Docetaxel rechallenge after an initial good response in patients with metastatic castration-resistant prostate cancer

Stéphane Oudard, Gero Kramer, Orazio Caffo, Lorraine Creppy, Yohan Loriot, Steinbjoern Hansen, Mats Holmberg, Frederic Rolland, Jean-Pascal Machiels, Michael Krainer

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

OBJECTIVE: To evaluate the benefit of docetaxel rechallenge in patients with metastatic castration-resistant prostate cancer (mCRPC) relapsing after an initial good response to first-line docetaxel.

PATIENTS AND METHODS: We retrospectively reviewed the records of consecutive patients with mCRPC with a good response to first-line docetaxel [serum prostate specific antigen (PSA) decrease ≥50%; no clinical/radiological progression]. We analysed the impact of management at relapse (docetaxel rechallenge or non-taxane-based therapy) on PSA response, symptomatic response (performance status/pain/analgesic consumption), and overall survival (OS). We used multivariate stepwise logistic regression to analyse potential predictors of a favourable outcome.

RESULTS: We identified 270 good responders to first-line docetaxel. The median progression-free interval (PFI) was 6 months from the last docetaxel dose. At relapse, 223 patients were rechallenged with docetaxel (82.5%) and 47 received non-taxane-based therapy. There was no significant difference in median OS {18.2 [95% confidence interval (CI) 16.1-22.00] and 16.8 [95%CI 13.4-21.5] months, respectively, P = 0.35}. However, good PSA response and symptom relief/stable disease were more frequent on docetaxel rechallenge (40.4% vs 10.6%, P < 0.001 for PSA). A PFI of >6 months and added estramustine predicted a good PSA response and symptomatic response on docetaxel rechallenge but only a PFI of >6 months predicted longer OS. Haemoglobin (<13 g/dL) and pain were associated with reduced OS. Docetaxel rechallenge increased the incidence of grade ≥3 sensory neuropathy, nail disorders and asthenia/fatigue.

CONCLUSIONS: Docetaxel rechallenge is a management option for responders to docetaxel with a PFI of >6 months, but did not prolong survival. Potential benefits should be weighed against the risk of cumulative toxicity.

OriginalsprogEngelsk
TidsskriftB J U International (Print)
Vol/bind115
Udgave nummer5
Sider (fra-til)744-752
ISSN1464-4096
DOI
StatusUdgivet - 2015

Fingeraftryk

docetaxel
Prostatic Neoplasms
Prostate-Specific Antigen
Estramustine
Confidence Intervals

Citer dette

Oudard, Stéphane ; Kramer, Gero ; Caffo, Orazio ; Creppy, Lorraine ; Loriot, Yohan ; Hansen, Steinbjoern ; Holmberg, Mats ; Rolland, Frederic ; Machiels, Jean-Pascal ; Krainer, Michael. / Docetaxel rechallenge after an initial good response in patients with metastatic castration-resistant prostate cancer. I: B J U International (Print). 2015 ; Bind 115, Nr. 5. s. 744-752.
@article{d4001e6ef88543fcb22ab86c2c0349e0,
title = "Docetaxel rechallenge after an initial good response in patients with metastatic castration-resistant prostate cancer",
abstract = "OBJECTIVE: To evaluate the benefit of docetaxel rechallenge in patients with metastatic castration-resistant prostate cancer (mCRPC) relapsing after an initial good response to first-line docetaxel.PATIENTS AND METHODS: We retrospectively reviewed the records of consecutive patients with mCRPC with a good response to first-line docetaxel [serum prostate specific antigen (PSA) decrease ≥50{\%}; no clinical/radiological progression]. We analysed the impact of management at relapse (docetaxel rechallenge or non-taxane-based therapy) on PSA response, symptomatic response (performance status/pain/analgesic consumption), and overall survival (OS). We used multivariate stepwise logistic regression to analyse potential predictors of a favourable outcome.RESULTS: We identified 270 good responders to first-line docetaxel. The median progression-free interval (PFI) was 6 months from the last docetaxel dose. At relapse, 223 patients were rechallenged with docetaxel (82.5{\%}) and 47 received non-taxane-based therapy. There was no significant difference in median OS {18.2 [95{\%} confidence interval (CI) 16.1-22.00] and 16.8 [95{\%}CI 13.4-21.5] months, respectively, P = 0.35}. However, good PSA response and symptom relief/stable disease were more frequent on docetaxel rechallenge (40.4{\%} vs 10.6{\%}, P < 0.001 for PSA). A PFI of >6 months and added estramustine predicted a good PSA response and symptomatic response on docetaxel rechallenge but only a PFI of >6 months predicted longer OS. Haemoglobin (<13 g/dL) and pain were associated with reduced OS. Docetaxel rechallenge increased the incidence of grade ≥3 sensory neuropathy, nail disorders and asthenia/fatigue.CONCLUSIONS: Docetaxel rechallenge is a management option for responders to docetaxel with a PFI of >6 months, but did not prolong survival. Potential benefits should be weighed against the risk of cumulative toxicity.",
keywords = "Adult, Aged, Aged, 80 and over, Antineoplastic Agents, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Prostatic Neoplasms, Castration-Resistant, Remission Induction, Retreatment, Retrospective Studies, Taxoids",
author = "St{\'e}phane Oudard and Gero Kramer and Orazio Caffo and Lorraine Creppy and Yohan Loriot and Steinbjoern Hansen and Mats Holmberg and Frederic Rolland and Jean-Pascal Machiels and Michael Krainer",
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year = "2015",
doi = "10.1111/bju.12845",
language = "English",
volume = "115",
pages = "744--752",
journal = "B J U International (Print)",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "5",

}

Oudard, S, Kramer, G, Caffo, O, Creppy, L, Loriot, Y, Hansen, S, Holmberg, M, Rolland, F, Machiels, J-P & Krainer, M 2015, 'Docetaxel rechallenge after an initial good response in patients with metastatic castration-resistant prostate cancer', B J U International (Print), bind 115, nr. 5, s. 744-752. https://doi.org/10.1111/bju.12845

Docetaxel rechallenge after an initial good response in patients with metastatic castration-resistant prostate cancer. / Oudard, Stéphane; Kramer, Gero; Caffo, Orazio; Creppy, Lorraine; Loriot, Yohan; Hansen, Steinbjoern; Holmberg, Mats; Rolland, Frederic; Machiels, Jean-Pascal; Krainer, Michael.

I: B J U International (Print), Bind 115, Nr. 5, 2015, s. 744-752.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Docetaxel rechallenge after an initial good response in patients with metastatic castration-resistant prostate cancer

AU - Oudard, Stéphane

AU - Kramer, Gero

AU - Caffo, Orazio

AU - Creppy, Lorraine

AU - Loriot, Yohan

AU - Hansen, Steinbjoern

AU - Holmberg, Mats

AU - Rolland, Frederic

AU - Machiels, Jean-Pascal

AU - Krainer, Michael

N1 - © 2014 The Authors. BJU International © 2014 BJU International.

PY - 2015

Y1 - 2015

N2 - OBJECTIVE: To evaluate the benefit of docetaxel rechallenge in patients with metastatic castration-resistant prostate cancer (mCRPC) relapsing after an initial good response to first-line docetaxel.PATIENTS AND METHODS: We retrospectively reviewed the records of consecutive patients with mCRPC with a good response to first-line docetaxel [serum prostate specific antigen (PSA) decrease ≥50%; no clinical/radiological progression]. We analysed the impact of management at relapse (docetaxel rechallenge or non-taxane-based therapy) on PSA response, symptomatic response (performance status/pain/analgesic consumption), and overall survival (OS). We used multivariate stepwise logistic regression to analyse potential predictors of a favourable outcome.RESULTS: We identified 270 good responders to first-line docetaxel. The median progression-free interval (PFI) was 6 months from the last docetaxel dose. At relapse, 223 patients were rechallenged with docetaxel (82.5%) and 47 received non-taxane-based therapy. There was no significant difference in median OS {18.2 [95% confidence interval (CI) 16.1-22.00] and 16.8 [95%CI 13.4-21.5] months, respectively, P = 0.35}. However, good PSA response and symptom relief/stable disease were more frequent on docetaxel rechallenge (40.4% vs 10.6%, P < 0.001 for PSA). A PFI of >6 months and added estramustine predicted a good PSA response and symptomatic response on docetaxel rechallenge but only a PFI of >6 months predicted longer OS. Haemoglobin (<13 g/dL) and pain were associated with reduced OS. Docetaxel rechallenge increased the incidence of grade ≥3 sensory neuropathy, nail disorders and asthenia/fatigue.CONCLUSIONS: Docetaxel rechallenge is a management option for responders to docetaxel with a PFI of >6 months, but did not prolong survival. Potential benefits should be weighed against the risk of cumulative toxicity.

AB - OBJECTIVE: To evaluate the benefit of docetaxel rechallenge in patients with metastatic castration-resistant prostate cancer (mCRPC) relapsing after an initial good response to first-line docetaxel.PATIENTS AND METHODS: We retrospectively reviewed the records of consecutive patients with mCRPC with a good response to first-line docetaxel [serum prostate specific antigen (PSA) decrease ≥50%; no clinical/radiological progression]. We analysed the impact of management at relapse (docetaxel rechallenge or non-taxane-based therapy) on PSA response, symptomatic response (performance status/pain/analgesic consumption), and overall survival (OS). We used multivariate stepwise logistic regression to analyse potential predictors of a favourable outcome.RESULTS: We identified 270 good responders to first-line docetaxel. The median progression-free interval (PFI) was 6 months from the last docetaxel dose. At relapse, 223 patients were rechallenged with docetaxel (82.5%) and 47 received non-taxane-based therapy. There was no significant difference in median OS {18.2 [95% confidence interval (CI) 16.1-22.00] and 16.8 [95%CI 13.4-21.5] months, respectively, P = 0.35}. However, good PSA response and symptom relief/stable disease were more frequent on docetaxel rechallenge (40.4% vs 10.6%, P < 0.001 for PSA). A PFI of >6 months and added estramustine predicted a good PSA response and symptomatic response on docetaxel rechallenge but only a PFI of >6 months predicted longer OS. Haemoglobin (<13 g/dL) and pain were associated with reduced OS. Docetaxel rechallenge increased the incidence of grade ≥3 sensory neuropathy, nail disorders and asthenia/fatigue.CONCLUSIONS: Docetaxel rechallenge is a management option for responders to docetaxel with a PFI of >6 months, but did not prolong survival. Potential benefits should be weighed against the risk of cumulative toxicity.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Antineoplastic Agents

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasm Recurrence, Local

KW - Prostatic Neoplasms, Castration-Resistant

KW - Remission Induction

KW - Retreatment

KW - Retrospective Studies

KW - Taxoids

U2 - 10.1111/bju.12845

DO - 10.1111/bju.12845

M3 - Journal article

VL - 115

SP - 744

EP - 752

JO - B J U International (Print)

JF - B J U International (Print)

SN - 1464-4096

IS - 5

ER -