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Which are the best treatments to add to long-term hormone therapy for advanced prostate cancer?

23 April 2018

Docetaxel or abiraterone, in addition to standard care, are very effective treatments for men with prostate cancer due to start long-term hormone therapy. Findings from the STAMPEDE trial and STOPCAP network meta-analysis, helping clinicians to choose between them, were published recently in Annals of Oncology.

The STAMPEDE trial, directly compared men recruited to the trial between November 2011 and March 2013. Patients were randomised to receive either docetaxel plus standard hormone therapy, or abiraterone plus standard hormone therapy. This is the first direct randomised data comparing the two treatments.

The STOPCAP network meta-analysis represents the most comprehensive and reliable assessment of the effects of current treatment options for men whose prostate cancer has spread, and who are starting long-term hormone therapy for the first time.  Results based on all current trial data show that abiraterone plus standard hormone therapy is most likely to be the best treatment; docetaxel is likely to be the second best. However, it is still not certain how much better abiraterone is than docetaxel in terms of improving the survival of men with advanced prostate cancer.

Although abiraterone appears to be the most effective treatment, it is still unclear whether, or by how much, patient variability across trials, changes in prognosis and treatments available over time, or the potential impact of newer treatments given after progression might influence the results. A  STOPCAP network meta-analysis using individual participant data, which will include the STAMPEDE trial, is underway to help resolve this uncertainty.

About STAMPEDE and STOPCAP

STAMPEDE is an internationally recognised multi-arm, multi-stage (MAMS) platform protocol, incorporating a number of comparisons of new treatments added to standard-of-care compared to standard-of-care alone.  It has already demonstrated improved survival with the addition of abiraterone or docetaxel to standard-of-care for men starting long-term hormone therapy.

The collaborative STOPCAP network meta-analysis has considerably more power to detect differences in treatment effects than any individual trial; STOPCAP makes use of existing reliable systematic reviews and up-to-date results of individual trials, and takes account of the multi-arm, multi-stage design of the STAMPEDE trial.