The use of Abiraterone with Prednisolone seems a potent combination for extending prostate cancer survival in men with non-metastatic prostate cancer but high risk of metastases.
Research, as part of the multi-arm STAMPEDE trial, and conducted in the UK and Switzerland amongst 1,974 randomised patients looked at whether there was a benefit for abiraterone acetate (Zytiga, from Janssen) in high-risk, nonmetastatic prostate cancer.
This subsection of the study was led by Gerhardt Attard, MD, PhD, John Black Charitable Foundation endowed chair in urological cancer research at University College London. He now believes the findings should be used as a new ‘Standard of Care’.
In this subsection, men had no metastatic disease but were at high risk of it and had at least two features out of T3/T4, a Geason of 8-10 and a PSA of 40.
Two studies took place:
i) A comparison of Androgen Deprivation Therapy (ADT) alone vs ADT + Abiraterone Acetate 1000 mg + Prednisolone (5mg daily) with daily Enzalutamide (160 mg)
ii) As above but without the Enzalutamide
Metastasis free survival (MFS) was determined by time to distant mets or death.
In his presentation to the ESMO conference, Attard said that the use of Prednisolone was shown to be of much greater benefit than previously thought. In combination with Abiraterone, 6 year rates of MFS improved to 82% from 69% when compared to standard treatment alone. Survival improved from 77% to 86%.
Indeed, the treatment effect was consistent across the groups whether Enzalutamide was or was not used.
The different groups had a median age of 68 years, (43-86); median PSA 34 ng/ml, (range 0.4-2773); 79% were Gleason 8-10, node positive 39%; planned for RT 85%. Median months to stopping Abiraterone + Prednisolone was 23.7 months.
Attard felt that the combination of Abiraterone plus Prednisolone should become the new standard of care for men who had no current metastases, but were at high risk.
Go to: Three foods starve prostate cancer of Glutamate
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Reference
- ESMO Conference 2021