Docetaxel (Taxotere), or chemotherapy, will as all other treatments for advanced prostate cancer stop working. Many of us will progress quickly to this stage and eventually face a situation where there are no longer any approved treatments available to control our prostate cancer. If you are lucky enough to have an oncologist who is creative and aggressive, the only alternative left is the hope of receiving some benefit from their artistry. All that a doctor can do at this point is to try to control your cancer is to “play with” unapproved combinations of drugs with the hope of extending your life.

We are in dire need of drugs and treatments to extend our life and while also providing us with a decent quality of life. Right now, these alternatives do not exist. Instead, we need to rely on the resourcefulness of our doctors, but despite how creative our doctor is, we all know that this is our final stage of our life.

There are a limited number of studies of new drugs and treatments, some of which might be useable once chemo has failed. One such study is a phase II trial, which evaluated sunitinib malate in men with progressing metastatic castrate resistant prostate cancer (CRPC) following prior docetaxel failure.

Men with metastatic CRPC progressing following one to two chemotherapy regimens using docetaxel were included in this study. The primary end point was progression-free survival (PFS) per radiographic and clinical evaluations. Oral sunitinib was administered 50 mg/day 4-weeks on followed by 2-weeks off per cycle up to a maximum of eight cycles or until clinical progression or intolerable toxicity.

Thirty-six men with a median age of 69.5 years were accrued for this study. The median PFS was 19.4 weeks with a 12-week PFS of 75.8%. Four patients (12.1%) had a >/=50% prostate-specific antigen (PSA) decline and seven (21.2%) had a >/=30% PSA decline. Two of 18 patients (11.1%) with measurable disease demonstrated 30% declines by RECIST and eight (44.4%) displayed some shrinkage. A decline in pain score >/=2 points occurred in 13.6% of 22 assessable patients. Drug discontinuation due to toxic effects occurred in 52.8% of patients.
Sunitinib malate demonstrated promising, but limited activity in metastatic CRPC progressing after prior docetaxel. Additional studies, including a larger, phase III trial is now needed.

Ann Oncol. 2009 Jul 24. Epub ahead of print.
Sonpavde G, Periman PO, Bernold D, Weckstein D, Fleming MT, Galsky MD, Berry WR, Zhan F, Boehm KA, Asmar L, Hutson TE.
PubMed Abstract

Joel T Nowak MA, MSW