Docetaxel rechallenge after an initial good response in patients with metastatic castration-resistant prostate cancer.

Abstract

OBJECTIVE:

To evaluate the benefit of docetaxel rechallenge in patients with metastatic castration-resistant prostate cancer (mCRPC) relapsing after an initial good response to first-line docetaxel.

PATIENTS AND METHODS:

We retrospectively reviewed the records of consecutive patients with mCRPC with a good response to first-line docetaxel [serum prostate specific antigen (PSA) decrease ≥50%; no clinical/radiological progression]. We analysed the impact of management at relapse (docetaxel rechallenge or non-taxane-based therapy) on PSA response, symptomatic response (performance status/pain/analgesic consumption), and overall survival (OS). We used multivariate stepwise logistic regression to analyse potential predictors of a favourable outcome.

RESULTS:

We identified 270 good responders to first-line docetaxel. The median progression-free interval (PFI) was 6 months from the last docetaxel dose. At relapse, 223 patients were rechallenged with docetaxel (82.5%) and 47 received non-taxane-based therapy. There was no significant difference in median OS {18.2 [95% confidence interval (CI) 16.1-22.00] and 16.8 [95%CI 13.4-21.5] months, respectively, P = 0.35}. However, good PSA response and symptom relief/stable disease were more frequent on docetaxel rechallenge (40.4% vs 10.6%, P < 0.001 for PSA). A PFI of >6 months and added estramustine predicted a good PSA response and symptomatic response on docetaxel rechallenge but only a PFI of >6 months predicted longer OS. Haemoglobin (<13 g/dL) and pain were associated with reduced OS. Docetaxel rechallenge increased the incidence of grade ≥3 sensory neuropathy, nail disorders and asthenia/fatigue.

CONCLUSIONS:

Docetaxel rechallenge is a management option for responders to docetaxel with a PFI of >6 months, but did not prolong survival. Potential benefits should be weighed against the risk of cumulative toxicity.

• Authors: Stéphane Oudard, Gero Kramer, Orazio Caffo, Lorraine Creppy, Yohan Loriot, Steinbjoern Hansen, Mats Holmberg, Frederic Rolland, Jean-Pascal Machiels, Michael Krainer
• Journal: BJU international (BJU Int) Vol. 115 Issue 5 Pg. 744-52 (May 2015) ISSN: 1464-410X [Electronic] England
• PMID: 24947139 (Publication Type: Evaluation Study, Journal Article, Multicenter Study)
• Copyright: © 2014 The Authors. BJU International © 2014 BJU International.

Chemical References

• Antineoplastic Agents
• Taxoids
• Docetaxel

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents (therapeutic use)
• Docetaxel
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local (drug therapy)
• Prostatic Neoplasms, Castration-Resistant (drug therapy)
• Remission Induction
• Retreatment
• Retrospective Studies
• Taxoids (therapeutic use)