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Intermittent
Chemotherapy - When Is Enough Enough?
(May 2008)
Dr. Tomaz Beer and
colleagues have generated a useful guideline for the management of the
fortunate minority of men with prostate cancer who experience a very
favorable response to chemotherapy. Based on data from a subset of
responding patients they reported on "Intermittent chemotherapy in
patients with metastatic androgen-independent prostate cancer: results
from ASCENT, a double-blinded randomized comparison of high-dose
calcitriol plus docetaxel with placebo plus docetaxel, CANCER
Jan 15, 2008. After a median initial treatment duration of 22 weeks 53
of the 250 men (21%) in the ASCENT trial achieved a PSA level of <4
ng/mL and were offered the option of interrupted therapy. Forty-five men
participated. For these men "Treatment was suspended until the PSA level
rose by 50% and was >2 ng/mL or until there was any other
evidence of disease progression." The median duration of the first
holiday was 18 weeks (range 4 - 70 weeks), with 20 of the men off
therapy for >20 weeks. Of 33 men who resumed treatment 15 (45.5%)
responded again achieving a >50% PSA reduction, and 15 others
exhibited a stable PSA for at least 12 weeks. At the time of this report
10 patients had completed their second holiday with a median time off of
12 weeks (range 7-22 weeks). Thirteen patients have taken >2
chemotherapy holidays.
The responding patients
who became eligible for intermittent therapy had favorable profiles for
performance status (82% ECOG 1), hemoglobin level(median 13.5 g/dl), and
alkaline phosphatase value (median 97 units). This group's median
baseline PSA was 25.28 ng/mL; median age, 70 years; and 80% had bone
metastases.
This
is the first report of a prospective testing of this approach to therapy
which offers a "practical method with which to balance disease control
and quality of life in the subset of AIPC patients whose disease is very
sensitive to docetaxel."
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