Chemotherapy for non-hormone refractory prostate cancer

Randomized clinical trials (RCTs) have demonstrated the benefits of chemotherapy for hormone-refractory prostate cancer (HRPC). These data have intensified interest in the use of chemotherapy for non-HRPC. Chemotherapy plus androgen deprivation therapy (ADT) is now under study in a number of RCTs in hormone-naïve patients.

Important data supporting the intuitive, preclinical and clinical rationale for study of chemotherapy plus ADT in non-HRPC were identified and narratively reviewed.

There is evidence that chemotherapy can improve survival in HRPC. Chemohormonal therapy reduces recurrence in premenopausal women with estrogen receptor-positive early breast cancer, a group analogous to men with localized prostate cancer. Preclinical data supports earlier use of use of chemotherapy plus ADT simultaneously rather than sequentially. Some RCTs suggest disease control is improved by this approach in non-HRPC. A large single arm trial of docetaxel plus ADT prior to radical prostatectomy has demonstrated safety, feasibility, and evidence of efficacy.

There is sufficient rationale for studying chemotherapy in combination with ADT in non-HRPC. Large scale RCTs investigating this are imminent for men with high-risk localized disease, with biochemical recurrence after local therapy, and with hormone-naïve metastatic disease.