Chemotherapy

Docetaxel versus mitoxantrone as first-line chemotherapy for hormone-refractory prostate cancer (HRPC) patients. A meta-analysis of 3-year overall survival results

Journal of Clinical Oncology 2004 ASCO Annual Meeting Proceedings 23(16S): 4634, supplement June 2005
S Oudard, E Banu, A Banu, F Scotte, E Levy, J Medioni, E Fabre Guillevin, J Ayllon, N Arakelyan and J M Andrieu

Study purpose: Chemotherapy using docetaxel, a medication that blocks cancer cell growth, is the standard treatment for men who have metastatic hormone-refractory prostate cancer (HRPC). Metastatic HRPC spreads outside the prostate and doesn’t respond to treatment blocking the male body’s production of the hormone testosterone, which feeds prostate cancer cells. Docetaxel-based chemotherapy enables patients to live two months longer compared to chemotherapy based around the drug mitoxantrone. This meta-analysis assesses the effects of docetaxel-based chemotherapy compared to mitoxantrone on metastatic HRPC patients.

Study description: A meta-analysis is a statistical method that combines study results in order to examine their overall findings. Data was studied from three trials comparing docetaxel with mitoxantrone in men with HRPC. The trials divided a total of 1,807 patients into two groups: 1,092 received docetaxel and 715 received mitoxantrone-based chemotherapy. The meta-analysis compares the results to find which group receiving chemotherapy lived longer overall, using intervals of 12, 18, 24, 30 and 36 months as gauges. The impact on “overall survival” by the intensity of the doses of docetaxel during chemotherapy was considered, as were differences in the ways patients received their doses of chemotherapy.

Findings: Analysis showed that docetaxel had an important survival benefit over mitoxantrone at any follow-up point — more men given docetaxel were alive at the 12, 18, 24, 30 and 36 month intervals. There was also an improvement in overall survival for patients receiving the “dose-intense” docetaxel-based chemotherapy compared to mitoxantrone. However, those patients getting docetaxel-based chemotherapy in a format known as “dense-dose” (higher doses at wider intervals) did no better than those who received mitoxantrone.

Conclusions: The meta-analysis shows that docetaxel-based chemotherapy reduced the risk of death in many patients by 8–21%, a benefit persisting at least 3 years after the start of chemotherapy. The benefit of docetaxel over mitoxantrone was related to the kind of dosage and the intensity of the doses of docetaxel-based chemotherapy.

The Evolving Role of Chemotherapy and Other Systemic Therapies for Managing Localized Prostate Cancer.

Journal of Urology 170(6, part 2 of 2): S28-S34, December 2003
William K Oh

Study purpose: This Harvard Medical School study reviews the medical literature to look at treatments for “localized” prostate cancer that remains within the prostate gland. It also reviews the use of neoadjuvant and adjuvant chemotherapy— treatments given before or after a main or “primary” therapy.

Study description: An Internet search was conducted for current studies evaluating the use of chemotherapy and other therapies for localized prostate cancer.

Findings: Men who have had treatment of cancer within the prostate were at high risk for the cancer’s return (recurrence) if their tumour was growing past the prostate’s outer lining when they were treated. This is known as stage T3 disease in a classifying system called TNM staging (a scale up to stage T4 that measures the extent of tumours). Men at high risk for recurrence also had biopsy Gleason scores of 8 to 10. These scores classify the seriousness of prostate cancer according to its differing destruction of normal cell tissue. Numbers up to ten indicate increasingly fast growing cancers. Finally, men at high risk for the return of localized prostate cancer showed serum prostate-specific antigen (PSA) levels greater than 20 ng/ml in tests where double-digit results may indicate the return of cancer. The review also looked at therapies for localized prostate cancer. Studies show men given androgen-deprivation therapy (to slow the body’s production of male hormones feeding prostate cancer) before surgery for high risk localized cancer lived no longer than others who did not receive the treatment. Recent trials have shown that cytotoxic chemotherapy (anti-cancer drugs that kill cells, especially cancer cells) can benefit men with hormone-refractory prostate cancer, the medical term for prostate cancer that doesn’t respond to androgen-deprivation therapy. This has led to ongoing trials investigating the use of chemotherapy at the very beginning of treatment.

Conclusions: The author concludes that therapy for advanced prostate cancer is improving.