Chemotherapy and Androgen Receptor-Directed Treatment of Castration Resistant Metastatic Prostate Cancer
Metastatic castration-resistant prostate cancer (mCRPC) remains incurable despite development of effective treatment. Since 2004, docetaxel every 3 weeks plus continuous prednisone has been standard first-line chemotherapy in castration-resistant prostate
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Introduction
Metastatic prostate cancer is sensitive to androgen deprivation in the majority of men. However, castration resistance inevitably occurs after a median of 18–24 months. Relatively few chemotherapeutic agents have been proven to be of benefit to patients. Single agent chemotherapeutic trials published in the late 1980s to early 1990s in men with castration-resistant disease found a response rate to various chemotherapeutic agents of less than 10 % in men with measurable disease with a median survival of 10–12 months [38].
2
hemotherapy in Castration C Resistant Prostate Cancer
2.1
Mitoxantone
In the early 1990s, PSA tests became available and have since been incorporated as response measurement in trials. Two trials investigated the combination of mitoxantrone 12 mg/m2on day 1 every 3 weeks plus daily prednisone 10 mg compared to
S. Osanto (*) • S.A.C. Luelmo Department of Oncology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands e-mail: [email protected]
prednisone alone. The first study investigated quality of life (clinical benefit consisting of a decrease in pain and use of analgesics) in 161 men with metastatic prostate cancer and found a significantly better pain control in the combination arm (Table 1, 29 % vs. 12 %, p
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