[Value of mitoxantrone in metastatic hormone-resistant prostate cancer]

The second-line treatment of hormone-resistant metastatic prostate cancer is controversial. This study was designed to evaluate the efficacy and toxicity of mitoxantrone in this clinical situation.

The author report a retrospective study of 16 patients with a mean age of 69 years (range: 51-80 years). In each case, the treatment regimen consisted of castration followed by fosfestrol tetrasodium after hormonal escape and second-line treatment with mitoxantrone at a dose of 12 mg/m2 per course (1 to 10 courses) associated with prednisone at a dose of 10 mg/day. The authors evaluated the response to treatment (clinical status and survival) as a function of the following parameters: initial PSA, Gleason score, number of bone metastases, time to hormonal escape, PSA and Karnofsky index on inclusion and total number of courses of mitoxantrone.

Two groups of eight patients were defined as a function of clinical status at the end of each course: group 1 (partial regression and no change) and group 2 (tumour progression). A correlation was demonstrated between the time to hormonal escape and the number of courses and the response to treatment (p = 0.058). The mean survival after introduction of mitoxantrone was 13 months with a significant difference (p = 0.0004) for a cut-off value of 4 courses: 7 months (n < or = 4) and 18 months (n > 4).

Mitoxantrone is a minimally toxic chemotherapeutic agent, which justifies its current indication in hormone-resistant advanced prostate cancer.