From the Guidelines
For advanced prostate cancer that no longer responds to hormone therapy, docetaxel is the preferred first-line chemotherapy treatment, administered at 75 mg/m² intravenously every 3 weeks along with daily prednisone (5-10 mg) 1. This regimen has been shown to confer a survival benefit in phase III studies, with median survival rates of 17-19.2 months compared to mitoxantrone-based regimens 1. The duration of therapy should be based on the assessment of benefit and toxicities, with patients receiving up to 10 cycles of treatment if no progression and no prohibitive toxicities are noted 1. Other chemotherapy options, such as weekly docetaxel and prednisone, and mitoxantrone and prednisone, may be considered as alternative regimens, but have not demonstrated an overall survival benefit 1. It is essential to note that treatment selection depends on previous therapies, performance status, comorbidities, and molecular characteristics of the tumor. Key considerations in managing advanced prostate cancer include:
- Optimizing symptom control
- Continuing gonadal androgen suppression and discontinuing antiandrogens
- Discussing the timing of docetaxel therapy with patients and individualizing treatment based on clinical status and preferences 1. In summary, docetaxel-based chemotherapy is the only treatment that has demonstrated an overall survival benefit in men with hormone-refractory prostate cancer, making it the preferred first-line treatment option 1.
From the FDA Drug Label
Mitoxantrone Injection, USP in combination with corticosteroids is indicated as initial chemotherapy for the treatment of patients with pain related to advanced hormone-refractory prostate cancer.
The chemotherapy option for advanced prostate cancer that is no longer responding to hormone therapy is mitoxantrone in combination with corticosteroids, as indicated for the treatment of patients with pain related to advanced hormone-refractory prostate cancer 2.
- Key points:
- Mitoxantrone is used in combination with corticosteroids.
- It is indicated for pain related to advanced hormone-refractory prostate cancer.
- The medication has shown palliative responses in clinical trials, including a reduction in pain intensity and analgesic use 2.
From the Research
Chemotherapy Options for Advanced Prostate Cancer
The following chemotherapy options are available for advanced prostate cancer that is no longer responding to hormone therapy:
- Docetaxel: a standard of care for metastatic castration-resistant prostate cancer (mCRPC) 3
- Cabazitaxel: a novel taxane drug that has shown significant improvements in overall survival and progression-free survival compared to mitoxantrone in patients with mCRPC who have progressed after docetaxel treatment 3, 4
- Abiraterone: an antiandrogen that has been shown to improve survival in patients with mCRPC who have progressed after docetaxel therapy 3, 5
- Enzalutamide: an androgen receptor inhibitor that has been shown to improve overall survival and progression-free survival in patients with mCRPC 5
- Platinum-based treatments: have demonstrated some benefit in a subset of patients with Aggressive Variant Prostate Cancer (AVPC) 6
- Olaparib: a poly-ADP-ribose polymerase (PARP) inhibitor that is approved for selected patients with mCRPC progressed on ARATs and in combination with abiraterone acetate as first-line treatment for mCRPC 7
Treatment Considerations
When considering chemotherapy options for advanced prostate cancer, it is essential to take into account the patient's previous treatment history and response to therapy. For example:
- Patients who have progressed after docetaxel therapy may be considered for treatment with cabazitaxel or abiraterone 3, 4
- Patients who have progressed after androgen receptor axis targeted therapies may be considered for treatment with olaparib or other experimental therapies 7
- Patients with PSMA-positive mCRPC may be considered for treatment with Lutetium-177 (177Lu)-PSMA-617 7