxel was 5,514 euros — or approximately $6,750 U.S. dollars — per QALY gained among metastatic patients.
Probabilistic sensitivity analysis showed a greater than 99% probability for docetaxel to be cost-effective for patients with and without metastatic disease. Further, docetaxel remained cost-effective in nonmetastatic patients when no survival advantage was assumed due to reductions and delays in relapse.
Results suggested use of docetaxel in selected nonmetastatic patients should be considered at both patient and provider levels, according to James. – by Melinda Stevens
Reference:
James ND, et al. Abstract 162. Presented at: Genitourinary Cancers Symposium; Feb. 8-10, 2018; San Francisco.
Disclosures: James reports honoraria and research funding from, and consultant/advisory or speaker’s bureau roles with Astellas Medivation, Bayer Health, Ipsen, Janssen, Merck Sharp & Dohme, Roche and Sanofi/Aventis. Please see the abstract for all other authors’ relevant financial disclosures.
Perspective
Back to Top
Sumanta K. Pal, MD
From its inception, the STAMPEDE trial has employed one of the most remarkable and innovative designs, allowing us to compare various therapies in a rolling fashion across multiple disease states in prostate cancer. In this analysis, we see that docetaxel — a chemotherapy drug that has been in our armamentarium for prostate cancer for over a decade — may be applied in earlier settings of the disease. James previously reported the survival gains associated with this drug, but [this analysis] adds dimension to demonstrating improved quality of life and potentially cost-effectiveness, as well.
It will be interesting to assess these results compared with data for abiraterone acetate (Zytiga, Janssen), an oral hormonal therapy for prostate cancer, which has shown similar benefit in the same settings in prostate cancer. Abiraterone acetate may have the benefit of improved tolerability over a short course compared with chemotherapy but requires a much more extensive duration of use and further mandates intake of prednisone. Understanding the cost and quality of life associated with abiraterone acetate in this setting may help adjudicate selecting either this drug or docetaxel for patients described in the study.
Click Here to Manage Email Alerts