It’s taxane season.

Top Line: Taxanes are all the rage in prostate cancer, but they achieve conflicting results with non-metastatic disease.
The Study: The phase 3 RTOG 0521 enrolled 612 men with high-risk (per NCCN) prostate cancer receiving definitive radiation to pelvic nodes and prostate with androgen deprivation therapy (ADT) starting 2 months prior to radiation and continued for a total of 24 months. It then randomized them to +/- the addition of docetaxel x 6 cycles following radiation. Everyone had to have a PSA <150 and initial staging CT or bone scan without evidence of metastases. At six years, the addition of docetaxel improved rates of disease-free survival 55 → 65%, mets 14 → 9%, and even...drum roll please...the golden egg of overall survival 81 → 86%. This is discordant with other similarly-designed trials, but importantly these patients were pretty darn high-risk with over half having grade group 5 disease and over a quarter with cT3-4 tumors. Another caveat is this trial accrued from 2005-2009 so the radiation was conventionally-fractionated with lower BEDs than typically used today.
Bottom Line: Upfront docetaxel appears to improve disease control and even overall survival at 6 years for (really) high-risk prostate cancer. | Rosenthal, J Clin Oncol 2019


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