OPTIMIZING USE OF DOCETAXEL IN PROSTATE CANCER

The publication of two landmark studies—TAX 327[4] and SWOG 9916,[5] both of which showed a survival benefit with docetaxel—has led to evolution in the management of CRPC. The survival benefit associated with the administration of chemotherapy to patients with CRPC is now well established.[4,5,13] These studies have also resulted in a radical change in the treatment algorithm for prostate cancer; a closer partnership between a multidisciplinary team consisting of urologists, radiation oncologists and medical oncologists; and a drive to explore the potential benefits of introducing chemotherapy at earlier stages of the disease.

Three-weekly docetaxel and prednisone has become the standard first-line chemotherapy in men with CRPC; however, there is currently no clear guideline as to when chemotherapy should be initiated. The use of prognostic models for assessing patient prognosis[18] may aid decisions on the timing and duration of chemotherapy by combining a number of relevant variables. Treatment decisions for patients with CRPC are very complex, from the timing of initiation through to deciding when to discontinue chemotherapy on progression. Initiating first-line chemotherapy before the onset of bone pain in these patients may result in greater benefits in terms of OS. There is currently no clear surrogate for disease progression or OS in CRPC and no standard second- or third-line therapy after progression on first-line therapy. Although treatment within a clinical trial is necessary to improve treatment for men with CRPC, many men are not enrolled in trials for a variety of reasons, and thus optimizing treatment outside the clinical trial setting is essential for improving patient outcomes.