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

Research output: Contribution to journalJournal articleResearchpeer-review

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.

Original languageEnglish
JournalB J U International (Print)
Volume115
Issue number5
Pages (from-to)744-752
ISSN1464-4096
DOIs
Publication statusPublished - 1. May 2015

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
  • chemotherapy
  • castration-resistant
  • prostate cancer
  • docetaxel

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