Multiple cycles of intermittent chemotherapy in metastatic androgen-independent prostate cancer.

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Br J Cancer. 2004 Oct 18;91(8):1425-7.

Multiple cycles of intermittent chemotherapy in metastatic androgen-independent prostate cancer.
 
Beer TM, Garzotto M, Henner WD, Eilers KM, Wersinger EM.

Department
of Medicine, Division of Hematology and Medical Oncology, Oregon Health
& Science University, Mail Code CR145, 3181 SW Sam Jackson Park
Road, Portland, OR 97239, USA.

Recently,
completed phase III studies demonstrated a survival benefit for a fixed
number of cycles of docetaxel-containing chemotherapy treatment of
androgen-independent prostate cancer (AIPC). Management of patients who
respond well to initial chemotherapy for AIPC remains ill-defined. We
previously reported that in a select group of such patients,
retreatment with the same regimen was feasible and was associated with
quality of life gains.
Here, we report that multiple cycles of such
intermittent chemotherapy are feasible. We prospectively tested
intermittent chemotherapy in eight AIPC patients responding to
calcitriol plus docetaxel who reached a serum prostate-specific antigen
(PSA) <4 ng ml(-1) (22% of the 37 patients who were initially
treated with this regimen). Chemotherapy was suspended until a rise in
PSA > or =50% and 1 ng ml(-1). The median duration of the first
treatment holiday was 20 weeks (13-74 weeks) and all patients retained
sensitivity to retreatment.
Four patients were eligible for a second
chemotherapy holiday, and the median duration was 21 weeks (17-28
weeks). Two patients elected to take a third chemotherapy holiday,
which lasted 10 and 28 weeks. The median time to treatment failure was
26.5 months (95% CI 23.6-29.4 months), and the median survival is 41
months (95% CI 33.7-48.3 months).
Multiple cycles of intermittent
chemotherapy interrupted by clinically meaningful treatment holidays
are feasible in a subset of AIPC patients treated with this
docetaxel-containing regimen. Intermittent chemotherapy for AIPC is
feasible and deserves further study.