This month we’re talking about chemotherapy for prostate cancer.
Dr. Snuffy Myers offers his thoughts about this month’s conversations:
Patients are often under the impression that chemotherapy drugs like Taxotere (docetaxel) and Jevtana (carbazitaxel) won’t significantly improve survival and will only dramatically impair quality of life. A patient once said to me, “That sounds like a bad deal.” I hope this issue of Prostapedia changes your view of chemotherapy.
The potential benefit of chemotherapy depends on where you are in the natural history of metastatic prostate cancer. If you have just been diagnosed with widespread metastatic prostate cancer, Lupron (leuprolide) plus Taxotere (docetaxel) can have a major benefit in terms of your survival. At this point, you are likely to tolerate chemotherapy better than you would if you had already been through multiple other treatments. However, even in patients who have been extensively treated before chemotherapy, this treatment can often provide significant relief of bone pain that outweighs the drug side effects.
The major alternatives to Taxotere (docetaxel) in this setting are the new androgen blocking agents, such as Zytiga (abiraterone), Xtandi (enzalutamide) or Erleada (apalutimide). Each of these drugs can cause side effects more severe than Taxotere (docetaxel) in some patients. Also, Taxotere (docetaxel) treatment extends for just six treatments done every 3 weeks. In contrast, the androgen blocking agents are typically given continuously until they fail to control your cancer.
In many other cancers, patients benefit greatly when we combine drugs. While the search for effective Taxotere (docetaxel)-based combinations has been going on for decades, no combination has survived rigorous Phase III testing. I, and many others in the field, think that this may be because prostate cancer is a very heterogeneous disease. The path to success requires that we understand at a molecular level the various forms of this disease and the key vulnerabilities of each variation.
One example is the sensitivity of prostate cancers with a BRCA2 mutation to Paraplatin (carboplatin). Another example is the activity of Jevtana (carbazitaxel) + Paraplatin (carboplatin) in anaplastic prostate cancer.
There are several reasons to be optimistic about progress. First, research into the molecular heterogeneity of prostate cancer and the clinical implications thereof is proceeding rapidly. Second, leads that emerge from this research are being tested more rapidly and with greater sophistication than at any time in the past.