Clinical experience of docetaxel in combination with prednisolone and zoledronic acid for hormone-refractory prostate cancer (HRPC): A Bangladesh perspective.

Abstract

e15049 Background:The patients with prostate cancer initially respond to androgen ablation therapy but most patients ultimately develop a hormone-refractory state. Most of the patients in our country present HRPC with bone metastasis. Earlier patients were treated with Mitoxantrone plus Prednisolone. Zoledronic acid was used for symptomatic relief of pain and increases the QoL. Docetaxel showed good response in case of HRPC. We conducted a study to evaluate the efficacy and toxicity of docetaxel in combination with zoledronic acid plus prednisolone in pain and PSA control. Methods:A total number of thirty patients were randomly assigned to receive zoledronic acid 4 mg/m2 in q3w with prednisolone 5 mg twice daily in combination with docetaxel 75 mg/m2 in patients with hormone refractory prostate cancer (HRPC) at our institution between July 2007 and June 2009. The primary endpoint was to evaluate the response to pain and PSA level. Secondary endpoint included overall survival and QoL. Results:A total of 28 patients were evaluable for the study. 43% of the pts had predefined reductions in pain. 54% had at least a 50% decrease in the serum PSA level. The overall response rate was 48.4% (13 patients), with partial responses in 24.24% (7 patients). The median duration of response was 20.2 weeks. 32% had improvement in the QoL. Median survival was 18.4 months. Adverse events related to Docetaxel included alopecia (60.7%), anorexia (50.1%) and fatigue (32.5%). Grade 3/4 neutropenia occurred in 48.4% of patients. Conclusions:Earlier for bone Metastasis with HRPC, zoledronic acid, Mitoxantrone and prednisolone was the choice of treatment. But the result was not satisfactory. Combining docetaxel with zoledronic acid and prednisolone in Bangladeshi population has shown excellent response in case of pain and PSA reduction with tolerable toxicities. Though the survival rate was unchanged the combination of docetaxel with ZA and Prednisolone regimen is effective in reduction of pain and PSA level in Bangladeshi patient population.