ASCO GU 2020: STAMPEDE Trial - Comparative Quality of Life in Patients Randomized Contemporaneously to Docetaxel of Abiraterone

San Francisco, California (Urotoday.com)  The multi-arm, multi-stage STAMPEDE trial has been a pivotal study in cementing novel drug combinations in the standard of care of localized and advanced prostate cancer over the last 10 years, with over 11,000 patients enrolled. From previously published arm comparisons, the STAMPEDE trial confirmed significant survival benefits from the addition of upfront abiraterone acetate or upfront docetaxel to androgen deprivation therapy. An outstanding question for the clinical implementation of these therapies is the relative risks and benefits with respect to the individual patient. In particular, the need to consider the impact on the quality of life of these therapies.  To this end, Hannah Rush, MBChB, Clinical Research Fellow at the MRC CTU at University College London, presented a comparative quality of life analysis of patients randomized to abiraterone or docetaxel in the STAMPEDE trial.


Dr. Rush demonstrated a previous comparative analysis of docetaxel and abiraterone arms in STAMPEDE, showing no significant difference in survival favoring either arm. Importantly, prospective quality of life data has been obtained, namely the EORTC QLQ-C30 and QLQ-PR25 questionnaires from baseline to 2 years.

Baseline characteristics of the abiraterone and docetaxel arms showed balanced characteristics between study arms, similar baseline QoL scores and similar frequency of pain from prostate cancer.

Focusing on global QoL over 2 years, patient scores were 3.9 points higher in patients treated with abiraterone consistent with more favorable QoL (a definition of 4 points differences was considered clinically significant). At pre-defined time points of 12 weeks, 24 weeks and 2 years, abiraterone was associated with a consistently better global QoL. The dip in QoL with docetaxel seen in early in follow-up was also concordant with findings of QoL of the CHAARTED trial of ADT versus ADT plus docetaxel, previously published by Morgans et al.

UROTODAY_ASCO_GU_2020_Rush.png

Furthermore, there was evidence that abiraterone was associated with perseveration of key functional domains (physical, role and social) in the first 2 years, with scores after this time being similar between arms. With respect to symptoms, docetaxel was associated with greater fatigue scores over 2 years (p=0.042) and higher pain scores over 2 years (p=0.001).

Dr. Rush concluded that the presented analysis was the only comparison of QoL of men randomized between the abiraterone and docetaxel, with clear evidence that abiraterone is associated with superior scores in several domains. Importantly, most differences were most marked in the first year and smaller differences may persist beyond the 2 year mark. Collectively these data should be incorporated into the discussion of the relative risks and benefits of abiraterone or docetaxel therapy for metastatic hormone-sensitive prostate cancer.


Presented by: Hannah L. Rush, MBChB, Clinical Research Fellow, MRC CTU at University College London

Written by: Anis Hamid, MBBS, Medical Oncology Research Fellow at Dana-Farber Cancer Institute and Medical Oncologist, Ph.D. candidate, University of Melbourne, Australia (Twitter: @anis_a_hamid) at the 2020 Genitourinary Cancers Symposium, ASCO GU #GU20, February 13-15, 2020, San Francisco, California

Reference:

1. Morgans, Alicia K., Yu-Hui Chen, Christopher J. Sweeney, David F. Jarrard, Elizabeth R. Plimack, Benjamin A. Gartrell, and Michael A. Carducci et al. 2018. "Quality Of Life During Treatment With Chemohormonal Therapy: Analysis Of E3805 Chemohormonal Androgen Ablation Randomized Trial In Prostate Cancer". Journal Of Clinical Oncology 36 (11): 1088-1095. doi:10.1200/jco.2017.75.3335.

email news signup