Feasibility and efficacy of early docetaxel plus androgen deprivation therapy for metastatic hormone-sensitive prostate cancer in a rural health care setting

Abstract

Aim/Background

The aim of this study was to evaluate the feasibility and efficacy, in terms of overall survival, of intensified upfront systemic therapy in patients with metastatic hormone-sensitive prostate cancer who lived in rural Nordland County, Norway.

Patients and methods

Overall 117 patients were included in this retrospective study. Three cohorts were created: early docetaxel and androgen deprivation therapy (ADT; the CHAARTED regimen; n = 37), ADT only during the same time period (2014–2020; n = 33), and ADT only in the years 2009–2014 (n = 47).

Results

Four patients (11%) did not complete 6 cycles of docetaxel, one of these due to early progression of cancer. During follow-up, 8 patients (22%) progressed to castration-resistant disease (mCRPC), compared to 24 (73%) with ADT only and 35 (75%) in the historical cohort, p = 0.000001. Such progression occurred within 12 months in 3 patients (8%) treated with docetaxel and 9 patients (27%) treated with ADT only during the same time period, p = 0.05. Median survival was 56 months (95% CI: 40–72 months), compared to 30 months in both other cohorts. 3-year survival rates were 79%, 38% and 37%, respectively (p = 0.016). In multivariate analysis, the CHAARTED regimen was associated with significantly improved survival.

Conclusion

In this rural health care setting, early docetaxel was feasible and effective in reducing progression to mCRPC and prolonging survival. Median survival was very close to the 58 months reported in the CHAARTED trial.

Keywords:

• Prostate cancer
• distant metastases
• chemotherapy
• systemic therapy
• survival
• pattern of care

Ethical approval

As a retrospective quality of care analysis, no approval from the Regional Committee for Medical and Health Research Ethics (REK Nord) was necessary (national policy in Norway). This research project was carried out according to our institutions’ guidelines and with permission to access the patients’ data.

Author contributions

CN participated in the design of the study and performed the statistical analysis. LS, AD, EH and CN collected patient data. CN, LS, EH and AD conceived of the study and drafted the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data will not be shared, but a copy of relevant baseline parameters can be provided to researchers attempting to pool data from several institutions for large-scale analyses.