Docetaxel for prostate cancer – pro
Chemotherapy has a definite role in the management of advanced androgen refractory prostate cancer. Mitoxantrone does not prolong survival over no chemotherapy but docetaxel has been shown to be more effective than mitoxantrone. There have been seven randomised controlled trials. One large well-conducted trial assessed docetaxel plus prednisone vs mitoxantrone plus prednisone; this showed statistically significant improvements with 3-weekly docetaxel in terms of overall survival, quality of life, pain response and PSA decline. Two other chemotherapy regimens that included docetaxel with estramustine also showed improved outcomes in comparison with mitoxantrone plus prednisone. Three trials that compared mitoxantrone plus corticosteroids with corticosteroids alone were identified and their results for overall survival combined, which showed very little difference between the two groups. The evidence suggests that chemotherapy regimens containing 3-weekly docetaxel are superior to mitoxantrone or corticosteroids alone for hormone refratory disease. .
FDA approvede docetaxel for hormone refractory prostete cancer in 2006. However, 2014 ASCO presented a first line trial that showed that the addition of docetaxel to androgen-deprivation therapy extended survival for men with newly diagnosed hormone-sensitive prostate cancer by more than 13 months in the National Cancer Instituteled phase III E3805 study5. The survival benefit was even greater for men with high-volume disease. This is a truly remarkable result but it had not yet been incorporated into guidelines (as of 2/105) and it is still being debated, since docetaxel is a moderately toxic treatment.
David M. Reese MD, Eric J. Small MD, Therapy of Advanced Prostate Cancer Part II: Response End Points and the Use of Chemotherapy, The Prostate Journal 2000 2:4 173
R Collins et al, A systematic review of the effectiveness of docetaxel and mitoxantrone for the treatment of metastatic hormone-refractory prostate cancer British Journal of Cancer (2006) 95, 457-462.
nccn.org, prostate cancer 2015, PROS-5