Clinical Outcomes and Survival Following Treatment of Metastatic Castrate-Refractory Prostate Cancer With Docetaxel Alone or With Strontium-89, Zoledronic Acid, or Both: The TRAPEZE Randomized Clinical Trial
| Autor: | Sarah Pirrie, James D. Wylie, Ilias Goranitis, Prabir Chakraborti, Ann Pope, Sharon Beesley, Duncan McLaren, Adam Daunton, Emilio Porfiri, Andrew Stanley, Syed A. Hussain, Lazaros Andronis, Nicholas D. James, Martin J. Russell, Alison Birtle, Stuart Collins, John Staffurth, Janet E. Brown, Chris Parker, Darren Barton, Lucinda Billingham, Joe M. O'Sullivan |
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| Rok vydání: | 2016 |
| Předmět: |
Oncology
Male Cancer Research medicine.medical_specialty medicine.medical_treatment Docetaxel Kaplan-Meier Estimate Zoledronic Acid Disease-Free Survival law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Maintenance therapy law Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans 030212 general & internal medicine Progression-free survival Survival analysis Aged Proportional Hazards Models Chemotherapy Diphosphonates business.industry Hazard ratio Imidazoles Prostatic Neoplasms Middle Aged Surgery Clinical trial Drug Resistance Neoplasm Strontium 030220 oncology & carcinogenesis Taxoids business medicine.drug |
| Zdroj: | JAMA oncology. 2(4) |
| ISSN: | 2374-2445 |
| Popis: | Importance Bony metastatic castrate-refractory prostate cancer (CRPC) has a poor prognosis and high morbidity. Zoledronic acid (ZA) is commonly combined with docetaxel in practice but lacks evidence that combining is effective, and strontium-89 (Sr89) is generally used palliatively in patients unfit for chemotherapy. Phase 2 analysis of the TRAPEZE trial confirmed combining the agents was safe and feasible, and the objectives of phase 3 include assessment of the treatments on survival. Objective To determine clinical effectiveness and cost-effectiveness of combining docetaxel, ZA, and Sr89, all having palliative benefits and used in bony metastatic CRPC to control bone symptoms and, for docetaxel, to prolong survival. Design, Setting, and Participants The TRAPEZE trial is a 2 × 2 factorial trial comparing docetaxel alone or with ZA, Sr89, or both. A cohort of 757 participants were recruited between February 2005 and February 2012 from hospitals in the United Kingdom. Overall, 169 participants (45%) had received palliative radiotherapy, and the median (IQR) prostate-specific antigen level was 146 (51-354). Follow-ups were performed for at least 12 months. Interventions Up to 10 cycles of docetaxel alone; docetaxel with ZA; docetaxel with a single Sr89 dose after 6 cycles; or docetaxel with both ZA and Sr89. Main Outcomes and Measures Primary outcomes included clinical progression-free survival (CPFS) (pain progression, skeletal-related events [SREs], or death) and cost-effectiveness. Secondary outcomes included SRE-free interval, pain progression–free interval, total SREs, and overall survival (OS). Results Overall, of 757 participants, 349 (46%) completed docetaxel treatment. Median (IQR) age was 68 (63-73) years. Clinical progression-free survival did not reach statistical significance for either Sr89 or ZA. Cox regression analysis adjusted for all stratification variables showed benefit of Sr89 on CPFS (hazard ratio [HR], 0.85; 95% CI, 0.73-0.99; P = .03) and confirmed no effect of ZA (HR, 0.98; 95% CI, 0.85-1.14; P = .81); ZA had a significant effect on SRE-free interval (HR, 0.78; 95% CI, 0.65-0.95; P = .01). For OS, there was no effect of either Sr89 (HR, 0.92; 95% CI, 0.79-1.08; P = 0.34) or ZA (HR, 0.99; 95% CI, 0.84-1.16; P = 0.91). Conclusions and Relevance Strontium-89 combined with docetaxel improved CPFS but did not improve OS, SRE-free interval, or total SREs; ZA did not improve CPFS or OS but did significantly improve median SRE-free interval and reduced total SREs by around one-third, suggesting a role as postchemotherapy maintenance therapy. |
| Databáze: | OpenAIRE |
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