Modified docetaxel regimen for prostate cancer patients who got poor tolerance to chemotherapy

Abstract

Objective To evaluate the efficacy and safety of the modified docetaxel plus prednisone scheme for the metastatic castration resistant prostate cancer patients who got poor tolerance to chemotherapy. Method The clinical data of 50 metastatic castration resistant prostate cancer who received docetaxel+ prednisone chemotherapy from March 2010 to October 2015 were analyzed retrospectively. 23 cases received the modified DP regimen (modified group), 27 cases received the standard DP regimen (standard group). The median age of the modified group and the standard group were 69 years (47-80 years) and 63 years (52-77 years)(P=0.005). There were 19 and 24 cases with pain in modified group and standard group respectively; 10 and 19 cases with lymph node metastasis respectively; 3 and 4 cases of visceral metastasis respectively; all of the 50 patients were complicated with bone metastasis. For the pathological Gleason score, there were 7 cases scored ≤7 points, 13 cases scored ≥8 points and 3 cases unscored in the modified group; 7 cases scored ≤7 points, 15 cases scored ≥8 points and 5 cases unscored in standard group. There was no significant difference of the pain, metastasis, and Gleason score between the two groups (P>0.05). Progression free survival(PFS), overall survival(OS)and adverse events were analyzed using Kaplan-Meier curves, and the differences were assessed using the log-rank test. Results In the modified group and standard group, the median follow-up times were 11.0 months and 14.0 months respectively, the median chemotherapy cycles were 4.5 cycles and 5.0 cycles respectively; OS were 18.0 months and 27.5 months respectively (P=0.746). The PFS of the two groups were 6.0 months and 5.2 months, respectively (P=0.822). The PSA response were 13 cases and 17 cases in the modified group and standard group respectively(P=0.615), and the pain response were 8 cases and 7 cases (P=0.927), grade 3 to 4 adverse events were 3 cases and 14 cases (P=0.003). The main adverse events were blood toxicity , neutrophils, gastrointestinal reaction, edema, fatigue and oral mucositis etc. Conclusions Compared with the standard DP scheme, the modified DP scheme had no significant difference in OS, PFS, pain response rate and PSA response rate, while the incidence of grade 3 to 4 adverse events was significantly reduced. Modified DP scheme may be a better choice for patients with metastatic castration resistant prostate cancer who get poor tolerance to chemotherapy. Key words: Metastatic castration resistant prostate cancer; Docetaxel; Chemotherapy