AUA 2013 - Session Highlights: Intermittent docetaxel therapy for metastatic prostate cancer. A new paradigm?

SAN DIEGO, CA USA (UroToday.com) - Intermittent androgen deprivation therapy has received significant clinician attention. Now, Japanese researchers have similarly explored intermittent docetaxel dosing for castration resistant prostate cancer (CRPC). Dosing schedules were driven by tracking post-infusion PSA levels. The primary outcomes were differences in adverse effect profiles.

In eligible patients with CRPC, docetaxel was administered at 75 mg/mL every three weeks with oral dexamethasone (1.0 mg/day). PSA monitoring was conducted every 3 weeks. Chemotherapy was then suspended if the serum PSA level was reduced by more than 50% and reached a level below 4 ng/mL. Treatment was resumed when serum PSA rose by more than 50% and was over 2 ng/mL. Fifty percent of men in the study qualified for intermittent treatment with 20% receiving the second round and 4% of cases the third round of intermittent therapy. This approach saved men a median of 251 days on the first chemotherapy-free interval and 140 days on the second. During the chemotherapy-free period, appetite loss, fatigue, diarrhea, alopecia, and nail change were fully recovered in the majority. However, more long-term adverse effects such as motor neuropathy and sensory neuropathy were only fully recovered in less than half. In addition, the overall survival was more than 3-times better in the intermittent chemotherapy group.

The authors conclude that the intermittent dosing regimen resulted in reduction of adverse events in about one half of patients, while allowing patients to enjoy infusion-free time periods with no observed compromise in oncologic efficacy.

Abstract Title: Intermittent docetaxel therapy for castration resistant prostate cancer

Presented by Haruki Kume, Masayoshi Nagata, Yasuhiko Igawa, Hiroaki Nishimatsu, Yutaka Enomoto, Tohru Nakagawa, Tetsuya Fujimura, Motofumi Suzuki, and Yukio Homma at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA

 

Reported for UroToday.com by Anthony T. Corcoran, MD

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