RESUMO
OBJECTIVE: To evaluate the benefit of docetaxel rechallenge in patients with metastatic castration-resistant prostate cancer (mCRPC) relapsing after an initial good response to first-line docetaxel. PATIENTS AND METHODS: We retrospectively reviewed the records of consecutive patients with mCRPC with a good response to first-line docetaxel [serum prostate specific antigen (PSA) decrease ≥50%; no clinical/radiological progression]. We analysed the impact of management at relapse (docetaxel rechallenge or non-taxane-based therapy) on PSA response, symptomatic response (performance status/pain/analgesic consumption), and overall survival (OS). We used multivariate stepwise logistic regression to analyse potential predictors of a favourable outcome. RESULTS: We identified 270 good responders to first-line docetaxel. The median progression-free interval (PFI) was 6 months from the last docetaxel dose. At relapse, 223 patients were rechallenged with docetaxel (82.5%) and 47 received non-taxane-based therapy. There was no significant difference in median OS {18.2 [95% confidence interval (CI) 16.1-22.00] and 16.8 [95%CI 13.4-21.5] months, respectively, P = 0.35}. However, good PSA response and symptom relief/stable disease were more frequent on docetaxel rechallenge (40.4% vs 10.6%, P < 0.001 for PSA). A PFI of >6 months and added estramustine predicted a good PSA response and symptomatic response on docetaxel rechallenge but only a PFI of >6 months predicted longer OS. Haemoglobin (<13 g/dL) and pain were associated with reduced OS. Docetaxel rechallenge increased the incidence of grade ≥3 sensory neuropathy, nail disorders and asthenia/fatigue. CONCLUSIONS: Docetaxel rechallenge is a management option for responders to docetaxel with a PFI of >6 months, but did not prolong survival. Potential benefits should be weighed against the risk of cumulative toxicity.
Assuntos
Antineoplásicos/uso terapêutico , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Taxoides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Docetaxel , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Retratamento , Estudos RetrospectivosRESUMO
PURPOSE: We assessed the efficacy and toxicity of a fixed dose of docetaxel and prednisone, combined with escalating doses of gemcitabine (DGP). The primary endpoint was PSA response. METHODS: Fifteen patients were enrolled in the phase I and 50 patients entered the phase II. Patients were given DGP, maximum of eight courses, until progression or unacceptable toxicity. Docetaxel 75 mg/m(2) was administered intravenously day 1, gemcitabine was given day 1 and 8 in doses increasing from 600 to 1,000 mg/m(2) every third week. Patients had castrate refractory metastatic prostate cancer (CRMPC), adequate function of liver, kidney and bone marrow; ECOG performance status Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
, Orquiectomia
, Neoplasias da Próstata/tratamento farmacológico
, Idoso
, Idoso de 80 Anos ou mais
, Anti-Inflamatórios/administração & dosagem
, Antimetabólitos Antineoplásicos/administração & dosagem
, Antineoplásicos Fitogênicos/administração & dosagem
, Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
, Desoxicitidina/administração & dosagem
, Desoxicitidina/análogos & derivados
, Docetaxel
, Determinação de Ponto Final
, Humanos
, Estimativa de Kaplan-Meier
, Masculino
, Pessoa de Meia-Idade
, Metástase Neoplásica
, Dor/epidemiologia
, Dor/etiologia
, Cuidados Paliativos
, Prednisona/administração & dosagem
, Neoplasias da Próstata/patologia
, Análise de Sobrevida
, Taxoides/administração & dosagem
, Gencitabina