Carboplatin Plus Paclitaxel Chemo After Failed -- An Alternative When There Is None

by Joel T. Nowak | AdvancedProstateCancer.net | 05.25.2010

Docetaxel is the first-line chemotherapy and the only approved chemotherapy for men with metastatic castrate resistant prostate cancer (CRPC). We all know that Docetaxel will stop working, so what do you do when this happens?

The Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY conducted a retrospective, bi-institutional review of Carboplatin and paclitaxel when used in men with CRPC who have failed docetaxel. Carboplatin and paclitaxel have demonstrated activity in CRPC, but published data are limited regarding use of these drugs after docetaxel failure.

The researchers looked at tolerability, response, and survival. Endpoints used modified Prostate Cancer Working Group 2 criteria (greater than or equal to 30% PSA decline within 3 months).

Twenty-five patients were identified from February 2000 to March 2008. Median pretreatment PSA was 130.2 ng/ml [range 0.1-2100]. Sites of metastases included bone (88%), lymph nodes (52%), pelvis (32%), lung (28%), and liver (20%). A median 4.5 cycles of docetaxel [range 1-22] were given with a median progression-free survival (PFS) of 12 weeks [range 2-68]. Eighty-eight percent of patients (22/25) were docetaxel-refractory at the initiation of therapy with carboplatin (AUC 4-6) day 1 plus paclitaxel 60-80 mg/m(2) days 1, 8, and 21 recycled every 28 days. Men received a median of 3.5 cycles [range 1-8] of carboplatin/paclitaxel with a median PFS of 12 weeks [range 2-35]. Sixty-four percent of patients (16/25) achieved >/=30% reduction in PSA with a median overall survival of 42 weeks [95% CI 30.6-53.5 weeks]. Grade 3 or 4 adverse hematologic events occurred in 11/25 (44%) patients, with no neutropenic fever or grade 3/4 non-hematologic toxicity.

They concluded that carboplatin/paclitaxel chemotherapy following failed docetaxel in men with metastatic CRPC is both well tolerated and can provide favorable PSA response rates and survival. This combination is a viable option after progression on docetaxel-based therapy.

Reference: Urol Oncol. 2010 May 5. Epub ahead of print.
doi: 10.1016/j.urolonc.2009.12.023; Jeske S, Tagawa ST, Olowokure O, Selzer J, Giannakakou P, Nanus DM.
PubMed Abstract
PMID: 20451413

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