Cancer Treatment Today

Lay Summary: After Taxotere fails in hormone refractory prostate cancer, there are few good options. Adding Carboplatin to the Taxotere is a promising approach that is still being studied.

Since 2004, the standard first-line chemotherapy for patients with metastatic prostate cancer that progresses despite androgen deprivation has been docetaxel. Docetaxel is the first (and, to date, only) treatment for metastatic castration resistant prostate cancer to be approved specifically on the basis of survival, as shown in a randomized study comparing docetaxel and prednisone with mitoxantrone and prednisone. The practical clinical problem is that there is no proven, effective salvage therapy once Taxotere fails, usually within 6-8 months. Mitzantrone alone at that point has a response rate of 8%.

In a 2006 study, docetaxel plus carboplatin demonstrated encouraging activity in patients who progressed after docetaxel-based therapy. PSA declines >50% were seen in 19%; measurable responses in 20%. There are several other studies as well, which I referenced. A study of this combination with estrmustine has also been published.

Oh WK, George DJ, Tay MH, Response to docetaxel/carboplatin in patients with hormone-refractory prostate cancer not responding to taxane-based chemotherapy. Clin Prostate , Cancer. 2005 Jun;4(1):61-4.

Michael J Morris Paclitaxel and carboplatin versus mitoxantrone: lessons of an underpowered study, Nature Clinical Practice Oncology (2006) 3, 536-537

William K. Oh et al, A Phase I Study of Estramustine, Weekly Docetaxel, and Carboplatin Chemotherapy in Patients with Hormone-Refractory Prostate Cancer Clinical Cancer Research Vol. 11, 284-289, January 2005

Tay MH, George D, Gilligan T, et al. Docetaxel plus carboplatin (DC) may have significant activity in hormone refractory prostate cancer (HRPC) patients who have progressed after prior docetaxel-based chemotherapy abstract. Proc Am Soc Clin Oncol 2004;23:2479.F. Vignani, L. Russo, M. Tucci, M. Motta, G. Vellani, M. Tampellini, M. Papotti, L. Dogliotti, and A. Berruti
Why castration-resistant prostate cancer patients with neuroendocrine differentiation should be addressed to a cisplatin-based regimen
Ann. Onc., December 1, 2009; 20(12): 2019 – 2020.
M. M. Regan , E. K. O’Donnell , W. K. Kelly , S. Halabi , W. Berry , S. Urakami , N. Kikuno , and W. K. Oh Efficacy of carboplatin–taxane combinations in the management of castration-resistant prostate cancer: a pooled analysis of seven prospective clinical trials
Annals of Oncology Advance Access published on July 24, 2009, DOI 10.1093/annonc/mdp308.