Real‑world data on the outcomes of upfront docetaxel in hormone‑sensitive metastatic prostate cancer

The present retrospective, single-centre study investigated the efficacy and toxicity of upfront docetaxel chemotherapy in patients with hormone-sensitive metastatic prostate cancer and evaluated the impact in high and low-volume disease. Data from 167 patients with hormone-sensitive metastatic prostate cancer treated between January 2016 and December 2019 were analysed. The data cut-off was February 2024; the median follow-up time was 37 months and the median age was 66 years. The cohort consisted of varying Gleason scores, with the majority scoring 9 (n=86; 51.1%). Surgical castration was performed in the majority of cases (n=136; 81.4%). Overall, 66 (39.5 %) of the patients had low-volume disease (≤5 sites of metastasis, no visceral metastasis), while 101 (60.5%) patients had high-volume disease. Disease progression occurred in 100 patients (59.9%), with a median progression-free survival (PFS) of 47 months (95% CI, 37.503-56.497). The median overall survival (OS) was 71 months. In the comparison of low-volume vs. high-volume disease groups, the median PFS was 57 vs. 47 months respectively (P=0.276) and the corresponding median OS was not reached vs. 57 months respectively (P=0.192). Among the 100 patients with disease progression, 20 received second-line therapy. The median OS for untreated patients was 9.88 months, while those treated with antiandrogens was 15.14 months and those with re-challenge chemotherapy was 12.46 months (P=0.496; 95% CI, -6.47-11.83). Grade 3-4 treatment-related toxicities were observed in ~37.8% of patients, while one death was associated with chemotherapy-related neutropenic sepsis. The most common toxicities were mucositis (n=53; 31.7%), febrile neutropenia (n=44; 26.3%) and sepsis (n=29; 17.4%). The present study demonstrated that upfront docetaxel chemotherapy may be an effective and tolerable treatment for hormone-sensitive metastatic prostate cancer, particularly in settings where access to novel antiandrogens is limited, thus potentially offering a viable management strategy amidst resource constraints.