Study Raises New Hope for Chemotherapy
At last, definitive news: Chemotherapy
prolongs life in men with prostate cancer—and it may be most effective
when it is started early, and used aggressively. This is the word from
a massive, worldwide study of 1006 men with hormone-refractory cancer,
led by Mario Eisenberger, M.D., the R. Dale Hughes Professor of Oncology
and Urology, published in the New England Journal of Medicine.
The results come after years of clinical
trials, of dozens of chemotherapy compounds and drug regimens—many of
them developed at the Kimmel Cancer Center by Eisenberger and colleagues.
Over the last decade, Eisenberger and colleagues have pioneered a new
approach to chemotherapy, hitting prostate cancer increasingly harder
and earlier—when it is much more vulnerable— and also using “smart” drugs
to target specific molecular steps of cancer cell growth. The journey
to this point has been hard, often discouraging, and yet Eisenberger has
always believed that the secret code of cancer was crackable—that it is
just a question of finding the right molecular key, or set of keys, and
knowing the right lock, or bank of locks.
| This shows that “prostate
cancer is as sensitive to chemotherapy as other tumor types, such
as breast cancer.”
This 24-country trial is the largest
study ever conducted in men with hormone-refractory prostate cancer—men
with cancer that has spread after months or years of hormonal therapy.
It was chaired by Eisenberger, along with physicians Ian Tannock, from
Canada, and Ronald DeWit, from the Netherlands. In the landmark study,
men were randomly assigned to receive a combination of prednisone and
docetaxel (Taxotere) a drug in the taxol family, used to treat breast
cancer— given weekly, or given every three weeks, or to receive a conventional
drug regimen of mitoxantrone and prednisone. The men who showed the biggest
improvement received prednisone and Taxotere every three weeks. Side effects,
including a decrease in white blood cells, were moderate and reversible.
“In general, treatment was well tolerated,” says Eisenberger. “Men receiving
Taxotere also were more likely to have a drop in their PSA level, better
control of pain, and improvement in quality of life.”
Because of the study’s results, the
Food and Drug Administration has approved the use of Taxotere for prostate
cancer, says Eisenberger, who presented these findings at the plenary
session of the American Society of Clinical Oncology. “This important
study sets a new standard for chemotherapy in prostate cancer,” he says.
“It also indicates that prostate cancer is a tumor that is as sensitive
to chemotherapy as other tumor types, such as breast cancer.” Finally,
he adds, the results point to further trials aimed at men with less advanced
disease—for example, men after radical prostatectomy, whose pathology
suggests that some cancer is still present, or men with no symptoms but
rapid PSA doubling times (read
related story). “Our clinical trials should now shift to using it
even earlier, to delay or prevent the onset of cancer-related symptoms,
and to further prolong survival.”