Docetaxel chemotherapy combined with androgen-deprivation therapy in metastatic hormone-sensitive prostate cancer: an efficacy and safety analysis

Abstract

Objective To investigate the efficacy and safety of docetaxel chemotherapy combined with androgen-deprivation therapy (ADT) for patients with metastatic hormone-sensitive prostate cancer. Methods One hundred and ninety-two cases of metastatic hormone-sensitive prostate cancer in Renji Hospital between January 2015 and July 2016 were analyzed retrospectively. Patients′ age was 39 to 90, the median age was 71 years. The median prostate-specific antigen (PSA) at diagnosis was 90.6ng/ml (4.1-2 556.0 ng/ml). One hundred and eighty were with bone metastasis and 12 were with distant lymphatic metastasis. Sixty-one of them received docetaxel chemotherapy plus ADT for 3 weeks, 131 received hormonal treatment alone. The median age of combination therapy group was 67 years (39-80 years), that of single treatment group was 75 years (50-93 years) (P<0.001). The median PSA baseline of the two groups were 91.6 ng/ml (35.5-157.5ng/ml) and 89.1 ng/ml (59.6-191.0 ng/ml) (P=0.324). Gleason score of combination therapy group showed that 3 cases (4.9%) was 6, 23 cases (37.7%) 7, 35 cases (57.4%) ≥8. That of single treatment group showed that 17 cases (13.0%) 6, 51 cases (38.9%) 7, 63 cases (48.1%) ≥8. There was no statistic difference between the two groups (P=0.122). But there was statistic difference in the rate of T3 or T4 clinical stage in primary lesion, that of combination therapy group was 50.7% (37/61) and 34.4% (21/61), and that of single treatment group was 60.3% (79/131) and 21.4% (28/131) (P=0.011). Imaging showed local lymph node metastasis in the two groups (80.3% vs. 67.9%, P=0.005). As to physical condition, the combination therapy group showed a lower ECOG score than the single treatment group (P<0.001). All the patients’ survival condition, PSA response rate and adverse events were analyzed. Results One hundred and ninety-two patients were regularly followed-up. The median follow-up time was 23.3(14.4-33.4) months. Median progression free survival time of combination therapy group and single treatment group were respectively 24.4 (7.5-31.3) months vs. 17.5 (3.0-30.7) months (P<0.001). There were 1 and 16 cases died in the two groups due to disease progression. During the treatment, the rate of PSA level less than 0.2 ng/ml was 29.5% (18/61) vs. 13.7% (18/131) in combination therapy group and single treatment group. Regarding the tolerance of combination therapy group, the incidence rate of grade 3-4 neutropenia was 27.9% (17/61). Skin and mucous membrane damaged in 24.6% (15/61) patients, transaminase rised in 13.1% (8/61) patients, and peripheral nerve toxicity occurred in 9.8% (6/61) patients. There was no significant difference between the 2 groups in relevant events caused by ADT, gynecomastia (14.8% vs. 16.3%) and erectile dysfunction (100% vs. 100%). Most of them could be relieved by symptomatic treatment. Conclusions For metastatic hormone-sensitive prostate cancer, docetaxel combined with hormonal treatment showed longer progression free survival than ADT alone with adverse reactions acceptable. Key words: Prostatic neoplasms, metastatic, hormone-sensitive; Docetaxel; Androgen deprivation therapy; Chemotherapy; Progression-free survival