A re-assessment of the role of combination therapy in advanced prostate cancer.

Authors:
Klotz L, Schellhammer P, Carroll K.

Journal:
BJU Int 2004; 93: 1177 -1182

Results from trials comparing combination therapy with castration alone vary, however, findings from a meta-analysis of randomised trials shows that the type of anti-androgen used in combination therapy is significant. Compared with castration alone combination therapy using a non-steroidal anti-androgen produces a statistically significant overall survival benefit, whereas use of steroidal anti-androgens is associated with an increased risk of death. The NSAAs are not identical, for example bicalutamide (‘Casodex’) 50mg combination therapy has an advantageous side-effect profile. This paper reports an analysis combining historical trial data that suggests that bicalutamide 50mg in combination may reduce the hazard ratio for prostate cancer mortality by 20% (HR = 0.80; 95% CI 0.66 – 0.98), with a 98.5% probability that the combination therapy provides a survival advantage over castration.

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