Prostate cancer patients who no longer respond to hormone therapy may benefit from a combination of docetaxel and estramustine

Prostate cancer patients whose cancer has spread to other parts of the body and who no longer respond to hormone therapy may benefit from a combination of the cancer drugs docetaxel and estramustine, according to a new study published in the Oct. 8 issue of the New England Journal of Medicine.

The study found that patients who received a combination of docetaxel and estramustine experienced an improvement in their survival rate vs. those treated with mitoxantrone, another cancer drug, and prednisone, a type of steroid.

“This work will be important in shaping future drug strategies in treating patients with advanced, hormone-resistant prostate cancer, as no prior study has shown an improvement in their median or overall survival,” said Derek Raghavan, M.D., director of the Cleveland Clinic Taussig Cancer Center, and co-author of the study. Dr. Raghavan is one of the leaders of the Genitourinary Committee of the Southwest Oncology Group, the team that conducted the study. The physicians at the Cleveland Clinic Taussig Cancer Center are members of this cooperative cancer research group.

Of the 770 men who participated in the study, 386 men received a combination of docetaxel and estramustine and 384 received mitoxantrone and prednisone. Researchers recorded the men’s overall survival, progression-free survival, response to treatment, relief of pain and decline of PSA (prostate-specific antigen) levels following treatment.

Results showed those who received docetaxel and estramustine had a longer median survival of 17.5 months compared with 15.6 months for patients treated with mitoxantrone and prednisone. Likewise, patients treated with docetaxel and estramustine saw their PSA levels decline 50 percent compared with 27 percent for patients treated with mitoxantrone and prednisone.

“What’s important is not the relatively small difference in median survival, but rather the fact that the patients receiving docetaxel and prednisone had a better outcome throughout the survival curve,” Dr. Raghavan said. “Also this is the first study that has shown a statistically significant survival benefit from chemotherapy after hormone failure in prostate cancer and thus docetaxel will be incorporated into many future studies.”

Patients in both groups reported similar pain relief following treatment. But patients treated with docetaxel and estramustine reported moderate levels of fever, gastrointestinal and cardiac side effects more frequently than those who received mitoxantrone and prednisone.

“It may well be that some patients will be more suited for initial mitoxantrone chemotherapy for prostate cancer,” said Robert Dreicer, M.D., a leading prostate cancer expert at the Cleveland Clinic. “We must not under-estimate the importance of an experienced physician in helping a patient to decide whether to go for a more effective, more toxic therapy first, or to try a gentler regimen and see if it works.”

The Cleveland Clinic Taussig Cancer Center comprises a team of more than 250 expert physicians who provide a comprehensive approach to cancer treatment for any age group and any part of the body. The center offers a full range of services including cancer prevention, diagnosis, treatment and follow-up care. The Taussig Cancer Center participates in numerous clinical trials, providing patients with access to innovative treatments.

http://www.clevelandclinic.org