Statins and the treatment of mCRPC with chemotherapy

A report on the UroToday web site has addressed a presentation given this week at the ESMO 2018 Congress in Munich, Germany, that is relevant to the potential value of taking a statin while you are being treated for very late stage prostate cancer.

The report on the presentation by Lorente et al. indicates the possibility that among the men participating in the TROPIC trial, who were being treated with either cabazitaxel (Jevtana) or mitoxantrone, the men treated with cabazitaxel who were also being treated with a statin had a small survival benefit (a median of 2.4 months) compared to men treated with cabazitaxel who were not also being treated with a statin.

However, there are a lot of underlying issues related to the interpretation of the available data, as follows:

  • This was a retrospective analysis of data from a prospective, randomized trial, but was not a trial in which the patients were prospectively randomized to a statin or not, and the analysis was not pre-planned.
  • At the start of the trial, compared to the men who were not taking a statin, the patients who were taking statins were older, had higher hemoglobin levels, had lower alkaline phosphatase levels, and had a lower rate of visceral metastases. In other words, the two different sets of patients were not well balanced.
  • The number of patients who were taking both cabazitaxel and a statin was small (n = 66) compared to the number of men who were taking cabazitaxel but not taking a statin (n = 305).
  • Patients were taking any one of as many as six different statins, and we have no idea whether one particular type of statin might have more benefit than the others in terms of an effect on prostate cancer.
  • We have no idea why the patients were taking statins in the first place, and that underlying medical reason for taking a statin may be important. (Statins are mostly used for the treatment of hyperlipidemia, but they can also be prescribed for the management of coronary artery disease and cerebriovascular events.)

The bottom line here is that we would be unwise to use these data to make any decisions as to whether or not men with very late-stage prostate cancer who are receiving taxane-based chemotherapy would benefit (or not) from taking a statin.

If we are ever going to get to the bottom of this question, we will only do so through the conduct of high quality, randomized, prospective trials designed to test, very specifically, whether a taking a statin is beneficial in a highly defined group of patients.

It is also arguable that such a trial might best be done in either

  • “Favorable” intermediate-risk patients who start on active surveillance for the management of their prostate cancer — in which case the question would be: Does taking a statin extend time to specific events associated with a recommendation for definitive treatment (by delaying the progression of the patient’s disease)? or
  • Men who are being started on continuous androgen deprivation therapy (ADT) — when the question would be: Does taking a statin either lower risk for cardiovascular side effects of ADT or extend time to the onset of castration-resistant prostate cancer?

Whether it will ever prove possible to conduct any trial of this type is a question with no answer at this time.

One Response

  1. Metformin &/vs. a statin as additions to standard-of-care for prostate cancer

    Thanks for posting this. Another related question is whether adding to or substituting metformin for a statin in such trials would have an impact, possibly a greater impact. Here’s a recent article on this site regarding metformin for prostate cancer patients. Arm K of the STAMPEDE trial is looking into metformin added to standard-of-care ADT versus standard-of-care ADT alone.

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