Docetaxel chemotherapy alongside hormone therapy

Your questions about STAMPEDE

• Can I still be part of the STAMPEDE trial?  

  The STAMPEDE trial is very big, and includes lots of different ‘arms’. Each ‘arm’ of the trial is testing something different. The investigators are reporting results from three arms of the trial at a big American cancer conference later this month. The arms being reported are: 
  
  •    hormone therapy plus docetaxel chemotherapy
  •    hormone therapy plus zoledronic acid
  •    hormone therapy plus docetaxel chemotherapy and zoledronic acid
  
  These results have already hit the headlines, and these trial arms are now closed to new patients (they are still continuing to follow-up the men who took part so they can find out the long-term effects of these drugs). However, other arms of the trial are still recruiting patients. 
  
  You can find out more on the STAMPEDE trial website. You can also speak to our Specialist Nurses.

• Does this mean that chemotherapy alongside hormone therapy is now available as soon as someone is diagnosed with advanced prostate cancer?  

  Not necessarily. The results of this trial are really positive, but at the moment ‘standard treatment’ is still hormone therapy, not chemotherapy. We’re working hard to find out exactly what needs to happen to change standard practice across the UK so that it includes offering chemotherapy alongside hormone therapy as soon as a man is diagnosed with advanced prostate cancer.
  
  Men in Scotland should be able to access this already. Work is currently underway to make this available to men in England, Wales and Northern Ireland as soon as possible, as detailed above. We’ll do everything we can to make that happen as soon as possible and we’ll keep you up to date with any developments.

• I’ve just been diagnosed with advanced prostate cancer. Can I ask my oncologist for chemotherapy now?  

  Yes, you can ask about chemotherapy alongside hormone therapy outside of the STAMPEDE trial. If this is a treatment option you’d like to consider, we would recommend that you do speak to your oncologist about it. But we can’t guarantee that the answer will be yes. 
  
  Docetaxel chemotherapy is already available on healthcare systems across the UK for men whose prostate cancer no longer responds to hormone therapy. But the licence that allows docetaxel to be used in the EU (and the use that NICE [National Institute for Health and Care Excellence] have agreed to) doesn’t include its use before the cancer has become resistant to hormone therapy. 
  
  Having said that, doctors do have the freedom to prescribe drugs ‘off-licence’, if they think it will be in the patients’ best interest, and if the NHS Trust/Board that employs them will allow it. So if this is a treatment option you’re considering, asking your oncologist is your best bet.

   

• Can I only ask for chemotherapy alongside hormone therapy if my prostate cancer has already spread to other parts of the body?  

  If your prostate cancer hasn’t yet spread to other parts of the body, but has spread to the area just outside the prostate, you can still ask, but the STAMPEDE trial results we’ve seen so far don’t show a clear survival benefit from taking docetaxel alongside hormone therapy in this situation.
  
  The researchers found that, on average, men with advanced prostate cancer (prostate cancer that has spread to other sites in the body) survived an extra 15 months. And the researchers said that they hope doctors will offer chemotherapy to all men newly diagnosed with advanced prostate cancer.

  They also think that men with locally advanced prostate cancer (prostate cancer that has just started to spread out of the prostate) might want to consider having chemotherapy earlier on alongside hormone therapy, because it can give them longer before their cancer starts to grow again.
  
  But the evidence doesn’t show a clear survival benefit from giving docetaxel chemotherapy at this stage, so your oncologist may not agree to prescribe you docetaxel alongside hormone therapy if your prostate cancer hasn’t yet spread.

• I’ve just started hormone therapy. If my oncologist won’t prescribe it now, will it be too late for me to have docetaxel alongside the hormone therapy, by the time it’s a standard treatment?  

  We don’t know yet whether there’s benefit in giving docetaxel chemotherapy to men with advanced prostate cancer who have already been on hormone therapy for a while. 
  
  This trial only recruited men with locally advanced, or advanced disease, who needed to take hormone therapy for the first time. Men on the trial started hormone therapy a few weeks before starting chemotherapy. There may well be some benefit in having docetaxel chemotherapy even after a longer period on hormone therapy alone, but this wasn't specifically tested for. 
  
  But if this is a treatment you're interested in, it's worth having a chat to your oncologist about it. 

   

• You’ve been campaigning for a while now to get abiraterone available before chemotherapy, because you say chemotherapy can have significant side effects. Aren’t you contradicting yourselves?  

  No, we’re not. We think that when a man is diagnosed with advanced prostate cancer, he should have access to as many effective treatment options as possible. Some men will choose not to have chemotherapy, or won’t be strong enough to have chemotherapy, in which case, we’d like them to have the option of taking abiraterone when their hormone therapy stops working.
  
  On the other hand, we’d like men to have the option of having chemotherapy earlier on in their treatment pathway, when they are newly diagnosed with advanced prostate cancer. The STAMPEDE trial, and previous data from another clinical trial called CHAARTED, has shown that this can help these men survive longer. It’s also worth considering that more men might choose to have chemotherapy earlier on, when they’re feeling stronger and better able to cope with the side effects.