The document discusses chemohormonal therapy for castrate-sensitive prostate cancer (CSPC) and its potential benefits over standard androgen ablation. It highlights findings from a phase III trial that shows improved overall survival with the addition of docetaxel to androgen deprivation therapy. The document also mentions key statistics and results presented at the 2014 ASCO annual meeting, emphasizing the effectiveness of this treatment approach for advanced prostate cancer.

1. Chemohormonal therapy for castrate-
sensitive prostate cáncer (CSPC)
Mauricio Lema Medina MD
Clínica de Oncología Astorga / Clínica SOMA - Medellín, Colombia
26.08.2017
Barranquilla, Centro de Convenciones – Blue Garden

2. @onconerd

4. 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.

8. Docetaxel
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

9. Docetaxel
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
Prostate Cancer
-Docetaxel and AR-

10. Docetaxel
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-

11. 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.

13. Phase III Trial of Androgen Ablation With or Without
Three Cycles of Systemic Chemotherapy for
Advanced Prostate Cancer
Millikan, R. E., Wen, S., Pagliaro, L. C., Brown, M. A., Moomey, B., Do, K.-A., & Logothetis, C. J. (2008). Phase
III Trial of Androgen Ablation With or Without Three Cycles of Systemic Chemotherapy for Advanced Prostate
Cancer. Journal of Clinical Oncology, 26(36), 5936–5942. https://doi.org/10.1200/JCO.2007.15.9830
Disease burden Median TTP (mo)
Local/regional and prior definitive local therapy 58.3
Local/regional without prior definitive local therapy 42.9
One or two lesions by bone scan 39.4
Three or more lesions by bone scan, or visceral involvement 14.2

14. Phase III Trial of Androgen Ablation With or Without
Three Cycles of Systemic Chemotherapy for
Advanced Prostate Cancer
Millikan, R. E., Wen, S., Pagliaro, L. C., Brown, M. A., Moomey, B., Do, K.-A., & Logothetis, C. J. (2008). Phase
III Trial of Androgen Ablation With or Without Three Cycles of Systemic Chemotherapy for Advanced Prostate
Cancer. Journal of Clinical Oncology, 26(36), 5936–5942. https://doi.org/10.1200/JCO.2007.15.9830
Disease burden Median TTP (mo)
Low-volume
Local/regional and prior definitive local therapy 58.3
Local/regional without prior definitive local therapy 42.9
One or two lesions by bone scan 39.4
High-volume
Three or more lesions by bone scan, or visceral involvement 14.2

15. Phase III Trial of Androgen Ablation With or Without
Three Cycles of Systemic Chemotherapy for
Advanced Prostate Cancer
Millikan, R. E., Wen, S., Pagliaro, L. C., Brown, M. A., Moomey, B., Do, K.-A., & Logothetis, C. J. (2008). Phase
III Trial of Androgen Ablation With or Without Three Cycles of Systemic Chemotherapy for Advanced Prostate
Cancer. Journal of Clinical Oncology, 26(36), 5936–5942. https://doi.org/10.1200/JCO.2007.15.9830

16. CHAARTED

17. <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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. STAMPEDE

43. 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

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. 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.

47. 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

48. 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

49. 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.

50. 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.

51. 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

52. 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

53. 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

54. Meta-analysis

55. 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

56. 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

57. 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

58. 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

59. Fig 2. Comparative effect in clinical progression-free survival of ADT with docetaxel versus
ADT alone.
Fig 3. Comparative effect in biochemical progression-free survival of ADT with docetaxel
versus ADT alone.
Fig 4. Comparative effect in overall survival of ADT with docetaxel versus ADT alone (Fixed-
effect model analysis).

60. 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
Fig 7. Comparative effect in overall survival of ADT with docetaxel versus ADT alone in
patients with low-volume disease.

61. 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

62. 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

63. Believe it, or not
No por ello debe perder credibilidad

64. Conclusions
Chemo-hormonal therapy may considered as a standard-of-care in CSPC
High-Risk
Metastatic Disease
Visceral metastases
>3 bone metastases
In Suitable patients
Good Performance Status
Without prohibitive co-
morbidities.

65. @onconerd

66. “Una conferencia consiste en
un combate cuerpo a cuerpo
con los minutos”
José Ortega y Gasset, Vives, 1940
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