Men who become castrate resistant in less than 12 months from starting androgen deprivation therapy (ADT) were found to have poor efficacy with a 2nd line of ADT.  However, the development of early castrate resistance did not impair the benefit of any of the docetaxel based chemotherapy.

Researchers examined the records of 132 consecutive men with mCRPC retrospectively coming from 9 different cancer centers. They looked at ther PSA response and time to biochemical progression (TTBP) with 1st and 2nd instances of ADT, docetaxel and cabazeltaxel.  They were then evaluated according to time to progression to CRPC, PSA response, TTBP and Overall Survival (OS).

All the men received their first round of ADT, docetaxil and cabazeltaxil and 94 of them received a second round of ADT. Time to developing CRPC that was less than 12 months was associated with a reduced OS, poor PSA response and TTBP with second ADT.

The taxanes showed a similar PSA response whatever the time to CRPC had been but TTBP was slightly shorter in men with time to CRPC less than 12 months.

This retrospective analysis suggests that rapid progression to CRPC is associated with a poor prognosis and a low response to second round of ADT. PSA response to taxanes does not seem to be affected by time to CRPC, but TTBP is shorter in men with early CRPC. Since this was a retrospective study it needs to be confirmed with prospective randomized.

J Clin Oncol 32, 2014 (suppl 4; abstr 282): Antoine Angelergues, Denis Maillet, Aude Flechon, Mustafa Ozguroglu, Florence Mercier, Aline Guillot, Sylvestre Le Moulec, Gwenaelle Gravis, Philippe Beuzeboc, Christophe Massard, Thibault De La Motte Rouge, Nicolas Delanoy, Reza-Thierry Elaidi, Stephane Oudard.

Joel T. Nowak, M.A., M.S.W.