Clinical outcomes in octogenarians treated with docetaxel as first-line chemotherapy for castration-resistant prostate cancer.

AIM: To assess clinical outcomes in octogenarians treated with docetaxel (DOC) for metastatic castration-resistant prostate cancer. PATIENTS & METHODS: The multicenter retrospective study was based on a review of the pre- and post-DOC clinical history, DOC treatment and outcomes. RESULTS: We reviewed the records of 123 patients (median age: 82 years) who received DOC every 3 weeks or weekly, without significant grade 3-4 toxicities. Median progression-free survival was 7 months; median overall survival from the start of DOC was 20 months, but post-progression treatments significantly prolonged overall survival. CONCLUSION: The findings of this study suggest that toxicity is acceptable, survival is independent of patient's age and survival can be significantly prolonged by the use of new agents.

Phase II study of docetaxel re-treatment in docetaxel-pretreated castration-resistant prostate cancer.

OBJECTIVE: To determine the activity and tolerability of docetaxel re-treatment after first-line therapy with docetaxel in castration-resistant prostate cancer (CRPC). PATIENTS AND METHODS: Between November 2005 and January 2009, 45 patients initially responding to docetaxel and then experiencing disease progression after a period of biochemical remission of at least 5 months were enrolled in a prospective multicenter study and re-treated with docetaxel. The primary endpoint was the biochemical response (biochemical partial response defined as > 50% prostate-specific antigen [PSA] decline); secondary endpoints were objective response, toxicity, progression-free survival (PFS) and overall survival (OS). RESULTS: Partial PSA responses were observed in 11 patients (24.5%), 4 (25%) of whom also had an objective response. The treatment was well tolerated, with grade 1-2 neutropenia, thrombocytopenia, vomiting and peripheral neuropathy noted in 18 (40%), 11 (24.5%), 8 (17.8%), and 6 (13.3%) patients, respectively. The most common grade 3 toxicity was neutropenia, which was observed in 8 patients (17.8%). Median PFS was 5 months and median OS was 13 months. CONCLUSIONS: Docetaxel re-treatment preserves anti-tumour activity and is well tolerated in a selected population of pretreated patients with CRPC. Further randomized trials are needed to confirm our preliminary results.

Pathological complete response induced by first-line chemotherapy with single agent docetaxel in a patient with advanced non small cell lung cancer.

BACKGROUND: Defining the optimal treatment for patients with inoperable non small cell lung cancer (NSCLC), presenting with metastatic mediastinal lymph nodes, is challenging. Nevertheless, preoperative chemotherapy or radiotherapy might offer a chance for these patients for radical surgical resection and, possibly, complete recovery. CASE PRESENTATION: A 62-year old man with IIIA-N2 inoperable NSCLC was treated with first-line single agent docetaxel. A platinum-based treatment, though considered more active, was ruled out because of renal impairment. The patient tolerated the treatment very well and, although his initial response was not impressive, after 14 cycles he obtained a complete clinical response, which was confirmed pathologically after he underwent surgical lobectomy. CONCLUSION: In non-operable NSCLC patients not eligible for a platinum-based treatment, single-agent docetaxel can provide complete pathologic responses. Failure to obtain a response after the first few cycles should not automatically discourage to continue treatment.

Targeted therapy in the treatment of metastatic renal cell cancer.

The treatment of metastatic renal cell carcinoma (MRCC) has evolved from being predominantly cytokine-based to being grounded in the use of drugs targeting vascular endothelial growth factor, platelet-derived growth factor and mammalian target of rapamycin (mTOR) pathways. New agents including the small-molecule targeted inhibitors sunitinib, sorafenib and temsirolimus and the monoclonal antibody bevacizumab have shown anti-tumor efficacy and have become the standard of care for most patients. Sunitinib and temsirolimus have shown significant improvements in overall survival (OS), in the first-line setting, when compared with interferon. Sorafenib has demonstrated prolonged progression-free survival (PFS) in a phase III study in comparison with placebo in the second-line setting. More recently, two phase III studies have compared bevacizumab and interferon with interferon alone. Both studies showed a statistically significant improvement in PFS for the combination arm but no difference in OS. Everolimus showed prolonged PFS in the second/third-line setting. Pazopanib prolongs PFS in naïve/cytokine refractory patients. Immunotherapy confers a small but significant OS advantage but only for the minority of patients with good prognostic features. The results of these trials and ongoing efforts to improve treatment of MRCC are the focus of this review.