Chemotherapy Options for Prostate Cancer

ANNOUNCER: Traditionally, chemotherapy had little to no role in treating advanced prostate cancer.TOMASZ BEER, MD: Initially, there were many, many studies that looked at chemotherapy agents that really weren't showing much activity at all ...

ANNOUNCER: Traditionally, chemotherapy had little to no role in treating advanced prostate cancer.

TOMASZ BEER, MD: Initially, there were many, many studies that looked at chemotherapy agents that really weren't showing much activity at all in advanced prostate cancer. And in fact when I started working on it, the mantra was that chemotherapy's not helpful in this cancer.

CELESTIA S. HIGANO, MD: At the end of the '80s, one of my colleagues wrote a review article about chemotherapy in the setting of prostate cancer, and their conclusion was that there was no benefit for chemotherapy.

ANNOUNCER: Doctors had been using the steroid prednisone to alleviate symptoms associated with advanced prostate cancer, and in the 1990s, a chemotherapy agent was proven effective for decreasing pain.

CELESTIA S. HIGANO, MD In the mid-'90s, we had the study with mitoxantrone and prednisone showing that the combination of the chemotherapy with prednisone was better than prednisone alone for helping patients with symptoms.

TOMASZ BEER, MD: Mitoxantrone in combination with prednisone can have important benefits in terms of pain control and quality of life, without extending life. But in patients who have advanced cancer and have significant symptoms, quality of life benefits were very important.

ANNOUNCER: But before 2004, oncologists couldn't give patients much hope that chemotherapy could improve survival.

TOMASZ BEER, MD: And then docetaxel came along, which not only improved upon mitoxantrone with regard to pain control, but also provided for the first time a benefit with regard to survival in men who have advanced metastatic prostate cancer and who are no longer responding to hormonal therapy.

ANNOUNCER: Docetaxel, under the brand name Taxotere, has been proven to not only alleviate symptoms of cancer, but it also has shown a survival benefit.

CELESTIA S. HIGANO, MD: In the clinical trials, the median time -- that means half the patients -- lived as long as 18 to 19 months, and half the patients lived less long. And that is a two-month improvement over the median for the other combination, which was mitoxantrone and prednisone.

But I think that when you say there's a two-month survival advantage, some people are rather shocked at how short that is. But this is for a whole group of men. This is not what the individual may get. And in fact, we've had some excellent, good long-term results with patients. I have patients who have had metastatic prostate cancer on and off chemotherapy for over five years.

ANNOUNCER: Currently docetaxel plus prednisone is the FDA-approved regimen for advanced prostate cancer. But researchers are also testing docetaxel with other agents in a number of clinical trials.

CELESTIA S. HIGANO, MD: We're at the beginning of a big learning experience about what other drugs we can combine with docetaxel to improve on what we've seen with docetaxel and prednisone.

ANNOUNCER: Some drugs used added to docetaxel are biologic agents, which target the blood supply to cancer cells.

TOMASZ BEER, MD: Most of the exciting new drugs that are being added to it are not conventional chemotherapy drugs, but novel drugs that we consider so-called biologic agents: drugs that target various activities or parts of the cancer that we think may give us an advantage. So drugs that target the cancer's ability to resist chemotherapy, the cancer's ability to grow its own blood supply.

ANNOUNCER: Another promising agent tested in combination with chemotherapy is a vitamin D compound.

TOMASZ BEER, MD: It turns out that cancer has receptors for activated vitamin D, which is calcitriol, and I'll call it calcitriol from now on. And in the lab, calcitriol can cause cancer to die, stop it from growing, and is synergistic with chemotherapy agents, including docetaxel.

And what we found was, there was a significant difference in survival in favor of the combination. So the median survival in patients treated with docetaxel alone was about 16.5 months, and the median survival for the combination arm hadn't been reached as of the last analysis, but is estimated at 24.5 months.

ANNOUNCER: There is no cure for advanced prostate cancer, but oncologists are confident that more advances in treatment are on the way.

TOMASZ BEER, MD: I think there's never been a better time to be a prostate cancer researcher. We have so many new drugs that hold promise, and really the most frustrating thing is how long it takes to get the answers. Both our patients and we are impatient and we would like to know right now what's going to help, and how can we move forward.

CELESTIA S. HIGANO, MD: The nice thing about being my age is that I got to live through the era when there was supposedly nothing we could do with chemotherapy to a time when we can offer chemotherapy to most patients and feel very good about the kinds of improvements we see in their quality of life.