Docetaxel-related toxicity in metastatic hormone-sensitive and metastatic castration-resistant prostate cancer.
Docetaxel plus androgen deprivation therapy (ADT) offers a survival benefit in metastatic hormone-sensitive prostate cancer (mHSPC). However, one trial evaluating docetaxel in mHSPC (GETUG-AFU15) showed unexpected toxicity; raising concerns that docetaxel may carry increased toxicity when used to treat mHSPC compared to metastatic castration-resistant prostate cancer (mCRPC). We conducted a retrospective analysis evaluating differences in toxicity based on the clinical state (i.e., mHSPC vs. mCRPC) that docetaxel was used. Patients initiating docetaxel between 1/1/2014 and 7/15/2015 were included, with the former date chosen to coincide with the press release for the first mHSPC study that showed a survival benefit with early docetaxel; ensuring contemporary docetaxel-treated cohorts. Thirty-nine mCRPC and 22 mHSPC patients were included. Compared to mCRPC, mHSPC patients were younger (median years: 66.3 vs. 71.8, P = 0.007); had better performance status (ECOG 0-1: 100 vs. 62 %, P < 0.0001); and used opiates less frequently (29 vs. 66 %, P = 0.04). Neutropenic fevers occurred in 9 and 5 % (P = 0.95) of men with mHSPC and mCRPC, respectively. Other toxicities also occurred at similar rates between cohorts. The incidence of any toxic event was 73 and 67 % (P = 0.84) for men with mHSPC and mCRPC, respectively. Within the mHSPC cohort, neutropenic fevers occurred at a similar rate regardless of the time interval between initiating ADT and the start of docetaxel. We did not observe a significant difference in toxicity between mHSPC and mCRPC patients receiving docetaxel. However, the small sample size and retrospective nature of this study limit our ability to draw definitive conclusions.
Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, 98109, USA. schweize@uw.edu.|Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA. schweize@uw.edu.
Michael T
MT
Schweizer
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
Roman
R
Gulati
Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, 98109, USA.|Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
Elahe A
EA
Mostaghel
Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, 98109, USA.|Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
Peter S
PS
Nelson
Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, 98109, USA.|Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
R Bruce
RB
Montgomery
Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, 98109, USA.|Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
Evan Y
EY
Yu
Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, 98109, USA.|Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
Heather H
HH
Cheng
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D018572:Disease-Free Survival; D000077143:Docetaxel; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy*; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects*
D000726:Androgen Antagonists; D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel
Adverse event; Castration-resistant; Docetaxel; Hormone-sensitive; Neutropenia; Neutropenic fever; Prostate cancer; Toxicity