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Chemotherapy in castration-resistant prostate cancer

Authors
Arif Hussain, MD
Nancy A Dawson, MD
Section Editors
Nicholas Vogelzang, MD
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD

INTRODUCTION

For men with advanced prostate cancer, androgen deprivation therapy usually can provide disease control for a substantial period of time. However, the vast majority of men eventually develop progressive disease that is resistant to further hormonal treatment.

Prior to the development of the taxanes, cytotoxic chemotherapy was considered to be relatively ineffective in men with castration-resistant prostate cancer. In early trials, objective response rates were 10 to 20 percent, and median survival generally did not exceed 12 months.

However, taxane-based regimens have been associated with higher rates of objective tumor regression and biochemical (prostate-specific antigen [PSA]) response, as well as longer overall survival. As discussed below, docetaxel has an established role in chemotherapy-naive patients, and a second-generation taxane, cabazitaxel, is active in patients who have received prior docetaxel.

The use of cytotoxic chemotherapy for the treatment of castration-resistant prostate cancer will be reviewed here. The use of chemotherapy in combination with androgen deprivation therapy for castration-sensitive disease is discussed separately, as are experimental approaches. (See "Overview of the treatment of disseminated prostate cancer" and "Investigational approaches for the treatment of advanced prostate cancer".)

CHEMOTHERAPY-NAIVE PATIENTS

For patients with castration-resistant prostate cancer who have not received prior chemotherapy, docetaxel given every three weeks in conjunction with prednisone remains the preferred approach to systemic chemotherapy. Alternative schedules and combinations, and the second-generation taxane cabazitaxel have been studied in randomized trials, but none has proven superior. However, in two large randomized trials, cabazitaxel was noninferior to docetaxel and was significantly less toxic, particularly at a dose of 20 mg/m². (See 'Docetaxel versus cabazitaxel' below and 'Dose of cabazitaxel' below.)

                      

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Literature review current through: May 2017. | This topic last updated: Jul 20, 2016.
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