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Definition |
A significant improvement in median survival of 2-2.5 months occurred with docetaxel-based chemotherapy
compared to mitoxantrone + prednisone therapy. The standard for first-line cytotoxic chemotherapy
is docetaxel using the same regimen as in the TAX 327 trial, that is, 75 mg/m2 3 weekly combined with
prednisone 5 mg BID, up to 10 cycles, and palliation is the main target.
The patients considered for docetaxel represent a heterogeneous population. Several poor
prognostic factors have been described, such as a PSA level > 114 ng/mL, PSA-DT < 55 days, or the presence
of visceral metastases. A better risk group definition has recently been presented, based on the TAX
327 study cohort. The predictive factors were visceral metastases, pain, anaemia (Hb < 13 g/dL), bone scan
progression, and prior estramustine before docetaxel. Patients were categorised into three risk groups: low risk
(0 or 1 factor), intermediate (2 factors) and high risk (3 or 4 factors), leading to three different lengths of median
OS: 25.7, 18.7 and 12.8 months, respectively. In addition, two independent studies have suggested that
improved survival can be predicted by C-reactive protein (CRP) levels < 8 mg/L (HR, 2.96). Age by
itself is not a contraindication to docetaxel.
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