Paclitaxel, estramustine and carboplatin combination chemotherapy after initial docetaxel-based chemotherapy in castration-resistant prostate cancer.
OBJECTIVE
Management of castration-resistant prostate cancer after docetaxel has become an unmet need for which various agents have been investigated. We report our experience with a paclitaxel-based regimen.


METHODS
From February 2004 to November 2007, 15 patients (PTS) received paclitaxel 80 mg/m(2) weekly on day 1, carboplatin (AUC = 6) on day 1 every 21 days and estramustine 140 mg on days -1, 0 and 1 every week.


RESULTS
Patient characteristics are: median age 67 years (range 44-81), median performance status (Eastern Cooperative Oncology Group) 1 (range 0-2) and median prostate-specific antigen 67.5 ng/ml (range 1.5-480). All PTS had soft-tissue and 12 (80%) also had osseous disease. A >50% decrease in prostate-specific antigen levels occurred in 9 PTS (60%, 95% CI 32-84). Responses included a partial response in 6 (40%, 95% CI 16-68) and stable disease in 5 PTS (33%). Median duration of progression-free survival was 4.0 months (range 1.1-13) and median survival was 14.6 months. After a median of 4 cycles (range 1-7), significant toxicity included fatigue grade 3 in 2 PTS (13%), neuropathy grade 2 and grade 4 in 1 patient each, and a single episode of grade 3 edema. Myelosuppression was mild. Two PTS (13%) had urinary tract infection and 1 patient neutropenic fever. One patient died due to brain hemorrhage.


CONCLUSIONS
Administration of second-line paclitaxel-based chemotherapy after docetaxel therapy is active in PTS with castration-resistant prostate cancer. This regimen is too toxic for palliative therapy. Careful patient selection is needed when this regimen is considered for therapy in these PTS.
Department of Oncology, Assaf Harofeh Medical Center, Zerifin, Israel. a_sella@asaf.health.gov.il
A
A
Sella
N
N
Yarom
A
A
Zisman
S
S
Kovel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage*; D000077143:Docetaxel; D019008:Drug Resistance, Neoplasm; D004961:Estramustine / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D043823:Taxoids / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D043823:Taxoids; D000077143:Docetaxel; D004961:Estramustine; D016190:Carboplatin; D017239:Paclitaxel