Clinical significance of a prostate-specific antigen flare phenomenon in patients with hormone-refractory prostate cancer receiving docetaxel

Olbert, P.; Hegele, Axel; Kraeuter, Petra; Heidenreich, Axel; Hofmann, Rainer; Schrader, Andres Jan

doi:10.1097/01.cad.0000231468.69535.97

Cited by 38 publications

(40 citation statements)

References 19 publications

(22 reference statements)

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“…Whether the PSA response is a clinically meaningful end point in this setting is still discussed controversially. Recent reports about a PSA elevation after starting systemic [12]. However, our study data could not confirm this result entirely.…”

Section: Commentscontrasting

confidence: 81%

“…This subset of patients seems to have better survival compared to patients with partial response or stable diasease (PSA decline <50% but !0) and to patients with continuous, irreversible rise of PSA but the difference was not statistically significant. We observed the maximum PSA elevation between three and six weeks, which corresponds to cycle 1 and 2 of a three-weekly regimen, whereas Olbert et al noticed the maximum PSA elevation up to eight weeks [12]. Therefore, the chemotherapy should be continued for a minimum of 6-8 weeks before removing patients from a docetaxel-based regimens.…”

Section: Commentsmentioning

confidence: 76%

“…A PSA rise followed by a decrease of PSA below the baseline level can be considered a temporary flareup. This flare-up phenomenon was recently described by others in 18% of patients treated with a docetaxel-based regimens [12].…”

Section: Introductionmentioning

confidence: 93%

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Impact of PSA flare-up in patients with hormone-refractory prostate cancer undergoing chemotherapy

et al. 2007

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A considerable portion of HRPC patients experience an initial PSA flare-up under systemic chemotherapy. In this study, occurrence of flare-up phenomenon did not impact survival. Chemotherapy should be continued a minimum of six weeks before removing patients from a docetaxel-based regimen. We showed evidence that co-medication with dexamethasone/prednisolone and/or estramustine itself can induce an initial PSA flare-up via androgen receptor mutations.

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Section: Commentscontrasting

confidence: 81%

Section: Commentsmentioning

confidence: 76%

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Impact of PSA flare-up in patients with hormone-refractory prostate cancer undergoing chemotherapy

et al. 2007

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“…Such a paradox has been described in prostate cancer, breast cancer and colorectal cancer, and has to be taken into account when tumor marker measurements are integrated into clinical decision making [13,14,15]. To the best of our knowledge, in pancreatic cancer a tumor marker flare phenomenon has not been reported so far.…”

Section: Introductionmentioning

confidence: 87%

Limited Value of CA 19-9 in Predicting Early Treatment Failure in Patients with Advanced Pancreatic Cancer

et al. 2009

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Objective: The role of CA 19-9 in monitoring treatment response in advanced pancreatic cancer remains uncertain. We assessed its value in predicting early failure of first-line chemotherapy. Methods: Data of 84 patients with advanced pancreatic cancer who had received first-line chemotherapy were analyzed with regard to changes in CA 19-9 during the first 2 months of treatment. Results: Median time to progression and overall survival in patients with a transient increase in CA 19-9 during month 1 (n = 15; 5.5 and 13 months) and in those with no increase during the 2 months (n = 52; 6.5 and 12 months) were comparable and slightly above the median values of the entire study population. The hazard ratios for disease progression for a 20% increase in CA 19-9 during the first and second month of therapy were 1.065 and 1.339 in the univariate- and 1.092 and 1.298 in the multiple Cox regression model, respectively. CA 19-9 did not influence survival. Conclusion: Our results suggest that early CA 19-9 measurements are weakly associated with disease progression rather than survival in patients with advanced pancreatic cancer receiving palliative chemotherapy. In view of a possible tumor marker flare, values after the first month of therapy must be interpreted with caution.

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“…We identified 23 patients with initial PSA increase that fulfilled criteria of progression but later had a decline of at least 50% in serum PSA compared with baseline. There may be additional patients who would have ''responded'' if their treatment had not been stopped or changed soon after randomization because of PSA progression (13). These data reflect the importance of not discontinuing chemotherapy too early and we now recommend administering at least four cycles of chemotherapy (i.e., continuing for at least 12 weeks) unless there is major clinical deterioration or toxicity.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Hormone-Refractory Prostate Cancer with Docetaxel or Mitoxantrone: Relationships between Prostate-Specific Antigen, Pain, and Quality of Life Response and Survival in the TAX-327 Study

Berthold

Pond

Roessner³

et al. 2008

Clinical Cancer Research

184

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on behalf of the TAX-327 investigators Abstract Purpose: The TAX-327 study randomized 1,006 men with metastatic hormone-refractory prostate cancer to receive 3-weekly docetaxel, weekly docetaxel, or mitoxantrone, each with prednisone. Experimental Design:We used theTAX-327 database to address (a) the relationship between quality of life (QoL) and pain; (b) whether minimally symptomatic patients benefit from treatment or have treatment-related decline in QoL; (c) the relationships between prostate-specific antigen (PSA) response, pain response, and QoL response; (d) the times at which these responses are first observed; and (e) whether PSA, pain, and/or QoL response predict for overall survival. Results: At baseline, 374 of 815 men assessed for QoL had major pain; of these, 92% had substantial impairment of QoL compared with 75% without major pain (P < 0.001). Men with minimal symptoms had prolonged survival (median, 25.6 months) compared with symptomatic patients (median, 17.1 months; P = 0.009); they were more likely to have initial deterioration of QoL if treated with weekly docetaxel. PSA response and pain response, but not QoL response, were independently associated with survival in landmark analysis. Median times to PSA and pain response were 44 and 27 days, respectively; some men had initial increase in serum PSA before subsequent decline. Conclusions: Symptoms other than pain contribute to impaired QoL in men with hormonerefractory prostate cancer. Those with minimal symptoms have prolonged survival. Both pain and PSA response are associated with survival but are not adequate to use as surrogate end points in phase 3 studies. Early increases in serum PSA (up to 12 weeks) should be ignored when determining response or progression.Metastatic prostate cancer is an incurable disease and the goal of treatment is palliation. Hormonal treatment is effective initially, but after a variable time, prostate cancer progresses to a hormone-refractory state. Many men then receive chemotherapy with the goals of alleviating symptoms and prolonging survival. The TAX-327 study was a large international randomized trial, which compared the effectiveness of 3-weekly mitoxantrone and prednisone (M/P) with 3-weekly docetaxel and prednisone (D3/P) or weekly docetaxel and prednisone (D1/P) for men with hormone-refractory prostate cancer (1). The primary end point of the study was overall survival, whereas pain response, prostate-specific antigen (PSA) response, and quality of life (QoL) response were secondary end points. Men treated with docetaxel every 3 weeks with prednisone were found to have superior overall survival, pain response, PSA response, and QoL response when compared with those receiving mitoxantrone and prednisone (1).Here, we have examined the database from the TAX-327 study to provide an in-depth analysis of the relationships between PSA response, pain response, QoL response, and survival. We attempt to address the following questions: Materials and MethodsDetails of participants and their treatment are descri...

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Clinical significance of a prostate-specific antigen flare phenomenon in patients with hormone-refractory prostate cancer receiving docetaxel

Cited by 38 publications

References 19 publications

Impact of PSA flare-up in patients with hormone-refractory prostate cancer undergoing chemotherapy

Impact of PSA flare-up in patients with hormone-refractory prostate cancer undergoing chemotherapy

Limited Value of CA 19-9 in Predicting Early Treatment Failure in Patients with Advanced Pancreatic Cancer

Treatment of Hormone-Refractory Prostate Cancer with Docetaxel or Mitoxantrone: Relationships between Prostate-Specific Antigen, Pain, and Quality of Life Response and Survival in the TAX-327 Study

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