Is it reasonable to consider second-line chemotherapy in patients with hormone-refractory prostate cancer?
At present, no consensus exists regarding the use of second-line chemotherapy in patients with hormone-refractory prostate cancer (HRPC). A total of 23 patients with evidence of disease progression during or after first-line chemotherapy (epirubicin, etoposide, and dexamethasone) were included in this study. Two second-line treatments were administered throughout the study period (2000-2004) with 15/23 patients receiving carboplatin AUC 3 on day 1 and vinblastine 5 mg/m2 on day 1 of a 21-day cycle and 8/23 patients treated with docetaxel 50 mg/m2 on day 1 of a 21-day cycle. The latter regimen has been used since 2003. The prostate-specific antigen (PSA) level decreased by > or =50% in 3 of 23 patients, corresponding to an overall PSA response rate of 13% (95% confidence interval, 3-34%). The median time to biochemical progression was 9, 24 and 33 weeks, respectively. The median overall survival was 39 weeks (range, 15-73 weeks) with no difference between the two chemotherapy groups (p=0.08). A significant reduction of analgesic use was observed in 2 of 10 patients (20%) who required analgesics for cancer pain upon study entry. The major toxicity was grade 3 thrombocytopenia in 2 of 23 patients (9%). Both second-line treatments, a combination of carboplatin and vinblastine and a monotherapy with docetaxel, showed modest activity at subtoxic doses in patients with HRPC.
Odrazka
Karel
K
Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic. odrazka@fnhk.cz
Vaculikova
Miloslava
M
Dolezel
Martin
M
Petera
Jiri
J
Moravek
Petr
P
Prosvic
Petr
P
Zoul
Zdenek
Z
Vosmik
Milan
M
Dolezal
Jiri
J
Simakova
Eva
E
D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000494:pharmacology*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019540:Area Under Curve; D016190:Carboplatin / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D018450:Disease Progression; D019008:Drug Resistance, Neoplasm; D015251:Epirubicin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D006728:Hormones / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000096:biosynthesis; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D013921:Thrombocytopenia / Q000139:chemically induced; D013997:Time Factors; D016896:Treatment Outcome
D000726:Androgen Antagonists; D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D006728:Hormones; D015251:Epirubicin; D005047:Etoposide; D003907:Dexamethasone; D016190:Carboplatin; D017430:Prostate-Specific Antigen