OBJECTIVE: To evaluate the overall benefits of non-taxane chemotherapies in a non-selected population including unfit patients presenting with symptoms and pain.
PATIENTS AND METHODS: This randomised phase 2 study reports data from 92 patients (52% > 70 yrs-old; 40% PS II) previously treated with taxane-based chemotherapy and collected at 15 centres in France. Patients received intravenous mitoxantrone (MTX), oral vinorelbine (VN), or oral etoposide (EP) associated with oral prednisone. Palliative benefit (pain response without progression of the disease), biological and tumoral responses, and toxicity profile as well as geriatric assessment (in elderly population) were analysed on an intention-to-treat basis.
RESULTS: The palliative response rate was 17% for the whole population, and reached 29% when considering the MTX arm. The control of pain was achieved in 40% of the patients. The median overall survival was 10.4 months, and was longer in palliative responders. Few grade 3-4 toxicities were observed. The subgroup analysis of elderly patients showed similar results regarding the number and dose-intensity of treatments, efficacy and safety.
CONCLUSION: In a population including frailty and/or elderly patients, who are poorly represented in most of the clinical studies, non-taxane chemotherapy may remain a relevant option for metastatic prostate cancer having relapsed after a docetaxel-based regimen.While new treatment options are now approved, decision-making process should take into account the expected benefit/risk ratio based on the patient status.
Written by:
Joly F, Delva R, Mourey L, Sevin E, Bompas E, Vedrine L, Ravaud A, Eymard J, Tubiana-Mathieu N, Linassier C, Houede N, Guillot A, Ringensen F, Cojocarasu O, Valenza B, Leconte A, Lheureux S, Clarisse B, Oudard S. Are you the author?
Medical Oncology Department - Clinical Research Department, Centre François Baclesse - CHU Côte de nacre, Caen, France; Universite Basse Normandie Caen, France.
Reference: BJU Int. 2013 Nov 1. Epub ahead of print.
doi: 10.1111/bju.12552
PubMed Abstract
PMID: 24180479
UroToday.com mCRPC Treatment Section
