[Patients with metastatic hormone-refractory prostate cancer. Second-line chemotherapy with mitoxantrone plus...

To date there has been no accepted standard for second-line chemotherapy in docetaxel-refractory patients with metastatic hormone-refractory prostate cancer (mHRPC). Therefore, we evaluated our experience with mitoxantrone plus prednisone (MP) in this setting.

Ten patients with docetaxel-refractory mHRPC were treated with MP. The parameters under investigation were prostate-specific antigen (PSA) remission, biochemical progression-free survival, and pain reduction under chemotherapy.

Partial PSA remission was seen in two patients, "stable disease" in three patients, and progression in five patients receiving MP. Progression-free survival was 8 months (mean) for patients with partial PSA remission and 2 months (median) for patients with "stable disease." Four of seven patients experienced pain reduction with MP. Grade 4 neutropenia was noted in only 10%. Patients with a decline of PSA under docetaxel and MP had a progression-free survival of 11.5 months (median).

Presently, we see the indication for MP as being second-line chemotherapy in docetaxel-refractory patients with mHRPC who cannot be included in phase II/III studies. Even with only a moderate rate of partial PSA remission, every second patient had an improvement in tumor-related pain. Progression-free survival was prolonged, and the side effects of MP were comparatively low.