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 doxetaxel.
PATIENTS AND METHODS: We retrospectively reviewed the records of consecutive mCRPC patients with a good response to first-line docetaxel (serum prostate specific antigen (PSA) decrease ≥50%; no clinical/radiological progression). We analyzed 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 analyze potential predictors of a favourable outcome.
RESULTS: We identified 270 good responders to first-line docetaxel. 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%CI, 16.1-22.0) and 16.8 (95%CI 13.4-21.5) months, respectively, p=0.35). However, a 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 >6 months and added estramustine predicted a good PSA response and symptomatic response on docetaxel rechallenge but only a PFI >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 >6 months but did not prolong survival. Potential benefits should be weighed against the risk of cumulative toxicity.
Written by:
Oudard S, Kramer G, Caffo O, Creppy L, Loriot Y, Hansen S, Holmberg M, Rolland F, Machiels JP, Krainer M. Are you the author?
Oncology department, European Hospital Georges Pompidou and Paris Descartes University, Paris 5, France.
Reference: BJU Int. 2014 Jun 20. Epub ahead of print.
doi: 10.1111/bju.12845
PubMed Abstract
PMID: 24947139
UroToday.com mCRPC Treatment Section
