Prostate news article, March 2005
| CHEMOTHERAPY
FOR HORMONE-ESCAPED PROSTATE CANCER - A NEW GOLD STANDARD
Tannock IF, de Wit R, Berry WR et al. Docetaxel plus prednisone or mitozantrone plus prednisone
for Advanced Prostate Cancer. Reviewed by: Dr Charlotte Foley MA BMBCh MRCS |
Once prostate cancer has spread to the bones, it is incurable. Testosterone suppression to inhibit cancer growth works well in most men for a median of 18 months. Eventually however, the cancer learns to grow without male hormones, and clinically a PSA rise and symptoms occur. At this point chemotherapy (drugs given into the blood stream to attack the cancer wherever it has spread) is often considered.
The current gold standard treatment against which all others must prove themselves is Mitoxantrone with steroids. This treatment improves pain, quality of life and lowers PSA levels, but does not prolong life in itself. Now the "TAX 327" study has been reported in the New England Journal of Medicine, describing a treatment that is not only better, but improves survival too.
Based in 24 countries, 1006 men with metastatic hormone-refractory prostate cancer were divided equally into 3 groups and given either mitoxantrone plus steroids every 3 weeks, docetaxel plus steroids every 3 weeks or docetaxel plus steroids every week. Three years later, it was clear that the patients who had been on docetaxel had less pain, better quality of life, and greater reductions in PSA levels. The group that got docetaxel every 3 weeks also lived longer than those who received it weekly or those given mitoxantrone (median survival 18.9 months compared to 17.4 and 16.5 months respectively). With all chemotherapy, the severity of side-effects is critical to the tolerability and feasibility of any regime. Docetaxel did cause more side-effects, but in general these were bothersome rather than life-threatening. The authors therefore propose docetaxel plus prednisolone every three weeks as the new gold standard.