Chemotherapy for hormone-refractory prostate cancer

Area of Science:

• Oncology
• Clinical Trials
• Cancer Therapeutics

Background:

• Prostate cancer incidence is rising, particularly in elderly men.
• Hormone therapy is standard for advanced prostate cancer, but resistance (hormone-refractory prostate cancer - HRPC) leads to poor outcomes.
• Existing treatments for HRPC, including chemotherapy, have shown limited efficacy, necessitating further investigation.

Purpose of the Study:

• To review randomized trials assessing chemotherapy's role in metastatic HRPC.
• To evaluate overall survival, pain relief, prostate-specific antigen (PSA) response, quality of life, and toxicity.

Main Methods:

• Systematic search of electronic databases and journals for published randomized trials.
• Inclusion of trials comparing chemotherapy regimens, or chemotherapy versus best standard of care/placebo.
• Data extraction on trial design, participants, outcomes, and quality assessment.

Main Results:

• 47 trials involving 6929 HRPC patients were reviewed; meta-analysis was not feasible.
• Docetaxel demonstrated a significant, though modest, improvement in overall survival compared to standard care.
• Docetaxel also showed superior pain relief and quality of life improvements versus mitoxantrone plus prednisone, with manageable toxicities.

Conclusions:

• Chemotherapy, especially docetaxel-based regimens, shows promise for HRPC patients.
• Improvements in survival, symptom palliation, and quality of life support considering chemotherapy.
• Informed patient decisions are crucial, balancing chemotherapy's benefits against its risks.