Outcomes with second-line chemotherapy in castrate metastatic prostate cancer

Abstract

4659 Background: Docetaxel is the standard 1st-line chemotherapy for patients (pts) with progressive castrate metastatic prostate cancer (CMPC). We describe the outcomes of patients following first-line therapy in the contemporary era. Methods: The outcomes of 108 pts treated with a microtubule-targeting chemotherapy as 1st-line were evaluated for response to 2nd and 3rd line cytotoxic treatments. The subsequent treatments included a docetaxel/paclitaxel, mitoxantrone, doxorubicin, cyclophosphamide or investigational agents. Parameters evaluated were: the proportion who received a subsequent treatment, and the Karnofsky Performance Status (KPS), LDH, Alk, Hb, Alb, and PSA at the start of the therapy. Post-therapy PSA levels were also recorded. Survival estimates were performed using the Kaplan-Meier method. Results: Of the entire cohort, 83% (90 of 108) received 2nd and 40% (44 of 108) received 3rd line therapy. The median survival for 1st line treatment was 21 months (95% CI, 18–25), for 2nd line 13 months (95% CI, 10–15), and 12 months (95% CI, 9–19) for 3rd line therapy. Baseline characteristics showed similar Hgb, Alb, and LDH between those receiving 1st, 2nd and 3rd line treatment, with a trend to higher Alk and PSA values. The proportion showing post-therapy PSA declines were .72, .15 and .24. Conclusions: In this cohort, a significant proportion of pts with CMPC who receive 1st-line therapy go on to receive 2nd and 3rd line chemotherapy. Most baseline characteristics do not change and survival remains notable. The results have implications in the design of trials for 2nd and 3rd line chemotherapy. Support: Prostate Cancer Foundation Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis Aventis