Three weekly docetaxel for advanced prostate cancer

Updated results from the Tax 327 study confirm that docetaxel given 3 weekly improves survival compared with mitoxantrone in men with hormone refractory metastatic prostate cancer. Mitoxantrone and prednisone have been shown to improve pain and quality of life in men with metastatic hormone-resistant prostate cancer (HRPC), compared with prednisone alone. The Tax 327 study showed a survival benefit using docetaxel compared with mitoxantrone, for men who had progressive disease following primary androgen deprivation. In the TAX 327 study, 1,006 men with metastatic hormone-resistant prostate cancer (HRPC), from 24 countries, were randomised to docetaxel (75mg/m2) given every 3 weeks (D3), docetaxel (30mg/m2) given weekly (D1), and mitoxantrone 12mg/m2) (MP), each with prednisone twice daily. This updated analysis of survival was performed when there had been 867 deaths, 111 had been lost to follow-up. Median survival was 19.2 months (95% CI, 17.5 to 21.3 months) in the D3P group, 17.8 months (95% CI, 16.2 to 19.2 months) in the D1P group, and 16.3 months (95% CI, 14.3 to 17.9 months) in the MP group. A total of 18.6% patients survived at least 3 years in the D3P, 16.6% in the D1P arms and 13.5% in the MP arm. Compared with the first analysis, the difference in median survival between D3P and MP arms had increased (P = 0.004) and there was still no significant difference between D1P and MP arms. Subgroup analysis showed similar trends for men older and younger than 65 years of age, with and without pain at baseline, and for those with baseline PSA greater than and less than the median of 115 ng/mL. The authors concluded that results confirmed the previously reported short term follow-up, and that the weekly schedule of docetaxel should not be adopted, although patients at high risk of neutropenic fever may be an exception. They concluded, “docetaxel given three weekly remains the preferred treatment option for most patients with metastatic HRPC.” They noted that future studies should address cost effectiveness of this and other new treatments for men with prostate cancer. Reference...