Chemotherapy for prostate cancer: Clinical practice in Canada

Abstract

Whereas prostate cancer was once deemed unresponsive to chemotherapy, there is now evidence that patients with metastatic castration-resistant prostate cancer can obtain a survival benefit from both first-line (docetaxel-based) and second-line (cabazitaxel-based) chemotherapy. The side effects of these agents have been shown to be predictable and manageable, particularly in North American centres. However, patient selection remains a key issue, with the aim of delivering each line of treatment at a time when the individual patient remains fit and well enough to tolerate a cytotoxic regimen. Hence, it is increasingly important for urologists and oncologists to work together to ensure timely consideration of the chemotherapeutic approach before it is precluded by a decline in performance status.

Fig. 1

TAX327 trial design. mCRPC: metastatic castration-resistant prostate cancer.

Fig. 2

TAX327 median overall survival. CI: confidence interval.

Fig. 3

TAX327 data on ≥3-year survival, PSA response, pain reduction and improvement in quality of life. PSA: prostate-specific antigen.

Fig. 4

TROPIC trial design.mCRPC: metastatic castration-resistant prostate cancer.

Fig. 5

TROPIC overall survival. Patients in both treatment lines also received prednisone or prednisolone. CI: confidence interval.

Fig. 6

TROPIC data on objective tumor response (in patients with measurable disease, n=405), PSA response (in evaluable patients, n=654) and pain response (evaluated in patients with high scores for pain and/or analgesia use, n=342). Patients in both treatment lines also received prednisone or prednisolone. PSA: prostate-specific antigen.

Fig. 7

Geographical range of the ongoing cabazitaxel early-access program.

Fig. 8

Patients reporting no pain or discomfort with increasing cycles, in the UK cabazitaxel early-access program.