Chemotherapy Is Effective!

By Dr Tay Miah Hiang, Associate Consultant
Dept of Medical Oncology, NCC

2004 was a good year for men with hormone refractory prostate cancer (HRPC). Prior to 2004, the treatment for men with metastatic prostate cancer who has since stopped responding to castration ie, HRPC was given best supportive care if the patient has no significant symptoms. Otherwise, palliative treatment with mitoxantrone-based chemotherapy was the alternative. The latter was approved by the Federal Drug Administration (FDA) in the United States for pain relief in 1996.

However, mitoxantrone-based chemotherapy was still not able to increase overall survival compared to best supportive care. Since then, newer chemotherapy drugs with greater potential have been developed and have been used in the treatment of prostate cancer in the clinical trial setting.

For the first time in history of prostate cancer, palliative treatment using chemotherapy that is docetaxel-based, was able to increase overall survival in men with metastatic HRPC. The result of these two trials were first presented in abstract form at the plenary session of the American Society of Clinical Oncology (ASCO), arguably one of the most important annual meetings for cancer specialists, and was later published in a prestigious medical journal.

In these two trials, docetaxel-based chemotherapy treatment was compared to mitoxantrone-based chemotherapy as the first line treatment in a total of 1800 men with metastatic HRPC. The average age was 69-70 years old. Both studies showed that the overall survival was significantly longer in men who received docetaxel-based chemotherapy as compared to those who received mitoxantrone- based chemotherapy. In addition, there were also longer duration of response, improved quality of life and a reduction in pain intensity in this group.

Importantly, the study showed that although the toxicity was slightly more in men receiving docetaxel, significant toxicity was low and not significantly more frequent. Therefore, this is a new paradigm in the management of HRPC. However, patient’s choice to undergo this treatment remains important. With advice from your medical oncologist, you can make a decision by weighing in terms of cost and your tolerance to chemotherapy.

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