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High-Risk Localized Prostate Cancer: A Case for Early Chemotherapy -
Martin Gleave and Kevin Kelly (January 2006)
The bottom line of this
review is that “there are no adequately powered randomized studies that
have been completed using adjuvant or neoadjuvant chemotherapy in
conjunction with surgery or radiotherapy” and the “use of early
chemotherapy remains investigational”. Dr. Gleave has pioneered the study
of the induction of the “stress-activated cytoprotective chaperones,
clusterin and Hsp27 [which prevent apoptosis] that are upregulated and
begin to increase immediately following androgen deprivation therapy (ADT).
He envisions early chemotherapy as a possible means of addressing their
emergence.
The
article lists ongoing or planned protocols. SWOG 9921 is active and
compares neoadjuvant ADT + Mitoxanthrone v. neoadjuvant ADT alone before
RP in high-risk patients. Planned studies include: NCI/CALGB/NCICanada - 6
cycles nADT + Docetaxel v. nADT both prior to surgery in high-risk
localized disease, a Sandofi-Aventis study of the same design prior to
irradiation; and NCI/RTOG - 3DCRT/IMRT followed by 24 months ADT v. 24
months ADT + 6 cycles Docetaxel/Prednisone for localized high-risk
prostate cancer. The authors point out that an advantage of employing
adjuvant therapy after surgery lies in “limiting the
morbidity of additional therapy to only the highest-risk patients” as
indicated by their pathology specimens.
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