Docetaxel Rechallenge Improves Survival in Patients with Metastatic Castration-Resistant Prostate Cancer: A Retrospective Study
Peng-Yen Wu, Sheng-Chun Hung, Li-Wen Chang, Kun-Yuan Chiu, Jian-Ri Li, Shian-Shiang Wang, Cheng-Kuang Yang, Chuan-Shu Chen, Kevin Lu, Cheng-Che Chen, Shu-Chi Wang, Chia-Yen Lin, Chen-Li Cheng, Yen-Chuan Ou, Chi-Rei Yang, Shun-Fa Yang, Chiann-Yi Hsu
Division of Urology, Department of Surgery, Taichung Veterans General Hospital; Institute of Medicine, Chung Shan Medical University; Department of Urology, Tungs' Taichung MetroHarbor Hospital; Department of Urology, China Medical University Hospital; Biostatistics Task Force of Taichung Veterans General Hospital
Purpose: The purpose of the study was to evaluate the efficacy of docetaxel rechallenge in patients with metastatic Castration–resistant Prostate Cancer (mCRPC).
Materials and Methods: We retrospectively compared patients who had received either first-line docetaxel and rechallenge after Androgen Receptor-axis Targeted therapies (ARAT) or cabazitaxel, to those without rechallenge docetaxel. Multivariate cox-regression analysis was used to evaluate survival.
Results: From 2008 to 2016, 204 patients with mCRPC in Taichung Veterans General Hospital were enrolled in the study. Twenty-four patients received docetaxel rechallenge and 180 didn’t. The median overall survival was 50.11 months in the rechallenge group, as compared to 26.36 months in the non-rechallenge group (p of log rank=0.044). In a multivariate model, doxetaxel rechallenge was an independent risk factor in overall survival (Hazard Ratio [HR] = 0.56, 95% Confidence Interval [CI] 0.32-0.99), together with hormone sensitive duration (HR=0.99, 95% CI 0.99-0.998), liver metastasis (HR=1.89, 95% CI 1.04-3.44) and brain metastasis (HR=3.01, 95% CI 1.2707.14). The advantage in overall survival was addressed in the ARAT non-response patients (HR=0.36, 95% CI 0.17-0.78). The adverse events were 29.17% with Grade 3/4 neutropenia and 20.83% with Grade 1/2 neutropenia in patients who had received docetaxel rechallenge.
Conclusions: Docetaxel rechallenge improved the survival rate in patients with mCRPC after failure of frontline treatment involving abiraterone acetate and enzalutamide. Independent predictive factors for overall survival included hormone sensitive duration, liver metastases and brain metastases. Patients with high metastases volume, high metastases risk and nonresponsiveness to ARATs will benefit from rechallenge docetaxel with regards to overall survival.