Race and survival of men after docetaxel-based treatment for mCRPC

A new paper in the Journal of Clinical Oncology has just reported that the overall survival (OS) of black and white men diagnosed with metastatic castration-resistant prostate cancer (mCRPC) seems to be near to identical after treatment with docetaxel or a docetaxel-containing regimen.

Halabi et al. looked at all the data from a total of nine randomized Phase III trials in which a total of > 8,000 patients with mCRPC were treated with either docetaxel + prednisone (DP) or a DP-containing regimen. Their primary goal was to see if there were any meaningful differences between the OS times of the black and the white patients.

There have been a number of studies over the years indicating that among black men with localized prostate cancer have a shorter overall survival (OS) time than white men with localized prostate cancer. By comparison, the available data on OS times of men with advanced forms of prostate cancer is sparse.

Here are the core data reported by Halabi et al. from their careful meta-analysis:

  • Data were available on 8,820 men with mCRPC treated with DP or a DP-containing regimen.
    • 7,528 of these patients (85.4 percent) self-reported as white
    • 500 (5.7 percent) self-reported as black
    • 424 (4.8 percent) self-reported as Asian
    • 368 (4.2 percent) were of unknown or unidentified race
  • Compared to the white patients, at study entry, the black patients
    • Were younger
    • Had worse performance statuses
    • Had higher PSA levels and higher serum testosterone levels
    • Had lower hemoglobin levels
  • After treatment with a DP or DP-containing regimen,
    • Median OS for the black men was 21.0 months
    • Median OS for the white men was 21.2 months
  • The black men had a small but statistically significant decrease in risk for death that the white men (pooled multivariate hazard ratio [HR] = 0.81; P < 0.001).

It is hard to know what to make of these data for all sorts of reasons, starting with the fact that, in relative terms, the number of black males in this study was 15 times lower than the number of white ones. It may also be relevant that the black patients were distinctly younger that the white ones.

On the other hand, Halabi et al. correctly conclude that

When adjusted for known prognostic factors, we observed a statistically significant increased OS in black versus white men with mCRPC who were enrolled in these clinical trials.

Perhaps the safer thing to conclude at this point in time is that race seems to have no major impact on survival times of men with mCRPC after initial treatment with DP or a DP-containing treatment regimen.

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