Real World Uptake, Safety Profile and Outcomes of Docetaxel in Newly Diagnosed Metastatic Prostate Cancer.

[pjoshea13]

New UK study below.

Perhaps the most useful finding is that:

"The risk of febrile neutropenia was nine times greater if chemotherapy was started within three weeks of ADT initiation".

Leading to the recommendation that:

"Chemotherapy should be started 3 weeks or more after androgen deprivation."

"Patients who received ADT alone had an increased risk of progression (HR 2.03 ...) and had an increased risk of death (HR 5.88 ...) compared to the docetaxel group."

-Patrick

ncbi.nlm.nih.gov/pubmed/289...

BJU Int. 2017 Sep 20. doi: 10.1111/bju.14025. [Epub ahead of print]

Real World Uptake, Safety Profile and Outcomes of Docetaxel in Newly Diagnosed Metastatic Prostate Cancer.

Rulach R1, McKay S1, Neilson S1, White L2, Wallace J1, Carruthers R1, Lamb C1, Cascales A1, Marashi H1, Glen H1, Venugopal B1,3, Sadoyze A1, Sidek N1, Russell JM1,3, Alhasso A1, Dodds D1, Laskey J1, Jones RJ1,3, MacLeod N1.

Author information

1

The Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK.

2

University Hospital Ayr, Dalmellington Road, Ayr, KA6 6DX, UK.

3

The University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.

Abstract

OBJECTIVES:

To investigate the uptake, safety and efficacy of docetaxel chemotherapy in hormone-naïve metastatic prostate cancer (mPC) in the first year of use outside of a clinical trial.

SUBJECTS/PATIENTS AND METHODS:

Patients in the West of Scotland Cancer Network (WoSCAN) with newly diagnosed mPC were identified from the regional multidisciplinary team (MDT) meetings and their treatment details were collected from electronic patient records. The rate of febrile neutropenia, hospitalisations, time to progression and overall survival were compared between those patients who received docetaxel and androgen deprivation therapy (ADT), or ADT alone using survival analysis.

RESULTS:

Out of 270 eligible patients, 103 received docetaxel (38.1%). 35 patients (34%) were hospitalised and there were 17 episodes of febrile neutropenia (16.5%). Two patients (1.9%) died within 30 days of chemotherapy. Patients who received ADT alone had an increased risk of progression (HR 2.03, 95% CI (1.27, 3.25), log-rank test, p= 0.002) and had an increased risk of death (HR 5.88, 95% CI 2.52, 13.72, log-rank p=0.001) compared to the docetaxel group. The risk of febrile neutropenia was nine times greater if chemotherapy was started within three weeks of ADT initiation (95% CI (1.22,77.72) p= 0.032).

CONCLUSION:

Docetaxel chemotherapy in hormone-naïve mPC has significant toxicities, but has a similar effect on time to progression and overall survival as seen in randomised trials. Chemotherapy should be started 3 weeks or more after androgen deprivation. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

KEYWORDS:

Docetaxel; Hormone-naïve; Metastatic; Prostate Cancer; Real World

PMID: 28940952 DOI: 10.1111/bju.14025

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Very interesting find. I waited about a month after starting ADT before chemotherapy for a few other reasons. Chemo is the weaker of the two treatments so I figured it would have an easier job after the initial big drop in PSA (463 to 12) that occurred in the first month. Knowing this makes me feel better about my decision.

[BigRich]

"35 patients (34%) were hospitalised " Those people were not just the ones who started chemo during the first 3 weeks of ADT? If so, that seems like a high percentage. Your thoughts. Thank you for your earlier reply.

Rich

[pjoshea13 in reply to BigRich]

Rich,

Might the neutropenia cases account for half?

It was a Scottish study. Perhaps the hospitals involved were playing it safe?

Would be helpful to know the levels of toxicity.

The hospitalization rate does seem high.

Getting Taxotere up front exposes men to morbity that ADT-only cases put off for a couple of years, perhaps. But the survival stats look much better.

-Patrick

[BigRich in reply to pjoshea13]

"The hospitalization rate does seem high." I agree with you.

Rich