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Prostate-specific antigen response rate of sequential chemotherapy in castration-resistant prostate cancer: the results of real life practice.

Song G, Lee C, You D, Jeong IG, Hong JH, Ahn H, Kim CS - Prostate Int (2013)

Bottom Line: The median pretreatment PSA and initial Gleason scores at baseline were 92.4 ng/mL (range, 2.0 to 6,370 ng/mL) and 9 (range, 6 to 10), respectively.PSA response rates were 57.1%, 52%, and 28.0%, respectively.The PSA response rates were 41.2%, 53.8%, and 11.1%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Prostate-specific antigen (PSA) response rate (>50% PSA decline in pretreatment PSA following chemotherapy) carries a significant survival advantage in castration-resistant prostate cancer (CRPC). We compared PSA response rates in first-, second- and third-line chemotherapy after failure of previous chemotherapy according to chemotherapeutic agents.

Methods: We retrospectively evaluated the oncological outcomes and PSA response rates of 384 patients with CRPC, who were treated with chemotherapy and had histologically proven adenocarcinoma of the prostate with failure after androgen ablation therapy between 1991 and 2012, at Asan Medical Center.

Results: In 384 eligible patients, the median age was 67.5 years. The median pretreatment PSA and initial Gleason scores at baseline were 92.4 ng/mL (range, 2.0 to 6,370 ng/mL) and 9 (range, 6 to 10), respectively. The time from first diagnosis of prostate cancer to CRPC was 23 months (range, 1 to 164 months). As first-line chemotherapy, 245 patients (63.8%) received estramustine, 91 (23.7%) received docetaxel, and 39 (10.2%) received mitoxantrone. The PSA response rates were 39.6%, 51.6%, and 46.2%, respectively. Of 169 patients with second-line chemotherapy, estramustine was 15 (8.9%), docetaxel was 84 (49.7%), and mitoxantrone was 52 (30.8%). PSA response rates were 57.1%, 52%, and 28.0%, respectively. Of 81 patients with third-line chemotherapy, estramustine was 18 (22.2%), docetaxel was 16 (19.8%), and mitoxantrone was 28 (34.6%). The PSA response rates were 41.2%, 53.8%, and 11.1%, respectively. Declines in serum PSA levels of at least 50% occurred more frequently after treatment with docetaxel than with other chemo-agents regardless of second-and third-line chemotherapy. Even in third-line chemothrapy, docetaxel maintained the PSA response rate, whereas the PSA response rate of other agents, including mitoxantrone, decreased in patients in whom prior therapy failed.

Conclusions: Docetacel was the most effective chemotherapeutic agent in second- and third-line trials of chemotherapy in Korean CRPC patients. Although docetaxel is not used as first-line chemotherapy, and new agents are not available for therapy in CRPC patients, we can consider docetaxel a second- or third-line chemotherapy in CRPC.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier estimates of overall survival among men with androgen-independent prostate cancer treated with chemotherapy agents. (A) Median overall survival was 19.0 months in total eligible patients. (B–D) According to first and third-line chemotherapy agents, there were no differences in median survival by the log rank test (P=0.365 and P=0.329). However, with second-line chemotherapy agents, docetaxel and estramustine group were longer in median survival than mitoxantrone group (P=0.003). HR, hazard ratio; CI, confidence interval.
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f2-pi-1-3-125-6: Kaplan-Meier estimates of overall survival among men with androgen-independent prostate cancer treated with chemotherapy agents. (A) Median overall survival was 19.0 months in total eligible patients. (B–D) According to first and third-line chemotherapy agents, there were no differences in median survival by the log rank test (P=0.365 and P=0.329). However, with second-line chemotherapy agents, docetaxel and estramustine group were longer in median survival than mitoxantrone group (P=0.003). HR, hazard ratio; CI, confidence interval.

Mentions: Median overall survival was 19.0 months (range, 1 to 99 months). The overall survival curve is presented in Fig. 2A. According to first-line and third-line chemotherapy agents, there were no differences in median survival (P=0.365 and P=0.329). However, according to second-line chemotherapy agents, the docetaxel and estramustine group had longer median survival than the mitoxantrone group did (median value, 30 months vs. 21 months vs. 19 months, P=0.003) (Fig. 2B–D). When overall survivor rates were analyzed based on the year 2004, the patients after docetaxel era (after 2004) showed significantly longer overall survival (median value, 14 months vs. 20 months; P=0.001; hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.52 to 0.83) (Fig. 3A). The median overall survival was 31.5 months in patients treated with docetaxel chemotherapy in second-line chemotherapy and 19.5 months in patients treated with docetaxel chemotherapy in first-line chemotherapy (P=0.002) (Fig. 3B). The corresponding hazard ratio for death was 0.60 (95% CI, 0.43 to 0.83).


Prostate-specific antigen response rate of sequential chemotherapy in castration-resistant prostate cancer: the results of real life practice.

Song G, Lee C, You D, Jeong IG, Hong JH, Ahn H, Kim CS - Prostate Int (2013)

Kaplan-Meier estimates of overall survival among men with androgen-independent prostate cancer treated with chemotherapy agents. (A) Median overall survival was 19.0 months in total eligible patients. (B–D) According to first and third-line chemotherapy agents, there were no differences in median survival by the log rank test (P=0.365 and P=0.329). However, with second-line chemotherapy agents, docetaxel and estramustine group were longer in median survival than mitoxantrone group (P=0.003). HR, hazard ratio; CI, confidence interval.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814118&req=5

f2-pi-1-3-125-6: Kaplan-Meier estimates of overall survival among men with androgen-independent prostate cancer treated with chemotherapy agents. (A) Median overall survival was 19.0 months in total eligible patients. (B–D) According to first and third-line chemotherapy agents, there were no differences in median survival by the log rank test (P=0.365 and P=0.329). However, with second-line chemotherapy agents, docetaxel and estramustine group were longer in median survival than mitoxantrone group (P=0.003). HR, hazard ratio; CI, confidence interval.
Mentions: Median overall survival was 19.0 months (range, 1 to 99 months). The overall survival curve is presented in Fig. 2A. According to first-line and third-line chemotherapy agents, there were no differences in median survival (P=0.365 and P=0.329). However, according to second-line chemotherapy agents, the docetaxel and estramustine group had longer median survival than the mitoxantrone group did (median value, 30 months vs. 21 months vs. 19 months, P=0.003) (Fig. 2B–D). When overall survivor rates were analyzed based on the year 2004, the patients after docetaxel era (after 2004) showed significantly longer overall survival (median value, 14 months vs. 20 months; P=0.001; hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.52 to 0.83) (Fig. 3A). The median overall survival was 31.5 months in patients treated with docetaxel chemotherapy in second-line chemotherapy and 19.5 months in patients treated with docetaxel chemotherapy in first-line chemotherapy (P=0.002) (Fig. 3B). The corresponding hazard ratio for death was 0.60 (95% CI, 0.43 to 0.83).

Bottom Line: The median pretreatment PSA and initial Gleason scores at baseline were 92.4 ng/mL (range, 2.0 to 6,370 ng/mL) and 9 (range, 6 to 10), respectively.PSA response rates were 57.1%, 52%, and 28.0%, respectively.The PSA response rates were 41.2%, 53.8%, and 11.1%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Prostate-specific antigen (PSA) response rate (>50% PSA decline in pretreatment PSA following chemotherapy) carries a significant survival advantage in castration-resistant prostate cancer (CRPC). We compared PSA response rates in first-, second- and third-line chemotherapy after failure of previous chemotherapy according to chemotherapeutic agents.

Methods: We retrospectively evaluated the oncological outcomes and PSA response rates of 384 patients with CRPC, who were treated with chemotherapy and had histologically proven adenocarcinoma of the prostate with failure after androgen ablation therapy between 1991 and 2012, at Asan Medical Center.

Results: In 384 eligible patients, the median age was 67.5 years. The median pretreatment PSA and initial Gleason scores at baseline were 92.4 ng/mL (range, 2.0 to 6,370 ng/mL) and 9 (range, 6 to 10), respectively. The time from first diagnosis of prostate cancer to CRPC was 23 months (range, 1 to 164 months). As first-line chemotherapy, 245 patients (63.8%) received estramustine, 91 (23.7%) received docetaxel, and 39 (10.2%) received mitoxantrone. The PSA response rates were 39.6%, 51.6%, and 46.2%, respectively. Of 169 patients with second-line chemotherapy, estramustine was 15 (8.9%), docetaxel was 84 (49.7%), and mitoxantrone was 52 (30.8%). PSA response rates were 57.1%, 52%, and 28.0%, respectively. Of 81 patients with third-line chemotherapy, estramustine was 18 (22.2%), docetaxel was 16 (19.8%), and mitoxantrone was 28 (34.6%). The PSA response rates were 41.2%, 53.8%, and 11.1%, respectively. Declines in serum PSA levels of at least 50% occurred more frequently after treatment with docetaxel than with other chemo-agents regardless of second-and third-line chemotherapy. Even in third-line chemothrapy, docetaxel maintained the PSA response rate, whereas the PSA response rate of other agents, including mitoxantrone, decreased in patients in whom prior therapy failed.

Conclusions: Docetacel was the most effective chemotherapeutic agent in second- and third-line trials of chemotherapy in Korean CRPC patients. Although docetaxel is not used as first-line chemotherapy, and new agents are not available for therapy in CRPC patients, we can consider docetaxel a second- or third-line chemotherapy in CRPC.

No MeSH data available.


Related in: MedlinePlus