Understanding the Reality of the Side Effects from Early Chemotherapy

/, Advanced Prostate Cancer, ASCO, docetaxel, Drugs & Treatments, Hormone Therapy, Research, Side Effects, taxotere, Uncategorized, Understanding APC/Understanding the Reality of the Side Effects from Early Chemotherapy

Ever since the research showing that men who are newly diagnosed with very aggressive prostate cancer have a significant life extension advantage if they move immediately to chemotherapy (with docetaxel) along with hormone therapy (ADT) there has been, what I can only describe as a paradigm shift in the clinical care of men with metastatic hormone-sensitive prostate cancer.

However, many men are very afraid to have chemotherapy as there remains concerns about the toxicity (side effects) of the drug.

A recent study, however, showed that the adverse events experienced by men who have early chemotherapy tends to be short-lived and that, overall, men treated with ADT and chemotherapy continue to enjoy a high quality of life.

According to Linda J. Patrick-Miller, PhD from the University of Chicago Medical Center “Many patients fear chemotherapy and think they are going to be sick for months and months but at about 6 months, patients felt almost ‘back to normal,’ and by 12 months, they felt as they did before treatment.” She also said that by 12 months after receiving the chemotherapy in combination with ADT men reported a better quality of life than those who had been only on ADT.

Miller’s study was presented at the Genitourinary Cancers Symposium 2016 (ASCO GU) in San Francisco. She did acknowledge, while receiving ADT and chemotherapy, men did experience symptoms. However, she also said that, “It did not have a long-term impact on overall quality of life or on their emotional well-being.”

Miller also said that when chemotherapy is used at this stage it isn’t like other cancer therapies, which might only confer a modest benefit. Prior research has showed that adding chemotherapy to hormone therapy at this stage does have a significant impact on a man’s potential survival. One could say, more bang for the buck.

In their quality-of-life analysis, Dr. Patrick-Miller and her colleagues utilized data from the pivotal ECOG E3805 CHAARTED trial.

If you are faced with this decision, given this finding and since you can always choose to stop the chemotherapy, I urge that you give it a try and stay around longer in this world and enjoy your life.

Genitourinary Cancers Symposium (GUCS) 2016: Abstract 286. Presented January 7, 2016.

http://meetinglibrary.asco.org/content/158431-172

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3 Comments

  1. Richard Stanton May 28, 2016 at 9:42 am

    I am not newly diagnosed (2008, age 52, pT3bNOMX (GS 4 +3 with 5), RRP, IGRT) but I have hormone naive metastatic disease in the lymph nodes, and depending upon who interprets a recent F18-NaF Pet/CT scan, in some bones. My doctor has strongly recommended I start ADT plus taxotere per the CHAARTERED trial results, but I have declined, for the reasons stated in your editorial – potential side effects. As I read the CHAARTERED trial results, survival is extended (on average) about 14 – 16 months compared to ADT alone, in high volume metastatic disease patients. According to the article above, it will take about a year to feel like you did before chemotherapy. That’s a net gain of about 2 to 4 months, on average, from a quality of life standpoint. I see no point to taking the risk.when I can guarantee I will have no side effects from chemotherapy by not using the taxotere. I suppose the decision whether to use ADT plus taxotere depends upon whether the individual values length of life more than quality of life.

  2. Stephan September 5, 2016 at 12:16 pm

    I am a 48 year old man with advanced prostate cancer with bone metastasis. As per the positive study trend of docetaxel + ADT (Firmagon in my case), I decided to go for it, despite my instinctive fear of “chemotherapy”, as a healthcare professional. Perhaps due to my age, and relatively healthy physical health (apart from the devastating diagnosis), I have yet to see any substantial side effects to my treatment, and am staying the course without hesitation. For me, fatigue is the main side effect, and very manageable. I am also fortunate that my neutrophils levels are staying strong so far. I am at my 4th chemo out of 6. So an encouraging comment for your blog.
    I am perplexed though as the reason why my physician did not recommend the removal of my prostate. It seems counterintuitive to me.
    I am also wondering why my oncologist prescribed Pamidronate instead of Zoledronic acid for my bone metastasis, since i’ve seemed to only come across studies that benefits Zoledronic acid over Pamidronate…
    If you have any suggestions and opinions, I’d appreciate.

  3. Joel September 12, 2016 at 6:51 pm

    Stephan,
    First, I want to say that I am sorry that you have joined our club.

    The six rounds of of chemotherapy is the new standard of care for newly diagnosed aggressive prostate cancer. In reference to your comments about side effects from chemotherapy, I am not surprised. Chemotherapy has a overly scarey reputation. Today’s chemotherapy is not the same as when it was given to “Aunt Tilley” 20 years ago. Of course, there are some men who do experience terrible side effects, but there seems to me many more who have only minimal side effects.

    There was a recent study that showed that after the first year post-chemotherapy a man’s quality of life is actually better than men who did not take chemotherapy (at the stage you described for yourself).

    Joel

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