STAMPEDE (clinical trial)
Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) is a clinical trial investigating treatments for high risk or terminal prostate cancer. Recruitment started in 2005 and ends in 2022 and in January 2020, over 10,000 participants have joined the trial. Name. STAMPEDE is an acronym for "Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy". Aims and procedure. The trial investigates new approaches for men with metastatic and locally advanced prostate cancer. 117 hospitals in the UK and Switzerland are involved with over 10,000 men are expected to take  part in the trial. The men are randomly assigned to one of a number of "arms". The primary outcome by which the arms were judged is overall survival. The following arms are documented in the publicly available literature. Arm A. Standard of care (SOC) is lifelong androgen deprivation therapy (ADT). After 2015 SOC was expanded to include docetaxel and radiotherapy (RT) at the start of treatment. Arm B. SOC plus zoledronic acid. Arm C. Standard care plus docetaxel and prednisolone. Arm D. SOC plus celecoxib. Arm E. SOC plus zoledronic acid and docetaxel. Arm F. SOC plus zoledronic acid and  celecoxib. Arm G. SOC plus abiraterone acetate and prednisolone. Arm H. SOC plus RT. Arm J. SOC plus abiraterone and enzalutamide and prednisolone. Arm K. SOC plus metformin. Arm L. SOC with transdermal oestradiol replacing standard ADT. Results. reported that "the addition of docetaxel to standard of care was associated with improved survival, with an HR of 0·78 and a difference in median survival of 10 months, as well as improvements in prostate-cancer-specific survival, failure-free survival, and skeletal-related events". They also noted that docetaxel plus zoledronic acid "was associated with similar improvements, although the benefit observed  was smaller". The overall conclusion was that "standard of care should be updated to include docetaxel chemotherapy in suitable patients with metastatic disease, and docetaxel may be considered for men with high-risk non-metastatic prostate cancer with or without radiotherapy".