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Currently, taxane chemotherapy, given with prednisone, is approved for men with newly diagnosed with metastatic prostate cancer who have not been exposed to ADT prior or patients who have progressed to metastatic castration resistant prostate cancer.  Taxanes kill prostate cancer cells by disrupting the protein structures (microtubules) required for cell division.  Docetaxel was the first agent approved in 2004 for mCRPC.  In 2015, it was discovered that patients with metastatic castration sensitive prostate cancer had a better response to the addition of docetaxel to ADT in these patients versus ADT alone.  Cabazitaxel was approved in 2010 for patients with mCRPC who have had prior exposure to docetaxel and have now progressed.

Both docetaxel and cabazitaxel are effective in prolonging life in these patients who have metastatic disease on scans.  Again, it should be noted that ADT is still required to be administered when starting either of these agents.

When is chemotherapy your best option?

  • Chemotherapy is not considered a "last resort."
  • For some patients having chemotherapy earlier in the treatment sequence can be more beneficial. 

Where is chemotherapy given?

  • When a medical oncologist orders the chemotherapy treatment, patients usually visit an infusion center or office to receive it.

How does chemotherapy feel?

  • There is a vast difference in how patients respond to chemotherapy. Often chemotherapy is given with other drugs to prevent side effects.
  • Some patients may experience side effects 1-2 weeks after their infusion and will often see improvement about 2 weeks after receiving the treatment. 

How long does chemotherapy treatment last?

  • Chemotherapy varies from patient to patient and is based on how they are responding.
  • Physicians monitor tolerance of side effects, PSA levels, tumor changes, etc. 
  • Typically chemotherapy is given every 3 weeks for 6-10 cycles.

First line Chemo: Docetaxel

  • Every 3-week docetaxel +/- prednisone was approved first-line chemotherapy for the mCRPC patient in 2004.
  • Dose: 75 mg/m2 by IV
  • In combination with prednisone 5mg by mouth, twice a day
  • Maintain ADT
  • Enjoys Category 1 evidence and consensus for the management of mCRPC and high volume mCSPC

Second Line chemo: Cabazitaxel

  • Semi-synthetic taxane derivative related to Docetaxel
  • Every 3 week Cabazitaxel approved by the FDA: June 2010
  • Dosing:  25 mg/m2 (initially 2010); 20 mg/m2 (Sept 2017)
  • Indications:  mCRPC in men previously treated with Docetaxel
  • In combination with prednisone, 5mg, by mouth, twice a day
  • Maintain ADT
  • Enjoys Category 1 evidence and consensus for the management of mCRPC in patients who have received docetaxel prior

Platinum Chemotherapy

Platinum-based chemotherapy agents including carboplatin, cisplatin, and oxaliplatin are used for the treatment of certain mCRPC patients that have been shown to exhibit neuroendocrine features, small cell histology or express mutations in DNA damage repair.  What many of the patients that have these rare tumor types have in common is the exposure to various treatments prior to this point.  Patients with advanced disease who are not responding to standard therapy can talk with their doctor about whether they may be candidates for platinum chemotherapy and if their current tumor might fall into one of these categories.

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How does chemotherapy work?

Cancerous/malignant tumors are characterized by unregulated cell division, non-cancerous/benign cells stop dividing when they come into contact with similar cells, a mechanism known as contact inhibition.  Cancerous cells, through various mechanisms, evade this process and continue to grow unchecked. 

The ability of chemotherapy to kill cancer cells depends on its ability to arrest cell division.  Usually, the drugs work by damaging the RNA or DNA that directs the cell how to copy itself in division.  If the cells are unable to divide they are unable to survive.  The faster the cells are dividing, the more likely it is that chemotherapy will be effective, resulting in tumor shrinkage.

Unfortunately, chemotherapy does not differentiate between dividing cells that are cancerous versus benign.  The "normal" cells most commonly affected by chemotherapy are the rapidly dividing cells in the body such as the circulating blood cells, cells in the mouth, stomach, bowel, and the hair follicles.  This can result in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different CT agents may affect different parts of the body and thus responsible for certain associated side affects that are associated with these drugs.

“…rather than waiting for the cancers to become resistant to hormone treatments, if you used hormones with chemotherapy right up front… you could have a more dramatic improvement in overall survival.”

Dr. William Oh Prostapedia Interview Aug. 2018