Given the new standard of care for men newly diagnosed with aggressive and high-risk metastatic prostate cancer, researchers at the West of Scotland Cancer Network (WoSCAN) investigated the uptake, safety, and efficacy of using early docetaxel chemotherapy in the first year of use outside of a clinical trial.
They used electronic records, to compare the rate of febrile neutropenia (the development of a fever, often with other signs of infection due to the chemotherapy suppressing the white blood cells), hospitalizations, time to progression and overall survival between men who received docetaxel chemotherapy and androgen deprivation therapy (ADT), or ADT alone using survival analysis statistics.
The comparison of two hundred seventy (270) eligible men showed that one hundred and three (103) received docetaxel (38.1%). Thirty-five (35) men (34%) had been hospitalized and there were seventeen (17) episodes of febrile neutropenia (16.5%).
Two men (1.9%) died within 30 days of receiving chemotherapy.
They found that the men who received ADT alone had an increased risk of having their prostate cancer progress and had an increased risk of death compared to the group of men who had docetaxel chemotherapy. They also found the risk of febrile neutropenia was nine times greater if the chemotherapy was started within three weeks of beginning ADT.
The researchers concluded that docetaxel chemotherapy in men who are hormone-naïve and have metastatic prostate cancer has significant toxicities, but like in the clinical trials it slowed disease progression and increased the overall survival as demonstrated in randomized clinical trials. However, given the significant increase in febrile neutropenia experienced, they concluded that docetaxel chemotherapy should be started three weeks or more after androgen deprivation is begun.
BJU Int. 2017 Sep 20. doi: 10.1111/bju.14025. [Epub ahead of print]; Rulach R1, McKay S1, Neilson S, et al.; DOI: 10.1111/bju.14025