Cancer Investigation, 32:445–450, 2014 ISSN: 0735-7907 print / 1532-4192 online C 2014 Informa Healthcare USA, Inc. Copyright DOI: 10.3109/07357907.2014.958233
ORIGINAL ARTICLE
Docetaxel in Castration-Resistant Prostate Cancer: A Single-Centre Experience Detti Beatrice,1 Franceschini Davide,1 Saieva Calogero,2 Di Brina Lucia,1 Baki Mohammed,1 Meattini Icro,1 Di Cataldo Vanessa,1 Monteleone Pasquetti Eleonora,1 Furfaro Ilaria,1 Mancuso Anna,1 Simontacchi Gabriele,1 and Livi Lorenzo1
Cancer Invest Downloaded from informahealthcare.com by Nyu Medical Center on 10/11/14 For personal use only.
Department of Radiation-Oncology, University of Florence, Florence, Italy,1 Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Center (ISPO), Florence, Italy2
Keywords: Therapy, Chemotherapy, Bladder, Prostate cancer
R the introduction of docetaxel (Taxotere , Sanofi-Aventis), the use of other chemotherapy (CHT) drugs for metastatic prostate cancer was unsatisfactory with a 10–20% of response rate (5). Docetaxel was the first CHT that led to an improved survival in CRPC, as shown in two independent phase III trials, and in 2004 it was approved by the US Food and Drug Administration (FDA). Currently, docetaxel, administered every 3 weeks with low-dose prednisone, represents the gold standard first-line CHT for patients with metastatic CRPC. (6, 7). We presented a single-institution series, reporting the efficacy and safety of docetaxel as first-line chemotherapy in CRPC; moreover we focused on a few patients and treatment parameters and their association with overall survival and progression-free survival (PFS).
INTRODUCTION
MATERIAL AND METHODS
Prostate cancer is the third most common cause of cancerrelated mortality in men in Europe. In 2014, approximately 70,100 deaths from this disease are estimated (1). In Italy prostate cancer mortality appeared to be increasing at 10.64/100,000 for all ages, but remained stable in the 35–64 years age group at 3.69/100,000 (2). Metastatic prostate cancer is at first managed with androgen deprivation therapy, usually with a good response. Despite the initial disease control, virtually all patients with metastatic prostate cancer will become resistant to hormonal therapy (HT) and therefore will present a progression of disease (3). This situation, defined as castration-resistant prostate cancer (CRPC), is the condition when the patients show a continuous rise in serum prostate-specific antigen (PSA) levels or present the progression of pre-existing disease and/or the appearance of new metastases, with the serum testosterone in the castrate range. When this happens, overall survival (OS) is consistently less than 2 years (4). Before
From November 2004 to January 2012, 51 patients with CRPC received docetaxel as first-line chemotherapy at Radiotherapy Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Mean age at diagnosis of prostate cancer was 66.8 years (range 53.1– 81.3 years); mean age at the beginning of chemotherapy was 69.8 years (range 54.7–82.6 years). All patients had histologically confirmed prostate adenocarcinoma with clinical or radiological evidence of metastatic disease at initial diagnosis or occurring during follow-up after radical treatment. All patients had received primary androgen therapy at some point of their clinical history, due to biochemical relapse or metastatic disease. Patients underwent chemotherapy only with performance status (PS) ≤2 and baseline left ventricular ejection fraction (LVEF) was ≥50%, and normal bone marrow and hepatic function. No patients included in the analysis had received previous chemotherapy for metastatic disease; all patients gave written informed consent. Toxicity was
We present a single-institution experience reporting the efficacy and safety of docetaxel, administered as first-line chemotherapy, in castration-resistant prostate cancer (CRPC), focusing on patients and treatment parameters. From November 2004 to January 2012, 51 patients received chemotherapy with docetaxel. With a mean follow-up time (from the beginning of CHT) of 1.6 years (range 0.1–5.1 years), 35 patients (68.6%) died for prostate cancer and 48 patients (94.1%) showed progression of the disease. Five factors influenced overall survival: nodal status at diagnosis, neoadjuvant hormonal therapy, number of cycles of docetaxel administered, schedule of docetaxel and ECOG performance status before starting chemotherapy.
Correspondence to: Davide Franceschini, MD, Department of Radiotherapy, University of Florence, Largo G.A. Brambilla 3, 50134 Florence, Italy, email: [email protected] Received 14 May 2014; revised 8 July 2014; accepted 9 August 2014.
D. Beatrice et al.
Table 1. Distribution of 51 prostate cancer cases according to selected individual clinical characteristics Variable ≤60 61–70 >70 20
Cancer Invest Downloaded from informahealthcare.com by Nyu Medical Center on 10/11/14 For personal use only.
low medium high No Surgery RT Surgery+RT 3a 3b 4 0 1 No Yes No Yes
N Age at initial diagnosis 12 26 13 PSA at initial diagnosis 17 12 22 Risk classification 33 11 7 Primary Treatment 10 18 8 15 pT 9 18 6 PN 22 11 Neo adjuvant HT 31 20 Adjuvant HT 26 25
Table 2. Distribution of 51 prostate cancer cases according to selected treatment characteristics % 23.5 51.0 25.5 33.3 23.5 43.2 64.7 21.6 13.7 19.6 35.3 15.7 29.4 27.3 54.6 18.1
≤6 >6 Weekly Three-weekly 0 1 2 Planned PD Toxicity
ORIGINAL ARTICLE
Docetaxel in Castration-Resistant Prostate Cancer: A Single-Centre Experience Detti Beatrice,1 Franceschini Davide,1 Saieva Calogero,2 Di Brina Lucia,1 Baki Mohammed,1 Meattini Icro,1 Di Cataldo Vanessa,1 Monteleone Pasquetti Eleonora,1 Furfaro Ilaria,1 Mancuso Anna,1 Simontacchi Gabriele,1 and Livi Lorenzo1
Cancer Invest Downloaded from informahealthcare.com by Nyu Medical Center on 10/11/14 For personal use only.
Department of Radiation-Oncology, University of Florence, Florence, Italy,1 Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Center (ISPO), Florence, Italy2
Keywords: Therapy, Chemotherapy, Bladder, Prostate cancer
R the introduction of docetaxel (Taxotere , Sanofi-Aventis), the use of other chemotherapy (CHT) drugs for metastatic prostate cancer was unsatisfactory with a 10–20% of response rate (5). Docetaxel was the first CHT that led to an improved survival in CRPC, as shown in two independent phase III trials, and in 2004 it was approved by the US Food and Drug Administration (FDA). Currently, docetaxel, administered every 3 weeks with low-dose prednisone, represents the gold standard first-line CHT for patients with metastatic CRPC. (6, 7). We presented a single-institution series, reporting the efficacy and safety of docetaxel as first-line chemotherapy in CRPC; moreover we focused on a few patients and treatment parameters and their association with overall survival and progression-free survival (PFS).
INTRODUCTION
MATERIAL AND METHODS
Prostate cancer is the third most common cause of cancerrelated mortality in men in Europe. In 2014, approximately 70,100 deaths from this disease are estimated (1). In Italy prostate cancer mortality appeared to be increasing at 10.64/100,000 for all ages, but remained stable in the 35–64 years age group at 3.69/100,000 (2). Metastatic prostate cancer is at first managed with androgen deprivation therapy, usually with a good response. Despite the initial disease control, virtually all patients with metastatic prostate cancer will become resistant to hormonal therapy (HT) and therefore will present a progression of disease (3). This situation, defined as castration-resistant prostate cancer (CRPC), is the condition when the patients show a continuous rise in serum prostate-specific antigen (PSA) levels or present the progression of pre-existing disease and/or the appearance of new metastases, with the serum testosterone in the castrate range. When this happens, overall survival (OS) is consistently less than 2 years (4). Before
From November 2004 to January 2012, 51 patients with CRPC received docetaxel as first-line chemotherapy at Radiotherapy Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Mean age at diagnosis of prostate cancer was 66.8 years (range 53.1– 81.3 years); mean age at the beginning of chemotherapy was 69.8 years (range 54.7–82.6 years). All patients had histologically confirmed prostate adenocarcinoma with clinical or radiological evidence of metastatic disease at initial diagnosis or occurring during follow-up after radical treatment. All patients had received primary androgen therapy at some point of their clinical history, due to biochemical relapse or metastatic disease. Patients underwent chemotherapy only with performance status (PS) ≤2 and baseline left ventricular ejection fraction (LVEF) was ≥50%, and normal bone marrow and hepatic function. No patients included in the analysis had received previous chemotherapy for metastatic disease; all patients gave written informed consent. Toxicity was
We present a single-institution experience reporting the efficacy and safety of docetaxel, administered as first-line chemotherapy, in castration-resistant prostate cancer (CRPC), focusing on patients and treatment parameters. From November 2004 to January 2012, 51 patients received chemotherapy with docetaxel. With a mean follow-up time (from the beginning of CHT) of 1.6 years (range 0.1–5.1 years), 35 patients (68.6%) died for prostate cancer and 48 patients (94.1%) showed progression of the disease. Five factors influenced overall survival: nodal status at diagnosis, neoadjuvant hormonal therapy, number of cycles of docetaxel administered, schedule of docetaxel and ECOG performance status before starting chemotherapy.
Correspondence to: Davide Franceschini, MD, Department of Radiotherapy, University of Florence, Largo G.A. Brambilla 3, 50134 Florence, Italy, email: [email protected] Received 14 May 2014; revised 8 July 2014; accepted 9 August 2014.
D. Beatrice et al.
Table 1. Distribution of 51 prostate cancer cases according to selected individual clinical characteristics Variable ≤60 61–70 >70 20
Cancer Invest Downloaded from informahealthcare.com by Nyu Medical Center on 10/11/14 For personal use only.
low medium high No Surgery RT Surgery+RT 3a 3b 4 0 1 No Yes No Yes
N Age at initial diagnosis 12 26 13 PSA at initial diagnosis 17 12 22 Risk classification 33 11 7 Primary Treatment 10 18 8 15 pT 9 18 6 PN 22 11 Neo adjuvant HT 31 20 Adjuvant HT 26 25
Table 2. Distribution of 51 prostate cancer cases according to selected treatment characteristics % 23.5 51.0 25.5 33.3 23.5 43.2 64.7 21.6 13.7 19.6 35.3 15.7 29.4 27.3 54.6 18.1
≤6 >6 Weekly Three-weekly 0 1 2 Planned PD Toxicity
