Prostate cancer: trial data meet the real world
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m519 (Published 12 February 2020) Cite this as: BMJ 2020;368:m519
- Santhanam Sundar, consultant oncologist
- sundar{at}oncology.org
The National Prostate Audit figures that show apparently lower uptake of docetaxel chemotherapy should be interpreted with caution.1
The STAMPEDE trial evaluated the role of docetaxel in newly diagnosed metastatic prostate cancer. The patients in this trial, like any other clinical trial, were much younger and healthier than the real world population because of various trial protocol inclusion and exclusion criteria. The median age of trial participants, for example, was 65, whereas the highest age specific prostate cancer incidence rates in the population are in the 75-79 age group.2
The median survival of patients with and without docetaxel chemotherapy in the trial was 81 months and 71 months, respectively—a net difference of 10 months.3 But docetaxel chemotherapy is more toxic in the real world population than in the trial population.45
It is not surprising that clinicians are individualising treatment and not exposing all older men with comorbidities to highly toxic chemotherapy by uncritically following the guidelines.
Footnotes
Competing interests: None declared.