Docetaxel is considered first-line chemotherapy for patients with metastatic castrate
resistant prostate cancer (CRPC). Carboplatin and paclitaxel have demonstrated activity
in CRPC but published data are limited regarding use after docetaxel.
A retrospective, bi-institutional review was conducted of patients with advanced CRPC
treated with carboplatin plus paclitaxel after docetaxel. Therapy was evaluated for
tolerability, response, and survival. Endpoints used modified Prostate Cancer Working
Group 2 criteria.
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. Patients 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
Carboplatin/paclitaxel chemotherapy following docetaxel in metastatic CRPC is well
tolerated with favorable PSA response rates and survival. This combination is a viable
option after progression on docetaxel-based therapy.
Copyright © 2011 Elsevier Inc. All rights reserved.