This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Google Scholar Articles by Berthold, D. Articles by Tannock, I. PubMed Articles by Berthold, D. Articles by Tannock, I. Related Articles Related Correspondence

In Reply

University of Toronto, Princess Margaret Hospital, Toronto, Ontario, Canada

We thank Dr Nabhan for giving us the opportunity to focus on the treatment of patients with asymptomatic, hormone-refractory, metastatic prostate cancer, and agree with the points raised in his letter. Men with prostate cancer form a heterogeneous population. Some patients have slowly progressing disease and remain without symptoms for many months despite having metastatic disease, while others progress rapidly. We agree that holding chemotherapy in reserve for patients in the former group is a reasonable option.

The TAX 327 study was not powered to address outcome in specific patient subpopulations. The analysis described in our recent publication¹ was not intended to determine the benefit of docetaxel for specific subpopulations, but to determine whether there were consistent effects across subgroups. Consistent findings of survival benefit among subgroups supports the main conclusion that docetaxel improves survival overall, but does not imply that patients in all subgroups should receive immediately chemotherapy.

If a patient does request active treatment of his metastatic disease, our data suggest that docetaxel given early during the course of disease can lead to a significant survival benefit, just as in the later stages, and this remains a reasonable option. We have used the TAX327 database to evaluate the probability of deterioration in quality of life for minimally symptomatic patients who received chemotherapy as part of the study. This deterioration occurred in approximately 30% of patients,² but it was not significantly different for the once every 3 weeks schedules of mitoxantrone and docetaxel, and might have occurred largely because of disease progression in nonresponding patients.

We agree that the prostate-specific antigen doubling time can give important information about evolution of the disease (aggressive v indolent) in a single patient. It is therefore reasonable that patients with a shorter PSA doubling time should be started earlier on chemotherapy than patients with longer PSA doubling time. We further support the idea to offer clinical trials without cytotoxic agents in patients that are minimally symptomatic from the disease before proceeding with chemotherapy, and pursue this policy in our own institutions.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Although all authors completed the disclosure declaration, the following author(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a "U" are those for which no compensation was received; those relationships marked with a "C" were compensated. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.

Employment or Leadership Position: None Consultant or Advisory Role: Ian Tannock, Sanofi-aventis Stock Ownership: None Honoraria: None Research Funding: Dominik Berthold, Sanofi-aventis; Ian Tannock, Sanofi-aventis Expert Testimony: None Other Remuneration: None

REFERENCES

1. Berthold DR, Pond GR, Soban F, et al: Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer: Updated survival in the TAX 327 study. J Clin Oncol 26:242-245, 2008[Abstract/Free Full Text]

2. Berthold DR, Pond GR, Roessner M, et al: Treatment of hormone-refractory prostate cancer with docetaxel or mitoxantrone: Relationships between PSA, pain and quality of life response and survival in the TAX-327 study. Clin Cancer Res (in press)

Related Correspondence

• Is Chemotherapy the Standard for Asymptomatic Androgen-Independent Prostate Cancer?
  Chadi Nabhan
  JCO 2008 26: 2413-2414 [Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Google Scholar Articles by Berthold, D. Articles by Tannock, I. PubMed Articles by Berthold, D. Articles by Tannock, I. Related Articles Related Correspondence