Chemotherapy - September 2021

This issue is focused on when to use Taxotere (docetaxel) chemotherapy. Taxotere (docetaxel) is most commonly used after hormonal therapy options have lost their effectiveness.

However, the CHAARTED trial showed that this is not necessarily the best option for all patients. This trial involved randomizing newly diagnosed men with metastatic prostate cancer to Lupron (leuprorelin) alone versus Lupron (leuprorelin) plus Taxotere (docetaxel) chemotherapy. Patients in both groups were divided into those with extensive disease versus those without extensive disease. The results showed a dramatic survival benefit for Taxotere (docetaxel) for those with extensive disease, but not in those patients with less extensive disease. The overall survival for those with extensive disease was 51.2 months on Lupron (leuprorelin) plus Taxotere (docetaxel) versus 34.4 months for those on Lupron (leuprorelin) alone. As cancer clinical trials go, this is a rather dramatic improvement in overall survival. The results of the CHAARTED trial were subsequently confirmed by the STAMPEDE trial.

Despite the clear survival benefit to early Taxotere (docetaxel), many patients with extensive disease do not receive early Taxotere (docetaxel), but rather proceed to exhaust all hormonal therapy options first. Perhaps the major reason for this is that many prostate cancer patients are very reluctant to go on chemotherapy. First, many have family or friends who have received aggressive multi-drug chemotherapy for other cancers that was extremely toxic. Second, many men think that going on chemotherapy means that the end is near. Neither of these objections reflect the reality of Taxotere (docetaxel) treatment. In this issue, our experts review the many advantages to early Taxotere (docetaxel) administration. I hope this leads more patients with extensive disease to take advantage of Taxotere (docetaxel) as part of their initial treatment.

Charles E. Myers, Jr., MD

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