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Overview of Canadian trials in hormonally resistant prostate cancer
1Department of Medicine, Princess Margaret Hospital, University of Toronto, Ontario, Canada.
Abstract:
There is no consensus about the best systemic treatment for hormonally resistant prostate cancer. Several regimens have been examined; none of them have demonstrated a consistent increase in overall survival. The treatment of hormonally resistant prostate cancer is therefore palliative. Recent studies in Canada have taken the approach that the best way to measure disease palliation is to assess the effects of therapy on disease-related symptoms and quality of life. Studies with mitoxantrone and prednisone confirm that this regimen is well tolerated and leads to symptomatic improvement in approximately 40% of patients, with a median duration of improvement of more than 10 months. This is greater than that achieved with prednisone alone. Treatments that have greater activity against hormonally resistant disease are urgently needed, although improvements probably will be gradual and modest. While it may be appealing to intensity treatments to obtain greater efficacy, there is a real risk that the toxicity will nullify any benefits. This approach of directly measuring the ability of systemic therapies to provide palliation is an appropriate way to assess newer therapies for hormonally resistant prostate cancer.
Insights
Systemic treatments for hormonally resistant prostate cancer offer palliative care, focusing on symptom improvement and quality of life. Mitoxantrone and prednisone showed symptomatic benefits in 40% of patients, exceeding prednisone alone.
Area of Science:
- Oncology
- Palliative Care
- Prostate Cancer Research
Background:
- Hormonally resistant prostate cancer lacks a consensus on optimal systemic treatment.
- Current regimens show inconsistent increases in overall survival.
- Treatment focuses on palliation, emphasizing symptom management and quality of life.
Purpose of the Study:
- To evaluate systemic therapies for hormonally resistant prostate cancer based on their palliative effects.
- To assess the impact of treatment on disease-related symptoms and quality of life.
Main Methods:
- Review of studies examining systemic treatments for hormonally resistant prostate cancer.
- Focus on assessing palliation through symptom improvement and quality of life metrics.
- Comparison of mitoxantrone and prednisone regimen against prednisone alone.
Main Results:
- Mitoxantrone and prednisone regimen is well-tolerated.
- Symptomatic improvement observed in approximately 40% of patients with this regimen.
- Median duration of symptomatic improvement exceeded 10 months, outperforming prednisone alone.
Conclusions:
- There is an urgent need for more effective treatments for hormonally resistant prostate cancer.
- Improvements in efficacy are expected to be gradual and modest.
- Directly measuring palliation is a valid approach for assessing new therapies, balancing efficacy and toxicity.