Docetaxel chemotherapy for metastatic hormone refractory prostate cancer as first-line palliative chemotherapy and subsequent re-treatment: Birmingham experience

Abstract

Abstract. Three-weekly docetaxel chemotherapy with prednisolone is now considered standard of care for patients with metastatic hormone refractory prostate cancer (MHRPC). This study reports the efficacy and toxicity of first-line docetaxel chemotherapy followed subsequently by re-treatment on biochemical disease progression (BDP). Forty-two patients with MHRPC were treated with three-weekly docetaxel chemotherapy 75 mg/m 2 and 10 mg of prednisolone daily. Median age 73 years (range 58-87) and median initial PSA 182 ng/ml (range 19.9-1500). Of these patients, 10 were re-treated with the same regimen (second-line chemotherapy) on BDP. A further 3 out of these 10 patients received 2nd re-treatment (third-line chemotherapy) with docetaxel chemotherapy on BDP. Fifty-four percent of patients responded to first-line docetaxel chemotherapy and all re-treated patients responded again with a PSA reduction >50%. Median treatment-free interval prior to second and third-line chemotherapy was 24 and 26 weeks, respectively. Grade 3 or 4 neutropenia occurred in 2.5, 7 and 12% of the total number of cycles in patients receiving first-, second-and third-line docetaxel chemotherapy, respectively. Median survival was 13 months (range 3-35) and one-year overall survival 52%. This is the first report of three-weekly docetaxel chemotherapy re-treatment in patients with MHRPC and demonstrates that patients who initially respond to docetaxel chemotherapy maintain their sensitivity to subsequent retreatment without a significant rise in haematological toxicity.

Randomized Phase II Trial of Custirsen (OGX-011) in Combination with Docetaxel or Mitoxantrone as Second-line Therapy in Patients with Metastatic Castrate-Resistant Prostate Cancer Progressing after First-line Docetaxel: CUOG Trial P-06c

“…Although PSA responses have been reported (32), reporting of survival from the start of second-line therapy is uncommon. In one retrospective study, 25 patients were retreated with docetaxel following a PSA response of 30% or more and a median treatment interval of 12 months (33).…”

Current Management of Castrate-Resistant Prostate Cancer

“…For patients who have not demonstrated definitive evidence of resistance to docetaxel, re-treatment with this agent can be considered [25][26][27][28] . In published reports of highly selected individuals who had shown previous sensitivity to docetaxel, psa declines of at least 50% were observed in 32%-45% of patients.…”

Pleuropulmonary and Lymph Node Progression after Docetaxel - Benefits from Treatment with Cabazitaxel in Metastatic Prostate Cancer

“…There are only retrospective studies that do not demonstrate improvement in overall survival. In addition, there is recent data about a probable lower efficacy in the reintroduction of treatment with docetaxel following abiraterone, suggesting some mechanism of cross-resistance [12]. …”