Researchers from Spain have reported that neoadjuvant Taxotere® (docetaxel) and androgen deprivation therapy (ADT) was well tolerated and associated with a 6% pathological complete response (pCR) rate and a 6% near pCR rate in men with high-risk prostate cancer. The details of this study appeared in the October 13, 2009 issue of the British Journal of Cancer.[1]

Men with localized prostate cancer can often be cured with surgery or radiation therapy alone. Men with certain risk factors—such as a high Gleason score, spread of cancer outside the prostate, and lymph node involvement—have a high recurrence rate even if all detectable cancer is surgically removed, radiated, or both. There are several clinical trials, randomized and non-randomized, which suggest that the results of surgery and radiation therapy can be improved with ADT before, during, and/or after therapy. However, an alternative approach is to use neoadjuvant and/or adjuvant chemotherapy. The two most active chemotherapy agents for the treatment of prostate cancer are Taxotere and estramustine. Researchers from Michigan have previously reported the feasibility of treating high-risk prostate cancer patients with Taxotere and estramustine before surgery or radiation therapy. Researchers from the Virginia Mason Medical Center in Seattle, Washington, have also reported that neoadjuvant Taxotere and Iressa® (gefitinib) is well tolerated in men with high-risk locally advanced prostate cancer.

The current study evaluated the effectiveness of ADT and three cycles of Taxotere in 57 men with high-risk prostate cancer. These patients had T1c-T2 prostate cancer with PSA levels >20 ng/mL and/or Gleason scores >7 or they had T3 disease. Ninety percent of patients completed planned therapy and radical prostatectomy. Three patients had a pCR (6%) or a near pCR with only microscopic disease (6%). The median follow-up was 36 months, at which time 32% of patients had a PSA relapse.

Comments: These results are not clearly better than neoadjuvant ADT alone. However, this study adds to the growing number of studies adding chemotherapy to ADT in attempts to improve outcomes of patients with high-risk prostate cancer.

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