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The New Standard of Care? Abiraterone in Metastatic Prostate Cancer
Interview with Oliver A Sartor MD
Dr. Oliver Sartor, Laborde Professor in Cancer Research in the Medicine and Urology Departments at Tulane School of Medicine, talked at ASCO with Dr. Farzanna Haffizulla on behalf of PracticeUpdate about the impressive results of the STAMPEDE and LATITUDE trials.
Dr. Haffizulla: Dr. Sartor, I wanted to talk about the most recent data from STAMPEDE. STAMPEDE assessed abiraterone in the context of hormone-sensitive prostate cancer. What do the data mean for clinical practice?
Dr. Sartor: I think they’re practice-changing. Androgen deprivation therapy, or ADT, has been used since 1941, and it is sort of the standard that we’ve become accustomed to. Now, there was a clinical trial called CHAARTED, which helped change that standard by adding in chemotherapy , and STAMPEDE had another arm that added in chemotherapy. However, the new data are with abiraterone, and it’s being compared against conventional ADT; the results are strikingly positive, and, within the metastatic subset, a reduction of almost 40 percent. It’s like a 39 percent reduction in mortality. It’s pretty reasonably well-tolerated.
Progression-free survival and other components of the endpoints were all strikingly positive, and I think the abiraterone is a practice-changer. I think people are going to be looking at abiraterone with low-dose prednisone, only 5 mg of prednisone, added to ADT as being a new potential standard of care.
Dr. Haffizulla: Well, how do these data differ from LATITUDE? 
Dr. Sartor: Well, the LATITUDE trial is a little bit more restricted. What I didn’t tell you about STAMPEDE is that it also enrolled nonmetastatic patients, and I personally feel as though the data on the nonmetastatic patients don’t have adequate maturity to be conclusive.
LATITUDE did not; LATITUDE was purely within the metastatic space and had some restrictions. Participants had to have at least three lesions or a high Gleason 8, a little bit different entry criteria. But I kind of look at LATITUDE in a way as confirmatory or STAMPEDE as confirmatory. The two really sync together, and together they make a really good story. The bottom line is that they’re positive, positive, positive for our most important endpoint, overall survival for those with metastatic disease.
Dr. Haffizulla: Fantastic to hear that. Now, you’ve also reviewed the role of chemotherapy in prostate cancer based on CHAARTED, as you mentioned, and a previous presentation of STAMPEDE but related to docetaxel. What do you think the role of docetaxel is in the face of the data from LATITUDE and STAMPEDE?
Dr. Sartor: Well, you know, I mentioned that we have a new standard. I didn’t say the new standard.
Dr. Haffizulla: Exactly; you did.
Dr. Sartor: I chose those words carefully. When we look at these data together I think they tell us that there are two options. I don’t think we have to go with the docetaxel. I don’t think we have to go with the abiraterone.
I think it’s conceivable that we’re unsure about which one really might be better. I’ll say that, from a side-effect perspective, probably from a safety perspective, the abiraterone might, in fact, be very favorable; but, at the same time, you have to realize the docetaxel is six doses and six doses only; then you’re done.
Whereas with abiraterone, you continue the therapy for a much longer period of time. So, there might be some men who choose to be treated with chemotherapy, and I think that that is clearly a benefit for the high-volume subset, and I think abiraterone presents another option.
Are we going to compare the two? Well, we need to. What about a study combining the two? We need to do that. So, there’s a lot of path forward here, and it just really means that men have more options.
Dr. Haffizulla: So, further research is needed before you can decide.
Dr. Sartor: Further research is needed, as always.
- James ND, De Bono JS, Spears MR, et al. Adding abiraterone for men with high-risk prostate cancer (PCa) starting long-term androgen deprivation therapy (ADT): Survival results from STAMPEDE (NCT00268476). Paper presented at: American Society of Clinical Oncology Annual Meeting; June 2-6, 2017; Chicago, IL. Abstract LBA5003.
- Sweeney CJ, Chen YH, Carducci M, et al. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. N Engl J Med. 2015;373(8):737-746.
- Fizazi K, Tran N, Fein LE, et al LATITUDE: A phase III, double-blind, randomized trial of androgen deprivation therapy with abiraterone acetate plus prednisone or placebos in newly diagnosed high-risk metastatic hormone-naive prostate cancer. Paper presented at: American Society of Clinical Oncology Annual Meeting; June 2-6, 2017; Chicago, IL. Abstract LBA3.