Once we become hormone refractory (HRPC) there remains only one approved drug to treat our prostate cancer, docetaxel. As with hormone therapy (ADT) docetaxel also stops working after a period. There have been different strategies used to try to deal with this untenable situation, including the use of docetaxel on an intermittent schedule.

A recent study at Klinik für Urologie und Kinderurologie, Philipps-Universität Marbur was designed to reevaluate both the toxicity and efficacy of intermittent -docetaxel-chemotherapy in patients whose cancers progressed after successful first-line docetaxel therapy.

Forty six (46), eighteen (18) , and five (5) patients with HRPC received one (1), two (2), or three (3) cycles of docetaxel based chemotherapy. Both the toxicity of the docetaxel as well as the PSA response and general conditions were evaluated systematically. SPSS 15.0 was applied for statistic analysis.

Fifty six (56 %) patients achieved a PSA response of > 50 %, another ten (22 %) patients of up to 50 %; and ten (22 %) patients progressed despite the reintroduction of the docetaxel. The median overall survival of the whole cohort calculated from the first docetaxel application was sixteen months(3-60 +). Tolerance, toxicity and general condition were crucial for the administration of a second cycle (n = 18); in contrast, age or the degree of the PSA decline in cycle 1 did not seem to be of importance. The -median overall survival of all patients who received at least two cycles were 35 months; and 13 of 18 patients achieved a biochemical response in cycle 2. Toxicity did not rise significantly. Five patients were given a third docetaxel cycle, three of whom responded.

Intermittent docetaxel therapy is well tolerated and shows high response rates in the sec-ond and third sequences of treatment in select HRPC patients who presented with low docetaxel toxicity, good clinical condition and responded to prior docetaxel-based treatment.

Conclusion: If you did respond to an initial cycle of docetaxel and did not suffer with significant toxicity issues you might benefit from additional cycles after a rest period.

Aktuelle Urol. 2009 Apr 15. Epub ahead of print.
doi: 10.1055/s-0028-1098888; Olbert PJ, Weil C, Hegele A, Hofmann R, Schrader AJ.

PubMed Abstract : PMID:19370533

Joel T Nowak MA, MSW