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Separate Chinese lines for prostate cancer?


 Center for Tobacco Control Research, Birkevej 17, DK-5230 Odense M, Denmark

Date of Submission21-Jun-2018
Date of Acceptance10-Jul-2018
Date of Web Publication20-Nov-2018

Correspondence Address:
Finn Edler von Eyben,
Center for Tobacco Control Research, Birkevej 17, DK-5230 Odense M
Denmark
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aja.aja_71_18

PMID: 30460931


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How to cite this URL:
von Eyben FE. Separate Chinese lines for prostate cancer?. Asian J Androl [Epub ahead of print] [cited 2018 Dec 9]. Available from: http://www.ajandrology.com/preprintarticle.asp?id=245880



The recent report of Chinese patients treated with abiraterone is important. It debates whether previous reports of mainly Western patients with docetaxel-naïve and docetaxel-resistant castration-resistant metastatic prostate cancer are valid for Chinese patients.[1] The study showed findings with abiraterone for Chinese patients like those previously published. However, it remains an open question whether Chinese patients with prostate cancer differ from Western patients.

The Chinese investigators started abiraterone as monotherapy after failure to androgen deprivation therapy (ADT) with or without failure to docetaxel. They questioned whether Chinese patients with metastatic prostate cancer should be given abiraterone before or after docetaxel. In recent years, several randomized trials showed that patients with castration naïve metastatic prostate cancer benefit from adding docetaxel or abiraterone to ADT.[2],[3],[4] Hence, should Chinese patients be treated with a combination of abiraterone and ADT or only be treated with abiraterone after the failure to ADT?

Complementary analyses elucidated whether patients planned for ADT would gain most from adding docetaxel or abiraterone to ADT.[5] In the Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) study, patients had a better progression-free survival when ADT was combined with abiraterone instead of docetaxel. However, the STAMPEDE trial also showed that overall survival was better when ADT was combined with abiraterone than with docetaxel. Hence, a question is whether Chinese patients heading for ADT should have ADT combined with abiraterone or docetaxel.

In addition to studies analyzing the choice between the addition of docetaxel or abiraterone, an ongoing PEACE trial (NCT 01957436, ClinicalTrials.gov) examines whether the three-drug combination of ADT, docetaxel, and abiraterone is better than a two drug combination of ADT and docetaxel. The question is also relevant for Chinese patients. Would they respond better if they were treated with the three-drug combination?

Recent years raised the question whether patients with oligometastatic prostate cancer is a separate group of metastatic prostate cancer. It is defined as detection of only up to three to five metastases with advanced imaging modalities, such as PSMA-based PET/CT scans. So far, oligometastatic prostate cancer was treated with targeted radiotherapy to delay systemic treatment.[6] Chinese centers might initiate phase II studies with a curative intention of patients with oligometastatic prostate cancer treated with a combination of high-technology radiotherapy and optimized systemic treatment.

The study of abiraterone is a small cohort study from a single Chinese hospital. In contrast, the STAMPEDE trial is a multicenter trial in the United Kingdom where more than 20 hospitals worked together in the framework of a single protocol. The centers contributed with a varying number of participants in the trial. Some centers recruited less than 10 participants, but many centers recruited more than 100 participants. Overall the STAMPEDE trial analyzed nearly 9000 participants. A similar Chinese multicenter trial organization may recruit more participants.

In the 1990s, it was shown that East-Asian female nonsmoking patients with nonsmall cell lung cancer often had mutations of the epidermal growth factor receptor (EGFR). Treatment with EGFR inhibitors gave a high response for patients with mutations of EGFR.[7] Randomized trials showed that EGFR inhibitors gave patients with EGFR mutations as effective results as established chemotherapy. Correspondingly, studies of Chinese patients with prostate cancer might disclose that Asian and Western prostate cancers have important genetic differences.

Recent years have given many changes in the treatment of prostate cancer. China might organize a National database of all patients with prostate cancer as has been done in Denmark. The database should be structured so it could provide feedback to health authorities and other interested parties. A Chinese database of prostate cancer might further elucidate whether guidelines based on Western populations are relevant for Asian populations.

It will be of interest for a Western oncologist to follow future Chinese clinical research of prostate cancer.


  Competing Interests Top


The author declares no competing interests.



 
  References Top

1.
Lin GW, Li GX, Dai B, Ye DW, Kong YY, et al. Clinical activity of abiraterone plus prednisone in docetaxel-naive and docetaxel-resistant Chinese patients with metastatic castration resistant prostate cancer. Asian J Androl 2019; doi: 10.4103/aja.aja_85_18 [Epub ahead of print].  Back to cited text no. 1
    
2.
Fizazi K, Faivre L, Lesaunier F, Delva R, Gravis G, et al. Androgen deprivation therapy plus docetaxel and estramustine versus androgen deprivation therapy alone for high-risk localised prostate cancer (GETUG 12): a phase 3 randomised controlled trial. Lancet Oncol 2015; 16: 787–94.  Back to cited text no. 2
    
3.
James ND, Sydes MR, Clarke NW, Mason MD, Dearnaley DP, et al. 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. Lancet 2016; 387: 1163–77.  Back to cited text no. 3
    
4.
Fizazi K, Tran N, Fein L, Matsubara N, Rodriguez-Antolin A, et al. Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med 2017; 377: 352–60.  Back to cited text no. 4
    
5.
Sydes MR, Spears MR, Mason MD, Clarke NW, Dearnaley DP, et al. Adding abiraterone or docetaxel to long-term hormone therapy for prostate cancer: directly randomised data from the STAMPEDE multi-arm, multi-stage platform protocol. Ann Oncol 2018; 29: 1235–48.  Back to cited text no. 5
    
6.
Ost P, Reynders D, Decaestecker K, Fonteyne V, Lumen N, et al. Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence: a prospective, randomized, multicenter phase II trial. J Clin Oncol 2018; 36: 446–53.  Back to cited text no. 6
    
7.
von Eyben FE. Epidermal growth factor receptor inhibition and non-small cell lung cancer. Crit Rev Clin Lab Sci 2006; 43: 291–323.  Back to cited text no. 7
    




 

 
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