Randomized, double-blind, placebo-controlled phase III trial comparing docetaxel and prednisone with or without bevacizumab in men with metastatic castration-resistant prostate cancer: CALGB 90401

Abstract

Purpose: A randomized, placebo-controlled study based on preclinical and clinical data that supports the potential role of vascular endothelial growth factor in prostate cancer was performed to evaluate the addition of bevacizumab to standard docetaxel and prednisone therapy in patients with metastatic castration-resistant prostate cancer (mCRPC).

Patients and methods: Patients with chemotherapy-naive progressive mCRPC with Eastern Cooperative Oncology Group performance status ≤ 2 and adequate bone marrow, hepatic, and renal function were randomly assigned to receive docetaxel 75 mg/m(2) intravenously (IV) over 1 hour for 21 days plus prednisone 5 mg orally twice per day (DP) with either bevacizumab 15 mg/kg IV every 3 weeks (DP + B) or placebo. The primary end point was overall survival (OS), and secondary end points were progression-free survival (PFS), 50% decline in prostate-specific antigen, objective response (OR), and toxicity.

Results: In total, 1,050 patients were randomly assigned. The median OS for patients given DP + B was 22.6 months compared with 21.5 months for patients treated with DP (hazard ratio, 0.91; 95% CI, 0.78 to 1.05; stratified log-rank P = .181). The median PFS time was superior in the DP + B arm (9.9 v 7.5 months, stratified log-rank P < .001) as was the proportion of patients with OR (49.4% v 35.5%; P = .0013). Grade 3 or greater treatment-related toxicity was more common with DP + B (75.4% v 56.2%; P ≤ .001), as was the number of treatment-related deaths (4.0% v 1.2%; P = .005).

Conclusion: Despite an improvement in PFS and OR, the addition of bevacizumab to docetaxel and prednisone did not improve OS in men with mCRPC and was associated with greater toxicity.

Fig 1.

CONSORT diagram.

Fig 2.

Kaplan-Meier plot for (A) overall survival and (B) progression-free survival by treatment arm. DP, docetaxel 75 mg/m² intravenously over 1 hour for 21 days plus prednisone 5 mg orally twice per day; DP + B, DP plus bevacizumab 15 mg/kg intravenously every 3 weeks.

Fig 3.

Forest plot of overall survival in select subgroups. ALK, alkaline phosphatase; DP, docetaxel 75 mg/m² intravenously over 1 hour for 21 days plus prednisone 5 mg orally twice per day; DP + B, DP plus bevacizumab 15 mg/kg intravenously every 3 weeks; HGB, hemoglobin; HR, hazard ratio; LDH, lactate dehydrogenase; PS, [Eastern Cooperative Oncology Group] performance status; PSA, prostate-specific antigen; TEST, testosterone. (*) HRs are based on the proportional hazards model adjusting for the stratification factors.