Metastatic castration sensitive prostate cancer (mCSPC)
[Pages:27]Metastatic castration sensitive prostate cancer (mCSPC)
Silke Gillessen, MD Medical Oncology Division of Cancer Sciences , University of Manchester and The Christie, Manchester,
UK and Kantonsspital St.Gallen, Switzerland Switzerland silke.gillessen@manchester.ac.uk
Conflicts of interest
Speakers Bureau: Janssen, Novartis
Consulting activities (including IDMC): AAA International, Active Biotech, Astellas, BMS, Bayer, Clovis, Curevac, Dendreon, Ferring, Janssen, MaxiVAX, Nectar, Orion, ProteoMediX, Roche, Sanofi Aventis
Pending patent application for a method for biomarker WO 2009138392 A1
Prostate Cancer: Castration sensitive/na?ve
Localised Prostate Cancer
Local Therapy (RT/OP/Active Surveillance)
Salvage RT
Advanced Prostate Cancer: Castration-sensitive/naive
ADT M0
PSA Rise M1
De Novo M1
ADT +/Docetaxel
ADT +/Abiraterone
Advanced Prostate Cancer: Castration-resistant
M0
1st-line
2nd-line
3rd-line
ADT: Androgen Deprivation Therapy M0: By imaging no evidence of metastases M1: Metastases detected by imaging
Androgen Deprivation Therapy
LHRH Analogues ? GnRH agonist ? GnRH antagonist
Orchiectomy
To prevent flare: Earlier generation androgen receptor inhibitor ? Bicalutamide ?...
Androgen Deprivation Therapy for metastatic disease: Other Forms
Intermittent ADT: Not generally recommended
Hussain M et al, N Engl J Med 2013
Combined (maximal) Androgen Blockade (CAB): Permanent combination of ADT and an earlier generation of AR antagonist (e.g. bicalutamide or flutamide)
Not generally recommended
Caubet JF et al, Urology 1997 Prostate Cancer Trialists Collaborative Group Lancet 2000 Samson DJ et al, Cancer 2002
What can we expect from ADT alone?
917 patients with de novo M1 PCa (2005-2014) treated by ADT alone (STAMPEDE randomized trial control arm)
Median OS from diagnosis: 42 mo
Patient Characteristics:
Age:
66y
PSA: 112
Bone only 62%
Liver 2%
Lung 4%
James ND et al, Eur Urol 2015
ADT plus Chemotherapy vs ADT alone
Castrationsensitive/na?ve men
(mostly M1)
Randomised
ADT
ADT + Docetaxel 75mg/m2 Every 21d x 6/9 Zyklen
GETUG-15 CHAARTED STAMPEDE
n=385 n=790 n= 2962
Accrual: 2004-2008 Accrual: 2006-2012 Accrual: 2005-2013
Gravis G et al. Lancet Oncol, 2013; Sweeney C et al. New Engl J Med, 2015; James N et al. Lancet, 2015
Addition of Docetaxel on OS in CHAARTED
+ 13.6 Mo HR 0.61
Sweeney C et al. N Engl J Med 2015
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