Abstract
Based on the TAX 327 phase III trial, docetaxel-based chemotherapy is the standard first-line treatment for hormone-resistant prostate cancer (HRPC); however, there is some heterogeneity in the use of this agent in routine clinical practice. The aim of the present study was to examine the patterns of docetaxel use in routine clinical practice at our institution and to compare them with docetaxel use in the TAX 327 clinical trial. We conducted a retrospective chart review of HRPC patients treated with first-line docetaxel between 2005 and 2007 at the Princess Margaret Hospital. In the first-line setting, 88 patients with HRPC received docetaxel. The main reasons for initiating docetaxel were rising prostate-specific antigen (PSA, 98%) and progressive symptoms (77%). The PSA response rate was 67%; median time to response was 1.5 months, and duration of response was 6.8 months. Median survival was 15.9 months (95% confidence interval: 12.4 to 20.5 months). Patients received a median of 7 cycles of treatment, and the main toxicities were fatigue (35%) and neuropathy (24%). Post docetaxel, 36 patients received second-line treatment with a 22% response rate. In routine clinical practice, HRPC patients received docetaxel mainly because of symptomatic disease progression. Overall response rates and toxicities were comparable to those in the TAX 327 trial. However, our patients received a median of only 7 cycles of treatment versus the 9.5 administered on trial, and survival was slightly shorter in our single-institution study. A larger prospective multicentre analysis, including performance status and quality-of-life parameters, may be warranted to determine if docetaxel performs as well in routine clinical practice as it does in the clinical trial setting.
Highlights
Prostate cancer is the most common cancer in men, with approximately 24,700 new cases diagnosed annually in Canada 1
A larger prospective multicentre analysis, including performance status and quality-of-life parameters, may be warranted to determine if docetaxel performs as well in routine clinical practice as it does in the clinical trial setting
Based on the tax 327 randomized trial, docetaxelbased chemotherapy is the standard first-line treatment for patients with hrpc; there is some heterogeneity in its use in routine clinical practice, which may vary from that in the tax 327 trial
Summary
Prostate cancer is the most common cancer in men, with approximately 24,700 new cases diagnosed annually in Canada 1. Patients presenting with localized prostate cancer are treated with curative intent by surgery or radiation, but up to 30% will relapse. Treatment involves androgen-ablation therapies, with initial response rates of about 80%. Those responses are temporary, and all patients will eventually develop hormone-refractory prostate cancer (hrpc). Hormone-refractory prostate cancer is defined as a rising psa despite androgen ablation. It can manifest as one or more of. Based on the tax 327 phase iii trial, docetaxel-based chemotherapy is the standard first-line treatment for hormone-resistant prostate cancer (hrpc); there is some heterogeneity in the use of this agent in routine clinical practice. The aim of the present study was to examine the patterns of docetaxel use in routine clinical practice at our institution and to compare them with docetaxel use in the tax 327 clinical trial
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