What is left for us once we become resistant to docetaxel (DOC) plus prednisone, which is the last FDA approved, standard of care treatment available for advanced hormone refractory prostate cancer? There has been some studies that indicate after a “vacation period” similar to what many of us do with a first line hormone blockade, DOC will sometimes be effective for an additional limited time period (see my post of February 29, 2008 titled: “Vacation Time For Chemotherapy in Patients With Metastatic Androgen-Independent Prostate Cancer”).

Other than the “vacation period” all we are left with is palliative treatment until we die a painful death. The Medical Oncology Department, at the Santa Chiara Hospital, in Trento, Italy (Caffo O, Sava T, Comploj E, Giampaolo MA, Segati R, Valduga F, Cetto G, Galligioni E ) just completed a study to evaluate whether the addition of estramustine (E) after a pause in DOC treatment can overcome DOC resistance.

They took men who had stopped responding to DOC in a previous randomized phase II trial and gave them a one-hour intravenous infusion of DOC 70 mg/m(2) and on day 2 in combination with oral E 840 mg/day divided into three daily administrations on days 1-5.

The study set up primary endpoint of >50% decrease in PSA; the secondary endpoints were biochemical progression-free survival, overall survival, the objective response rate, and toxicity.

The researchers found a biochemical response in 52% of the 25 patients evaluated. The only grade 4 event (significant event) was a cerebral stroke that occurred a few days after the administration of the first treatment course. Treatment discontinuation due to worsened compliance was observed in the patients who received a higher cumulative number of courses.

The researchers concluded that there was a very strong suggestion that the addition of E may be useful in over coming DOC resistance in selected HRPC patients. However, this research needs to be duplicated and the study sample in this case is vry small.

Urol Oncol. 2008 Oct 9. Epub ahead of print.

PubMed Abstract

Are you now resistant to DOC, tell your oncologist to look up this study and discuss the possibility of adding E to your DOC.

Joel T Nowak MA, MSW