Chemo: Taxotere tegenover Mitoxantrone in combinatie met prednison - verlengt leven van prostaatkankerpatiënten met gemiddeld drie maanden, maar chemo bij prostaatkanker is geen effectieve behandeling

17 oktober 2022: Zie ook dit artikel : https://kanker-actueel.nl/pembrolizumab-plus-olaparib-geeft-betere-respons-en-ziekteprogressievrije-overleving-bij-patienten-met-eerder-behandelde-uitgezaaide-prostaatkanker-in-vergelijking-met-abirateron-of-enzalutamide-maar-niet-statistisch-significant.html

21 oktober 2019: Zie ook dit artikel:

https://kanker-actueel.nl/docetaxel-zou-altijd-gegeven-moeten-worden-naast-hormoontherapie-bij-reeds-uitgezaaide-prostaatkanker-blijkt-uit-stampede-studie-na-6-jaar-was-er-een-betere-overall-overleving-en-progressievrije-ziekte-dan-alleen-hormoontherapie.html

7 februari 2013: afgelopen week kreeg ik de vraag of en welke chemo bij prostaatkanker effectief zou zijn. Ik kan alleen maar verwjizen naar onderstaand artikel dat schrijft dat chemo bij prostaatkanker bijna geen therapeutisch effect geeft. Alleen als er sprake is van vergevorderde hormoon resistente prostaatkanker wil nog wel eens in een enkel geval chemo worden ingezet, maar algemeen wordt chemo bij prostaatkanker niet gezien als een effectieve behandeling, zelfs niet palliatief. Onderstaande studie publicatie is ook niet meer gevolgd door andere positieve studies.

11 juli 2004: Bron: NCI - Pubmed

Op ASCO 2004 werden onderstaande studieresultaten bekend gemaakt die bewijzen dat de chemo Taxotere tegenover Mitoxantrone beide in combinatie met prednison (ontstekingsremmer) het leven van een prostaatkankerpatiënt die resistent is geworden voor hormoontherapie met 2 tot 3 maanden zou verlengen. Tot nu toe leek chemo bij prostaatkanker geen enkel positief effect te hebben. Wel wordt ook opgemerkt dat de bijwerkingen bij Taxotere ernstiger en heftiger zijn dan bij mitoxantrone. Maar de FDA geeft door de onderstaande studieresultaten toestemming voor gebruik van deze chemo bij regulier uitbehandelde prostaatkankerpatiënten. Wij hebben onze bedenkingen bij dit soort resultaten en publicaties. Twee tot drie maanden levensverlenging met ook nog eens heftige bijwerkingen lijkt ons minstens even tot nadenken te stemmen voordat u hieraan begint, zeker als we bedenken dat specifieke gezonde voeding en bv. prostasol en PC-Spes vaak voor veel langere overleving en betere levenskwaliteit zorgen, ook bij vergevorderde prostaatkanker. En als u toch Taxotere neemt lees ook bericht onder deze artikelenreeks over effect van vitamine D. bij deze chemokuur met Taxotere - Docetaxel. Maar lees onderstaande informatie gehaald van de website van het NCI.

First Evidence That Chemotherapy Extends Life in Advanced Prostate Cancer.

Summary
Chemotherapy regimens that include the drug docetaxel extend median survival by two to three months in patients with advanced prostate cancer that is no longer responsive to hormone therapy, two large phase III studies have shown. These are the first clinical trials to show that chemotherapy can improve survival in advanced prostate cancer.

Source: American Society of Clinical Oncology annual meeting, New Orleans, June 7, 2004.

Background
Therapies that lower the body’s level of the male sex hormone testosterone, which encourages prostate cancer growth, are the mainstay of treatment for prostate cancer that has spread to other organs. However, many patients stop responding to hormonal therapies after two to three years of treatment. No effective therapy currently exists for advanced prostate cancer that stops responding to hormonal therapy.

Chemotherapy with the drugs prednisone and mitoxantrone has been shown to reduce pain in men with advanced prostate cancer that has spread to the bones, but this regimen does not help patients to live any longer. Several previous studies of different chemotherapy regimens had failed to identify a drug or combination of drugs that extended patients’ survival.

Study 1 (Southwest Oncology Group and others)
This study involved 770 men with advanced prostate cancer no longer responding to hormonal therapy. The men were randomly assigned to treatment with the drugs docetaxel and estramustine or with prednisone and mitoxantrone. The latter treatment is the only currently approved treatment for prostate cancer patients at this point in their disease.

The trial was conducted by a number of cooperative groups sponsored by the National Cancer Institute, led by the Southwest Oncology Group (SWOG).
Study 1 Results
After a median follow-up period of 32 months, men who received docetaxel and estramustine lived for a median of 18 months. By contrast, men treated with prednisone and mitoxantrone lived for a median of 16 months, said one of the lead researchers, Daniel Petrylak, M.D., of Columbia University in New York. Progression of disease was delayed for twice as long (six months compared with three months) in patients treated with docetaxel and estramustine.

Severe side effects – particularly stomach and heart problems – occurred more frequently in the docetaxel/estramustine group. However, the number of patient deaths due to adverse reactions to chemotherapy was about the same in both groups.

Levels of prostate-specific antigen (PSA) - an enzyme that can be elevated in men with prostate cancer - declined more in patients treated with docetaxel/estramustine than in those on standard therapy, Petrylak added.

Study 2 (Aventis Pharmaceuticals, Inc.)
This study involved 1,006 men in the United States, Canada, Europe, and Latin America. As with the SWOG study, all participants had advanced prostate cancer that had stopped responding to hormonal therapy.
The men were randomly assigned to one of three treatment groups:
One group got weekly doses of the drugs prednisone and docetaxel. A second group got a higher dose of docetaxel, plus prednisone, every three weeks. A third group got weekly doses of the currently approved treatment, prednisone and mitoxantrone. This study was supported by Aventis Pharmaceuticals, Inc., which manufactures docetaxel.

Study 2 Results
Patients were followed for a median of 20.7 months. Those who received docetaxel and prednisone at three-week intervals survived a median of 18.9 months. By contrast, median survival for patients treated with weekly docetaxel and prednisone was 17.4 months. Patients treated with prednisone and mitoxantrone lived for a median of 16.5 months.
More patients on the three-week docetaxel/prednisone regimen suffered low white blood cell counts; nevertheless, their levels of infection and fatigue were similar to the other groups.

As in Study 1, more patients in the groups treated with docetaxel experienced a drop in their PSA levels compared to the prednisone and mitoxantrone group, said principal investigator Mario Eisenberger, M.D., of Johns Hopkins University in Baltimore.

On the basis of this study’s findings, the U.S. Food and Drug Administration recently approved docetaxel, in combination with prednisone, to treat advanced prostate cancer that is no longer responding to hormonal therapy. The SWOG trial (Study 1) provided additional data to support the approval.

Limitations
During the discussion at the ASCO presentation, Bruce J. Roth, M.D., of Vanderbilt-Ingram Cancer Center cautioned that the results “don’t support the routine use of chemotherapy in less advanced prostate cancer.”

Comment
Whether earlier use of chemotherapy can prolong survival in patients at a less-advanced stage of their disease is something that is being investigated in several phase III clinical trials currently enrolling participants.

As a result of these findings, however, “docetaxel is definitely a new standard of care” for patients with advanced prostate cancer that is resistant to hormone therapy, said Petrylak.

“These results are a reason for celebration as well as for optimism for the future,” added Eisenberger. They put to rest concerns that advanced prostate cancer would not respond to chemotherapy, he said. In an extremely severe disease such as advanced prostate cancer, he added, a treatment must be very effective to achieve a two- to three-month increase in median survival.