[Docetaxel or abiraterone in combination with androgen deprivation therapy for metastatic prostate cancer]

Androgen deprivation therapy (ADT) alone has long been the standard of care in the treatment of metastatic prostate cancer (mCSPC). A paradigm shift in the treatment of patients with mCSPC has now been initiated by the results of three major phase 3 clinical trials (CHAARTED, STAMPEDE, LATITUDE): They demonstrated a significant advantage of ADT in combination with docetaxel or abiraterone/prednisone over ADT alone.

This review presents the current evidence for the use of docetaxel or abiraterone/prednisone in combination with ADT and discusses-in the absence of directly comparing studies-which patients may have an advantage of ADT plus abiraterone/prednisone over ADT plus docetaxel or vice versa.

A systematic review based on bibliographic literature search was conducted.

Both the combinations of ADT with docetaxel and with abiraterone/prednisone represent a major advance in the treatment of patients with mCSPC, in particular of patients with multiple metastases. Compared to chemotherapy, the use of abiraterone in addition to ADT avoids (rare) neutropenic complications and treatment-associated deaths. Long-term oral treatment with abiraterone/prednisone as a complementary therapy to ADT replaces short-term intravenous treatment (docetaxel).

In patients with mCSPC, ADT plus docetaxel or ADT plus abiraterone/prednisone is recommended. In particular in patients with pre-existing cardiovascular disease, ADT should be considered with a GnRH (gonadotropin-releasing hormone) antagonist to reduce the risk of cardiotoxic side effects.