Interview with Dr Cora N. Sternberg: Prostate Cancer Chemotherapy

Published:January 17, 2007DOI:
      Dr Cora N. Sternberg earned her medical degree from the University of Pennsylvania, Philadelphia, USA. She completed her residency in internal medicine at Mt. Sinai Hospital, New York and at Stanford University and received her Oncology Fellowship training at Memorial Sloan Kettering Cancer, New York. On moving to Italy in 1988, Dr Sternberg obtained a second medical degree from La Sapienza University in Rome. She is board certified in Internal Medicine and in Oncology in the US, Italy, and Austria and is currently Chief of the Division of Medical Oncology and Chair of the Department of Medical Oncology at the San Camillo and Forlanini Hospitals in Rome.Where does chemotherapy currently sit in the treatment armamentarium for prostate cancer?Hormonal androgen deprivation therapy is the basis of treatment for patients with metastatic prostate cancer. Androgen ablation can rapidly lessen bone pain, produce regressions in soft-tissue metastasis and reduce serum prostate-specific antigen (PSA). Hormonal therapy is palliative, but eventually it fails, and patients develop hormone insensitive prostate cancer. Metastatic tumours progress at a median of 18 to 24 months. Traditionally, the patient with prostate cancer has been predominantly under the care of urologists and radiation oncologists. The benefit of chemotherapy was thought to be limited to palliation of late-stage prostate cancer, and thus medical oncologists only became involved in patient care towards the end of the disease process, if at all. There has been a definite change in philosophy concerning the perceived lack of responsiveness to chemotherapy in patients with hormone refractory prostate cancer (HRPC). The standard of care for HRPC until very recently has been mitoxantrone chemotherapy combined with cortisone. This therapy ameliorates bone pain in about 30% of patients, but has never been associated with a survival advantage. The results of two independent research teams have revealed that a docetaxel-based chemotherapy regimen can lead to a survival benefit in patients with HRPC.In metastatic patients, which chemotherapy regimen has shown the most promise and what degree of benefit are we talking about?In metastatic patients, a large international study known as the TAX 327 trial compared two regimens of docetaxel and prednisone with mitoxantrone and prednisone. A total of 1006 men with HRPC were randomly assigned to docetaxel 75 mg/m2 every 3 weeks, docetaxel 30 mg/m2 once per week for 5 weeks, or mitoxantrone 12 mg/m2 every 3 weeks. All patients also received prednisone 5 mg orally twice daily and the planned treatment duration was 30 weeks. Results showed that docetaxel given every 3 weeks increased survival by 24% as compared with mitoxantrone and prednisone. The median survival was 18.9 months in the every 3 week docetaxel group, 17.4 months in the weekly docetaxel arm and 16.5 months in the mitoxantrone group.
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