Chemotherapy

Updated: 9 November 2004

Because of the difficulty of treating many patients in this population and also evaluating the response, cytotoxic chemotherapy is only recommended in suitable selected patients with active drugs with low subjective toxicity. The combination of Mitoxantrone and Prednisone (GUPMX) has demonstrated clinical palliative benefit in patients with painful bone metastases without improvement in overall survival. More recently, in randomized studies, Docetaxel given every three weeks in conjunction with prednisone (GUPDOC) has been shown to improve overall survival and provide superior pain relief and improvement in quality of life parameters, as compared to mitoxantrone. Palliative benefit is most likely to accrue to patients where general condition and marrow function is adequately preserved.

Suitable criteria:

  • Early recognition of hormonal resistance and disease progression e.g., rising PSA despite castrate levels of testosterone and failure of trial of secondary nonsteroidal anti-androgen therapy
  • Minimal prior radiotherapy (less than 25% of bone marrow)
  • At least partially ambulatory
  • A parameter measurable for response (palpable tumour mass, rising serum PSA, or symptoms that can be evaluated)

Refer suitable patients early to the medical oncology service for consideration of chemotherapy, after recognition of development of hormone resistant disease. Chemotherapy may be delayed in asymptomatic patients without visceral disease. Patients in severe and/or uncontrolled pain should be first managed with radiotherapy and analgesics as appropriate.

Details of current protocols are available on request.

References:

  1. Tannock IF. de Wit R. Berry WR. Horti J. Pluzanska A. Chi KN. Oudard S. Theodore C. James ND. Turesson I. Rosenthal MA. Eisenberger MA. TAX 327 Investigators. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. New England Journal of Medicine. 351(15):1502-12, 2004 Oct 7.

  2. Tannock IF. Osoba D. Stockler MR. Ernst DS. Neville AJ. Moore MJ. Armitage GR. Wilson JJ. Venner PM. Coppin CM. Murphy KC. Chemotherapy with mitoxantrone plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer: a Canadian randomized trial with palliative end points. Journal of Clinical Oncology. 14(6):1756-64, 1996 Jun.