Continuation of Docetaxel May Improve Survival in Metastatic Castration-Resistant Prostate Cancer
The number of docetaxel cycles completed was associated with improved overall survival among men with metastatic castration-resistant prostate cancer receiving docetaxel, prednisone, and lenalidomide (Revlimid; DPL) or docetaxel/prednisone (DP), in the phase III Mainsail trial. de Morrée et al reported this post hoc analysis in JAMA Oncology.
Study Details
In the Mainsail trial, 1,059 patients were randomized to receive DPL or DP plus placebo until disease progression or unacceptable toxicity. Median overall survival was significantly poorer in the DPL group. Due to greater toxicity, patients in the DPL group received fewer docetaxel cycles (median of 6 vs 8); docetaxel dose intensity was similar in the two groups. In the current analysis, the effect of the number of docetaxel cycles on overall survival was evaluated in the intent-to-treat population.
Association With Survival
On multivariate analysis including all patients, receipt of ≥ 8 cycles of docetaxel was associated with improved overall survival (hazard ratio [HR] = 1.909, P < .001), whereas the treatment group was not significantly associated with survival (HR = 1.060, P = .41, for DPL vs DP). In a sensitivity analysis, median overall survival was 33.0 months in patients receiving > 10 cycles, 26.9 months in those receiving 8 to 10 cycles, and 22.8 months in those receiving 5 to 7 cycles (P < .001 overall).
The investigators concluded: “These findings suggest that continuation of docetaxel chemotherapy contributes to the survival benefit. Prospective validation is warranted.”
This study was supported by Celgene Corporation.
Ronald de Wit, MD, of Erasmus MC Cancer Institute, is the corresponding author of the JAMA Oncology article.
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