Docetaxel and Estramustine Compared with Mitoxantrone and Prednisone for Advanced Refractory Prostate Cancer
Daniel P. Petrylak, M.D., Catherine M. Tangen, Dr.P.H., Maha H.A. Hussain, M.D., Primo N. Lara, Jr., M.D., Jeffrey A. Jones, M.D., Mary Ellen Taplin, M.D., Patrick A. Burch, M.D., Donna Berry, Ph.D., R.N., Carol Moinpour, Ph.D., Manish Kohli, M.D., Mitchell C. Benson, M.D., Eric J. Small, M.D., Derek Raghavan, M.D., Ph.D., and E. David Crawford, M.D.
Background Mitoxantrone-based chemotherapy palliates pain withoutextending survival in men with progressive androgen-independentprostate cancer. We compared docetaxel plus estramustine withmitoxantrone plus prednisone in men with metastatic, hormone-independentprostate cancer.
Methods We randomly assigned 770 men to one of two treatments,each given in 21-day cycles: 280 mg of estramustine three timesdaily on days 1 through 5, 60 mg of docetaxel per square meterof body-surface area on day 2, and 60 mg of dexamethasone inthree divided doses before docetaxel, or 12 mg of mitoxantroneper square meter on day 1 plus 5 mg of prednisone twice daily.The primary end point was overall survival; secondary end pointswere progression-free survival, objective response rates, andpost-treatment declines of at least 50 percent in serum prostate-specificantigen (PSA) levels.
Results Of 674 eligible patients, 338 were assigned to receivedocetaxel and estramustine and 336 to receive mitoxantrone andprednisone. In an intention-to-treat analysis, the median overallsurvival was longer in the group given docetaxel and estramustinethan in the group given mitoxantrone and prednisone (17.5 monthsvs. 15.6 months, P=0.02 by the log-rank test), and the correspondinghazard ratio for death was 0.80 (95 percent confidence interval,0.67 to 0.97). The median time to progression was 6.3 monthsin the group given docetaxel and estramustine and 3.2 monthsin the group given mitoxantrone and prednisone (P<0.001 bythe log-rank test). PSA declines of at least 50 percent occurredin 50 percent and 27 percent of patients, respectively (P<0.001),and objective tumor responses were observed in 17 percent and11 percent of patients with bidimensionally measurable disease,respectively (P=0.30). Grade 3 or 4 neutropenic fevers (P=0.01),nausea and vomiting (P<0.001), and cardiovascular events(P=0.001) were more common among patients receiving docetaxeland estramustine than among those receiving mitoxantrone andprednisone. Pain relief was similar in both groups.
Conclusions The improvement in median survival of nearly twomonths with docetaxel and estramustine, as compared with mitoxantroneand prednisone, provides support for this approach in men withmetastatic, androgen-independent prostate cancer.
Source Information
From Columbia University, Herbert Irving Comprehensive Cancer Center, New York (D.P.P., M.C.B.); Southwest Oncology Group Statistical Center, Seattle (C.M.T., C.M.); the University of Michigan Comprehensive Cancer Center, Ann Arbor (M.H.A.H.); the University of California, Davis, Sacramento (P.N.L.); Baylor College of Medicine, Houston (J.A.J.); the University of Massachusetts Medical Center, Worcester (M.E.T.); the Mayo Clinic, Rochester, Minn. (P.A.B.); Biobehavioral Nursing and Health Systems, University of Washington, Seattle (D.B.); the University of Arkansas for Medical Science, Little Rock (M.K.); the University of California, San Francisco, Cancer Center, San Francisco (E.J.S.); the Cleveland Clinic Foundation, Cleveland (D.R.); and the University of Colorado Health Science Center, Denver (E.D.C.).
Address reprint requests to the Southwest Oncology Group (S9916) Operations Office, 14980 Omicron Dr., San Antonio, TX 78245-3217, or at pubs{at}swog.org.
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Huang, C.-Y., Beer, T. M., Higano, C. S., True, L. D., Vessella, R., Lange, P. H., Garzotto, M., Nelson, P. S.
(2007). Molecular Alterations in Prostate Carcinomas that Associate with In vivo Exposure to Chemotherapy: Identification of a Cytoprotective Mechanism Involving Growth Differentiation Factor 15. Clin. Cancer Res.
13: 5825-5833
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Armstrong, A. J., Garrett-Mayer, E., Ou Yang, Y.-C., Carducci, M. A., Tannock, I., de Wit, R., Eisenberger, M.
(2007). Prostate-Specific Antigen and Pain Surrogacy Analysis in Metastatic Hormone-Refractory Prostate Cancer. JCO
25: 3965-3970
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Shimazui, T., Kawai, K., Miyanaga, N., Kojima, T., Sekido, N., Hinotsu, S., Oikawa, T., Joraku, A., Akaza, H.
(2007). Three-weekly Docetaxel with Prednisone is Feasible for Japanese Patients with Hormone-refractory Prostate Cancer: A Retrospective Comparative Study with Weekly Docetaxel Alone. Jpn J Clin Oncol
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Sharifi, N., Hamel, E., Lill, M. A., Risbood, P., Kane, C. T. Jr., Hossain, M. T., Jones, A., Dalton, J. T., Farrar, W. L.
(2007). A bifunctional colchicinoid that binds to the androgen receptor. Molecular Cancer Therapeutics
6: 2328-2336
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Quintero, I. B., Araujo, C. L., Pulkka, A. E., Wirkkala, R. S., Herrala, A. M., Eskelinen, E.-L., Jokitalo, E., Hellstrom, P. A., Tuominen, H. J., Hirvikoski, P. P., Vihko, P. T.
(2007). Prostatic Acid Phosphatase Is Not a Prostate Specific Target. Cancer Res.
67: 6549-6554
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Agarwal, C., Veluri, R., Kaur, M., Chou, S.-C., Thompson, J. A., Agarwal, R.
(2007). Fractionation of high molecular weight tannins in grape seed extract and identification of procyanidin B2-3,3'-di-O-gallate as a major active constituent causing growth inhibition and apoptotic death of DU145 human prostate carcinoma cells. Carcinogenesis
28: 1478-1484
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Agarwal, C., Tyagi, A., Kaur, M., Agarwal, R.
(2007). Silibinin inhibits constitutive activation of Stat3, and causes caspase activation and apoptotic death of human prostate carcinoma DU145 cells. Carcinogenesis
28: 1463-1470
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Small, E. J., Sacks, N., Nemunaitis, J., Urba, W. J., Dula, E., Centeno, A. S., Nelson, W. G., Ando, D., Howard, C., Borellini, F., Nguyen, M., Hege, K., Simons, J. W.
(2007). Granulocyte Macrophage Colony-Stimulating Factor-Secreting Allogeneic Cellular Immunotherapy for Hormone-Refractory Prostate Cancer. Clin. Cancer Res.
13: 3883-3891
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Tamura, K., Furihata, M., Tsunoda, T., Ashida, S., Takata, R., Obara, W., Yoshioka, H., Daigo, Y., Nasu, Y., Kumon, H., Konaka, H., Namiki, M., Tozawa, K., Kohri, K., Tanji, N., Yokoyama, M., Shimazui, T., Akaza, H., Mizutani, Y., Miki, T., Fujioka, T., Shuin, T., Nakamura, Y., Nakagawa, H.
(2007). Molecular Features of Hormone-Refractory Prostate Cancer Cells by Genome-Wide Gene Expression Profiles. Cancer Res.
67: 5117-5125
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Chen, C.-S., Wang, Y.-C., Yang, H.-C., Huang, P.-H., Kulp, S. K., Yang, C.-C., Lu, Y.-S., Matsuyama, S., Chen, C.-Y., Chen, C.-S.
(2007). Histone Deacetylase Inhibitors Sensitize Prostate Cancer Cells to Agents that Produce DNA Double-Strand Breaks by Targeting Ku70 Acetylation. Cancer Res.
67: 5318-5327
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Eymard, J-C, Priou, F, Zannetti, A, Ravaud, A, Lepille, D, Kerbrat, P, Gomez, P, Paule, B, Genet, D, Herait, P, Ecstein-Fraisse, E, Joly, F
(2007). Randomized phase II study of docetaxel plus estramustine and single-agent docetaxel in patients with metastatic hormone-refractory prostate cancer. Ann Oncol
18: 1064-1070
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Loblaw, D. A., Virgo, K. S., Nam, R., Somerfield, M. R., Ben-Josef, E., Mendelson, D. S., Middleton, R., Sharp, S. A., Smith, T. J., Talcott, J., Taplin, M., Vogelzang, N. J., Wade, J. L. III, Bennett, C. L., Scher, H. I.
(2007). Initial Hormonal Management of Androgen-Sensitive Metastatic, Recurrent, or Progressive Prostate Cancer: 2007 Update of an American Society of Clinical Oncology Practice Guideline. JCO
25: 1596-1605
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Lee, K. C., Sud, S., Meyer, C. R., Moffat, B. A., Chenevert, T. L., Rehemtulla, A., Pienta, K. J., Ross, B. D.
(2007). An Imaging Biomarker of Early Treatment Response in Prostate Cancer that Has Metastasized to the Bone. Cancer Res.
67: 3524-3528
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Frederiksen, L. J., Sullivan, R., Maxwell, L. R., Macdonald-Goodfellow, S. K., Adams, M. A., Bennett, B. M., Siemens, D. R., Graham, C. H.
(2007). Chemosensitization of Cancer In vitro and In vivo by Nitric Oxide Signaling. Clin. Cancer Res.
13: 2199-2206
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Beer, T. M., Ryan, C. W., Venner, P. M., Petrylak, D. P., Chatta, G. S., Ruether, J. D., Redfern, C. H., Fehrenbacher, L., Saleh, M. N., Waterhouse, D. M., Carducci, M. A., Vicario, D., Dreicer, R., Higano, C. S., Ahmann, F. R., Chi, K. N., Henner, W. D., Arroyo, A., Clow, F. W.
(2007). Double-Blinded Randomized Study of High-Dose Calcitriol Plus Docetaxel Compared With Placebo Plus Docetaxel in Androgen-Independent Prostate Cancer: A Report From the ASCENT Investigators. JCO
25: 669-674
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