CHAARTED: What the Prostate Cancer Trial Found

Chemotherapy moved to the front of the queue

Hormone treatment has been the backbone of metastatic prostate cancer care since the 1940s. The usual sequence was: start hormone treatment, wait for it to stop working, then bring in chemotherapy.

CHAARTED reversed the order. It gave docetaxel at the same time as hormone treatment, while the cancer was still hormone-sensitive, rather than saving it for later.

Who was randomised

Field	Detail
Trial	CHAARTED (E3805)
Identifier	NCT00309985
Phase	Phase 3
Design	Randomised, open-label
Cancer type	Metastatic prostate cancer still responding to hormone treatment
Comparator	Hormone treatment plus six cycles of docetaxel, against hormone treatment alone
Primary endpoint	Overall survival

790 men took part, median age 63. Docetaxel was given by infusion every three weeks for up to six cycles, at an amount worked out from body size. The trial's stated aim was to test whether median survival would be a third longer with chemotherapy added.

Thirteen and a half months, at first

After a median follow-up of 28.9 months, median survival was 57.6 months with chemotherapy added and 44.0 months without — a difference of 13.6 months. The hazard ratio for death was 0.61 (95% CI 0.47 to 0.80, p<0.001).

Time until the cancer progressed by PSA, symptoms or imaging was 20.2 months against 11.7 months, hazard ratio 0.61 (95% CI 0.51 to 0.72, p<0.001). A PSA under 0.2 ng/mL at 12 months was reached by 27.7% against 16.8% (p<0.001).

The chemotherapy cost something. Febrile neutropenia — a fever with dangerously low white cells — of grade 3 or 4 occurred in 6.2% of the chemotherapy group. Grade 3 or 4 infection with neutropenia occurred in 2.3%, and grade 3 sensory and motor nerve damage in 0.5% each.

What longer follow-up did to that number

A second analysis was published in 2018, at a median follow-up of 53.7 months. The overall result held, but both figures shifted: 57.6 months against 47.2 months, hazard ratio 0.72 (95% CI 0.59 to 0.89, p=0.0018).

The control group's median rose by more than three months as more data came in. That is a normal thing for an early median to do, and it is a good reason to treat the first number from any trial as provisional.

High volume and low volume

The 2018 analysis split the men by how much cancer they had. High-volume disease meant metastases in organs, or four or more bone metastases with at least one outside the spine and pelvis.

• High volume (513 men): median survival 51.2 months against 34.4 months, hazard ratio 0.63 (95% CI 0.50 to 0.79, p<0.001)
• Low volume (277 men): hazard ratio 1.04 (95% CI 0.70 to 1.55, p=0.86)

For low-volume disease there was no survival benefit at all. The headline number from 2015 was an average across two groups that behaved differently, and only one of them was getting the gain.

What this trial cannot tell you

• Whether chemotherapy up front helps men with low-volume metastatic disease. On longer follow-up it did not.
• How this compares with today's options. The control arm was hormone treatment alone, which is no longer standard, and hormone-pathway drugs and three-drug combinations have since been tested.
• Anything about non-metastatic prostate cancer. Everyone here had metastases.
• How you would feel on it. The trial reports rates of severe events, not what six cycles of docetaxel is like to live through.

Questions at a metastatic prostate cancer diagnosis

• Is my disease high-volume or low-volume by the definition this trial used?
• What are the options besides chemotherapy for adding to hormone treatment?
• What would we do if I developed a fever during a chemotherapy cycle?

Sources

This article was written from the sources below, which were checked on the source-check date shown above.

• NEJM: Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer (CHAARTED) (primary)
• JCO: CHAARTED Long-Term Survival Analysis (primary)
• ASCO Post: Adding Docetaxel to ADT Prolongs Overall Survival (secondary)

How this article was prepared

Prepared by Cancer Explained's AI-assisted editorial system and checked against the sources listed below. This article has not been reviewed by a healthcare professional unless a named reviewer is specifically shown.

Cancer Explained is published by the National Cancer Information Foundation as a nonprofit-oriented public-interest education project. It is not a diagnostic service, does not recommend treatments, and is not for emergencies.

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