Chemotherapy in hormone-sensitive metastatic prostate cancer: Evidences and uncertainties from the literature.
Data from the literature support with strong evidence the addition of docetaxel to androgen-deprivation therapy (ADT) for men with metastatic prostate cancer, and starting therapy for the first time. A meta-analysis of three randomized controlled trials showed a significant improvement of overall survival when ADT was combined with docetaxel when compared to ADT alone (HR=0.77; 95% CI: 0.68-0.87; p<0.0001). Consequently, combination therapy should be considered presently as the new standard of care, using 6 cycles of docetaxel, without prednisone. However, candidates for this upfront combination therapy in whom the balance between its side effects and benefits is favorable are still to be identified more precisely. Patients' stratification according to Gleason score, previous local treatment and age or performance status were shown to have a prognostic impact. The volume of metastases, as defined in the CHAARTED study for instance, could be an interesting predictive factor. However, data accumulated until now remain only hypothesis generating and further analysis and studies are needed to establish any potential discriminating factors. Several new efficient therapeutic options are now available in prostate cancer management and should be evaluated against a chemo-hormonal combination therapy. Other trials are warranted to establish the role of docetaxel in earlier stages of the disease, the combination with the new hormonal therapies as well as the best management options after docetaxel.
Department of Medical Oncology, Institut Paoli-Calmettes, 232 boulevard Sainte-Marguerite, BP 156, 13273 Marseille, France.
Gwenaëlle
G
Gravis
Department of Urology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris cedex 15, France, Assistance Publique Hôpitaux de Paris et Université Paris Descartes, France. Electronic address: francois.audenet@aphp.fr.
François
F
Audenet
Department of Urology, Hôpital Kremlin Bicêtre, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France, Assistance Publique Hôpitaux de Paris et Université Paris Sud, France.
Jacques
J
Irani
Department of Urology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris cedex 15, France, Assistance Publique Hôpitaux de Paris et Université Paris Descartes, France.
Marc-Olivier
MO
Timsit
Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67091 Strasbourg, France.
Philippe
P
Barthelemy
Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France.
Philippe
P
Beuzeboc
Centre Léon Bérard, 28 rue Laennec, 69008 Lyon, France.
Aude
A
Fléchon
Department of Medical Oncology, Hôpital Bretonneau, 2 bd Tonnellé, 37044 Tours, France.
Claude
C
Linassier
Department of Medical Oncology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris cedex 15, France, Assistance Publique Hôpitaux de Paris et Université Paris Descartes, France.
Stéphane
S
Oudard
Department of Urology, Clinique Beau Soleil, 119 av Lodève, 34070 Montpellier, France.
Xavier
X
Rebillard
Department of Radiotherapy, Institut Bergonié, 229 cours de l'Argonne CS 61283, 33076 Bordeaux cedex, France.
Pierre
P
Richaud
Academic Department of Urology, Hôpital Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651 Paris Cedex 13, France, Assistance Publique Hôpitaux de Paris and University Paris 6, France.
Morgan
M
Rouprêt
Department of Medical Oncology, hôpital Jean-Minjoz, boulevard Fleming, 25000 Besançon cedex, France.
Antoine
A
Thiery Vuillemin
Department of Urology, CHU Rennes Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes cedex 9, France.
Sébastien
S
Vincendeau
Department of Medical Oncology, Institut Gustave Roussy, 39-53 rue Camille Desmoulins, 94805 Villejuif, France.
Laurence
L
Albiges
Department of Urology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France.
François
F
Rozet
D000367:Age Factors; D000726:Androgen Antagonists / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D000077143:Docetaxel; D019317:Evidence-Based Medicine; D006304:Health Status; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D018579:Patient Selection; D011159:Population Surveillance; D011241:Prednisone / Q000008:administration & dosage; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D043823:Taxoids / Q000008:administration & dosage; D047368:Tumor Burden; D035501:Uncertainty
D000726:Androgen Antagonists; D043823:Taxoids; D000077143:Docetaxel; D011241:Prednisone
Androgen deprivation therapy; Chemotherapy; Combination therapy; Docetaxel; Prostate cancer