A British expert has stressed the importance of combining both early hormone therapy and chemotherapy for patients with metastatic prostate cancer.
“Prostate cancer specialists should learn (about the necessity of chemotherapy) from breast cancer specialists,” said Dr. Amit Bahl from the Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust. “Breast cancer treatment is seen as an extension of chemotherapy – but in prostate cancer, chemotherapy is administered sporadically.”
However, domestic experts cast doubts about the early combination of hormone therapy and chemotherapy, saying there hasn’t been enough evidence.
Jevtana will be reimbursed as a second line treatment when used with prednisolone for metastatic castration-resistant prostate cancer patients who were treated with chemotherapy that includes docetaxel. The current standard of care for metastatic castration-resistant prostate cancer is getting chemotherapy after getting treated with hormone therapy.
“In no other cancer do we wait for cancer to progress to start chemotherapy as we do with metastatic castration-resistant prostate cancer. Chemotherapy should be started as soon as disease progress is found radiologically. If not, then it will lead to only chemotherapy toxicity,” Bahl said.
He stressed that prostate cancer patients needed to start chemotherapy when they can withstand side effects.
Bahl also said he found metastatic prostate cancer patients have a high survival rate when initially treated with hormone and chemotherapy.
In fact, researchers at the American Society of Clinical Oncology in 2015 reported that the overall survival time was extended by 10 months for metastatic prostate cancer patients who were initially treated concurrently with chemotherapy and hormone therapy.
"When we talk to doctors who treat prostate cancer, they often think that chemotherapy does not significantly improve survival and that it lowers quality of life," Bahl said. "But there are also studies that show that it improves the quality of life."
“If you asked your patients to choose between pills and chemotherapy, most will take pills. You could have better conversations if you instead ask them to choose just the order of taking the pill and chemotherapy,” he added.
However, some domestic experts contacted by Korea Biomedical Review noted there is not enough evidence to revise the standard of care wherein chemotherapy is administered after hormone therapy based on the current research data.
One of the leading professors of urology in Korea said while it is true that combination of hormone therapy and chemotherapy leads to a good prognosis, there was not enough evidence to make it the standard of care.
“Even though Zytiga (Abiraterone acetate), a hormonal agent, won approval to be used after chemotherapy docetaxel, there has been a foreign study result showed administering Zytiga before docetaxel led to good results. There is a high possibility of early concurrent treatment of hormone and chemotherapy becoming a trend in metastatic prostate cancer treatment,” he said.
“But if you compare it with breast cancer, the amount of research data is low, and it’s only at the beginning stages,” the professor said. “There isn’t enough evidence to establish the combination therapy as the standard of care even though it’s difficult to stay that there is a complete lack of it.”
Another professor of urology at a university hospital voiced a similar opinion.
“We got the concept of hormone-refractory cancer because hormone therapy is a standard of care. We lack the data and evidence to compare it with breast cancer,” the professor said.
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