Ponencia en simposio satélite de Janssen en el congreso de la Sociedad Colombiana de Urología, Cartagena, Colombia (16.08.2017)

1. Chemohormonal therapy for castrate-
sensitive prostate cáncer (CSPC)
Mauricio Lema Medina MD
Clínica de Oncología Astorga / Clínica SOMA - Medellín, Colombia
Cartagena, 16/08/2017

2. @onconerd

3. Androgen
ADT
Increase Prostate Cancer
Tumor-load
Increase Epidermal-
Mesenchymal Transition
Decrease Prostate Cancer
Tumor-load
Increase Epidermal-
Mesenchymal Transition
(G1-S)
(ZEB1)
Resistance to ADT /
Chemotherapy
Resistance to ADT /
Chemotherapy
CRPC (AR-dependent, AR-
independent)
Fitzpatrick JM, de Wit R. Taxane Mechanisms of Action: Potential Implications for Treatment Sequencing in
Metastatic Castration-resistant Prostate Cancer. Eur Urol. 2014;65(6):1198-1204.
doi:10.1016/j.eururo.2013.07.022.
Taxane Mechanisms of Action: Potential Implications for Treatment
Sequencing in Metastatic Castration-resistant Prostate Cancer.

5. Docetaxe
l Decrease Androgen
Receptor
Decrease
PSA
Fitzpatrick JM, de Wit R. Taxane Mechanisms of Action: Potential Implications for Treatment Sequencing in
Metastatic Castration-resistant Prostate Cancer. Eur Urol. 2014;65(6):1198-1204.
doi:10.1016/j.eururo.2013.07.022.
Docetaxel mechanism of action in prostate cancer may be related
to its anti-AR effects
Decrease Tubulin de-
polimerization
Interfere with
Mitosis
1. Docetaxel - ↑FOXO1 -↓AR
cAR
nAR
2. Docetaxel
Apoptosis
Prostate Cancer
-Docetaxel and AR-

6. Post-Docetaxel PSA decline decreases
with prior anti androgen therapy
Fitzpatrick JM, de Wit R. Taxane Mechanisms of Action: Potential Implications for Treatment Sequencing in
Metastatic Castration-resistant Prostate Cancer. Eur Urol. 2014;65(6):1198-1204.
doi:10.1016/j.eururo.2013.07.022.

7. CHAARTED

8. <br /><br />E3805<br />CHAARTED: ChemoHormonal Therapy versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

9. A Quick Review of the History of Hormone Sensitive Metastatic Prostate Cancer
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

10. Early Chemo+ADT: A debate in one slide – a need for randomized phase 3 trial
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

11. The CHAARTED Hypothesis
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

12. E3805 – CHAARTED Treatment
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

13. Key Eligibility Criteria
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

14. Study Endpoints
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

15. Statistical Design: History of CHAARTED<br />Intent to treat analysis, 80% power 1-sided alpha=2.5% to detect 33% improvement in median OS (with all versions)
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

16. Results:
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

17. Patient characteristics
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

18. Patient characteristics
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

19. Patient characteristics
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

20. Primary endpoint: Overall survival
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

21. Causes of Death
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

22. OS by extent of metastatic disease at start of ADT
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

23. ADT + Docetaxel benefited all subgroups
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

24. Secondary Endpoints
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

25. Therapy beyond progression
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

26. Chemotherapy Doses Given
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

27. Non-Hematologic Toxicity (%)
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

28. Hematologic Toxicity (%)
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

29. Conclusion
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

30. Clinical interpretation
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

31. Designed and conducted by:
Presented By Christopher Sweeney at 2014 ASCO Annual Meeting
Sweeney, C. J., Chen, Y.-H., Carducci, M., Liu, G., Jarrard, D. F., Eisenberger, M., … DiPaola, R. S. (2015).
Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New England Journal of
Medicine, 373(8), 737–746. https://doi.org/10.1056/NEJMoa1503747

32. STAMPEDE

35. STAMPEDE: Study Design
• Randomized, controlled, multiarm, multistage trial
• Primary endpoint: OS
• Secondary endpoints: FFS (PSA, local, or lymph node failure; distant
metastases; prostate cancer death), toxicity, QoL, skeletal events, cost-
effectiveness
WHO stage 0-2 pts with
prostate cancer who have
never received hormone
therapy, fitting criteria based
on stage of disease
(N = 2962)
SOC
(n = 1184)
SOC + Docetaxel
(n = 592)
SOC + Zoledronic Acid
(n = 593)
SOC + Zoledronic Acid + Docetaxel
(n = 593)
James ND, et al. ASCO 2015. Abstract 5001.
Stratified by age, WHO stage,
metastases, previous treatments,
center, use of NSAIDS or aspirin
Dosage:
 SOC: ADT ± RT
 Zoledronic acid: 4 mg
q3w to 18 wks, then
q4w to 2 yrs
 Docetaxel: 75 mg/m2
q3w for 6 cycles +
prednisolone 10 mg QD

36. James, N. D., Sydes, M. R., Clarke, N. W., Mason, M. D., Dearnaley, D. P., Spears, M. R., … STAMPEDE investigators.
(2016). Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE):
survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. The Lancet, 387(10024), 1163–
1177. https://doi.org/10.1016/S0140-6736(15)01037-5

37. James, N. D., Sydes, M. R., Clarke, N. W., Mason, M. D., Dearnaley, D. P., Spears, M. R., … STAMPEDE investigators.
(2016). Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE):
survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. The Lancet, 387(10024), 1163–
1177. https://doi.org/10.1016/S0140-6736(15)01037-5

38. STAMPEDE: Pt Characteristics
Baseline Characteristics
Characteristic
Pt Population
(N = 2962)
Median age, yrs (range) 65 (40-84)
WHO stage, %
 PS 1
 PS 2
21
1
Metastatic disease, %
 N + M0
 N0M0
61
15
24
Previous treatments, %
 LHRL analogues
 Radiotherapy
 Local therapy
98
29
6
James ND, et al. ASCO 2015. Abstract 5001.

39. James, N. D., Sydes, M. R., Clarke, N. W., Mason, M. D., Dearnaley, D. P., Spears, M. R., … STAMPEDE investigators.
(2016). Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE):
survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. The Lancet, 387(10024), 1163–
1177. https://doi.org/10.1016/S0140-6736(15)01037-5

40. James, N. D., Sydes, M. R., Clarke, N. W., Mason, M. D., Dearnaley, D. P., Spears, M. R., … STAMPEDE investigators.
(2016). Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE):
survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. The Lancet, 387(10024), 1163–
1177. https://doi.org/10.1016/S0140-6736(15)01037-5

41. Regimen
(+ SOC)
Metastatic
Status
Pts, n OS Events HR (95% CI)
ZA M0 686 93 0.96 (0.62-1.48)
M1 1091 509 0.92 (0.76-1.11)
Overall 1777 602 0.93 (0.79-1.11)
DOC M0 689 93 1.01 (0.65-1.56)
M1 1087 477 0.73 (0.59-0.89)
Overall 1776 570 0.76 (0.63-0.91)
ZA + DOC M0 687 91 1.03 (0.66-1.61)
M1 1090 495 0.78 (0.65-0.95)
Overall 1777 586 0.81 (0.68-0.97)
STAMPEDE: Metastatic Analysis
• Adding docetaxel to SOC showed significant improvement in OS in pts with
M1 metastatic status (P = .002) but not M0 pts in preplanned analysis
James ND, et al. ASCO 2015. Abstract 5001.

42. Regimen
(+ SOC)
Metastatic
Status
Pts, n OS Events HR (95% CI)
ZA M0 686 93 0.96 (0.62-1.48)
M1 1091 509 0.92 (0.76-1.11)
Overall 1777 602 0.93 (0.79-1.11)
DOC M0 689 93 1.01 (0.65-1.56)
M1 1087 477 0.73 (0.59-0.89)
Overall 1776 570 0.76 (0.63-0.91)
ZA + DOC M0 687 91 1.03 (0.66-1.61)
M1 1090 495 0.78 (0.65-0.95)
Overall 1777 586 0.81 (0.68-0.97)
STAMPEDE: Metastatic Analysis
• Adding docetaxel to SOC showed significant improvement in OS in pts with
M1 metastatic status (P = .002) but not M0 pts in preplanned analysis
James ND, et al. ASCO 2015. Abstract 5001.

43. James, N. D., Sydes, M. R., Clarke, N. W., Mason, M. D., Dearnaley, D. P., Spears, M. R., … STAMPEDE investigators.
(2016). Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE):
survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. The Lancet, 387(10024), 1163–
1177. https://doi.org/10.1016/S0140-6736(15)01037-5
Treatment effect by metastatic
status
Failure-Free Survival
Overall Survival

44. James, N. D., Sydes, M. R., Clarke, N. W., Mason, M. D., Dearnaley, D. P., Spears, M. R., … STAMPEDE investigators.
(2016). Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE):
survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. The Lancet, 387(10024), 1163–
1177. https://doi.org/10.1016/S0140-6736(15)01037-5

45. James, N. D., Sydes, M. R., Clarke, N. W., Mason, M. D., Dearnaley, D. P., Spears, M. R., … STAMPEDE investigators.
(2016). Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE):
survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. The Lancet, 387(10024), 1163–
1177. https://doi.org/10.1016/S0140-6736(15)01037-5

46. Meta-analysis

47. Fig 1. Trial selection flow.
Botrel TEA, Clark O, Lima Pompeo AC, Horta Bretas FF, Sadi MV, et al. (2016) Efficacy and Safety of Combined Androgen
Deprivation Therapy (ADT) and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic
Review and Meta-Analysis. PLOS ONE 11(6): e0157660. https://doi.org/10.1371/journal.pone.0157660
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157660

48. Table 1. Characteristics of excluded studies.
Botrel TEA, Clark O, Lima Pompeo AC, Horta Bretas FF, Sadi MV, et al. (2016) Efficacy and Safety of Combined Androgen
Deprivation Therapy (ADT) and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic
Review and Meta-Analysis. PLOS ONE 11(6): e0157660. https://doi.org/10.1371/journal.pone.0157660
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157660

49. Table 2. Characteristics of randomized studies evaluating ADT ± docetaxel for mHNPC.
Botrel TEA, Clark O, Lima Pompeo AC, Horta Bretas FF, Sadi MV, et al. (2016) Efficacy and Safety of Combined Androgen
Deprivation Therapy (ADT) and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic
Review and Meta-Analysis. PLOS ONE 11(6): e0157660. https://doi.org/10.1371/journal.pone.0157660
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157660

50. Table 3. Efficacy results of randomized studies evaluating ADT ± docetaxel for mHNPC.
Botrel TEA, Clark O, Lima Pompeo AC, Horta Bretas FF, Sadi MV, et al. (2016) Efficacy and Safety of Combined Androgen
Deprivation Therapy (ADT) and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic
Review and Meta-Analysis. PLOS ONE 11(6): e0157660. https://doi.org/10.1371/journal.pone.0157660
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157660

51. Fig 2. Comparative effect in clinical progression-free survival of ADT with docetaxel versus
ADT alone.
Botrel TEA, Clark O, Lima Pompeo AC, Horta Bretas FF, Sadi MV, et al. (2016) Efficacy and Safety of Combined Androgen
Deprivation Therapy (ADT) and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic
Review and Meta-Analysis. PLOS ONE 11(6): e0157660. https://doi.org/10.1371/journal.pone.0157660
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157660

52. Fig 3. Comparative effect in biochemical progression-free survival of ADT with docetaxel
versus ADT alone.
Botrel TEA, Clark O, Lima Pompeo AC, Horta Bretas FF, Sadi MV, et al. (2016) Efficacy and Safety of Combined Androgen
Deprivation Therapy (ADT) and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic
Review and Meta-Analysis. PLOS ONE 11(6): e0157660. https://doi.org/10.1371/journal.pone.0157660
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157660

53. Fig 4. Comparative effect in overall survival of ADT with docetaxel versus ADT alone (Fixed-
effect model analysis).
Botrel TEA, Clark O, Lima Pompeo AC, Horta Bretas FF, Sadi MV, et al. (2016) Efficacy and Safety of Combined Androgen
Deprivation Therapy (ADT) and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic
Review and Meta-Analysis. PLOS ONE 11(6): e0157660. https://doi.org/10.1371/journal.pone.0157660
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157660

54. Fig 5. Comparative effect in overall survival of ADT with docetaxel versus ADT alone (random-
effects model analysis).
Botrel TEA, Clark O, Lima Pompeo AC, Horta Bretas FF, Sadi MV, et al. (2016) Efficacy and Safety of Combined Androgen
Deprivation Therapy (ADT) and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic
Review and Meta-Analysis. PLOS ONE 11(6): e0157660. https://doi.org/10.1371/journal.pone.0157660
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157660

55. Fig 6. Comparative effect in overall survival of ADT with docetaxel versus ADT alone in
patients with high-volume disease.
Botrel TEA, Clark O, Lima Pompeo AC, Horta Bretas FF, Sadi MV, et al. (2016) Efficacy and Safety of Combined Androgen
Deprivation Therapy (ADT) and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic
Review and Meta-Analysis. PLOS ONE 11(6): e0157660. https://doi.org/10.1371/journal.pone.0157660
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157660

56. Fig 7. Comparative effect in overall survival of ADT with docetaxel versus ADT alone in
patients with low-volume disease.
Botrel TEA, Clark O, Lima Pompeo AC, Horta Bretas FF, Sadi MV, et al. (2016) Efficacy and Safety of Combined Androgen
Deprivation Therapy (ADT) and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic
Review and Meta-Analysis. PLOS ONE 11(6): e0157660. https://doi.org/10.1371/journal.pone.0157660
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157660

57. Fig 8. Comparative effect in hematologic toxicities of ADT with docetaxel versus ADT alone.
Botrel TEA, Clark O, Lima Pompeo AC, Horta Bretas FF, Sadi MV, et al. (2016) Efficacy and Safety of Combined Androgen
Deprivation Therapy (ADT) and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic
Review and Meta-Analysis. PLOS ONE 11(6): e0157660. https://doi.org/10.1371/journal.pone.0157660
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157660

58. Fig 9. Comparative effect in non-hematologic toxicities of ADT with docetaxel versus ADT
alone.
Botrel TEA, Clark O, Lima Pompeo AC, Horta Bretas FF, Sadi MV, et al. (2016) Efficacy and Safety of Combined Androgen
Deprivation Therapy (ADT) and Docetaxel Compared with ADT Alone for Metastatic Hormone-Naive Prostate Cancer: A Systematic
Review and Meta-Analysis. PLOS ONE 11(6): e0157660. https://doi.org/10.1371/journal.pone.0157660
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157660

59. Conclusions
Chemo-hormonal therapy may considered as a standard-of-care in CSPC
High-Risk
Metastatic Disease
Visceral metastases
4 or more bone metastases
In Suitable patients
Good Performance Status
Without prohibitive co-
morbidities.

60. @onconerd

61. “Una conferencia consiste en
un combate cuerpo a cuerpo
con los minutos”
José Ortega y Gasset, Vives, 1940
Gracias, mauriciolema@yahoo.com