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Update in Oncology
- Julie R. Brahmer, MD
- From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland.
2005–2006 Series: Update Sessions from ACP's 2005 Annual Session
This Update in Oncology focuses on 4 common tumors in patients: prostate cancer, non–small-cell lung cancer, breast cancer, and colorectal cancer. The hot topic in 2004 for prostate cancer was docetaxel. The hot topic for non–small-cell lung cancer was pemetrexed, which was approved for second-line use in 2004, and epidermal growth factor receptor (EGFR) mutations. The hot topic in 2004 for breast cancer was the use of aromatase inhibitors for adjuvant treatment. Finally, the hot topics for colorectal cancer were the trials studying bevacizumab and cetuximab.
Prostate Cancer
For localized prostate cancer, the treatment paradigm is local treatment, radiation, and surgery. For patients with either relapsed or new metastatic disease, the treatment is androgen ablation. Patients with metastatic prostate cancer become androgen-independent at a median of 18 to 24 months after castration. Once the cancer is androgen-independent, median survival is 10 to 12 months. Mitoxantrone combined with prednisone does not improve survival of patients with androgen-independent disease, but it does improve symptoms. Until 2004, no treatment had improved survival.
Docetaxel and Estramustine Improved Survival in Patients with Advanced Prostate Cancer
Docetaxel and paclitaxel have the same mechanism of action: inhibition of microtubule formation during cell division. Estramustine combines an alkylating chemotherapeutic agent and the hormone estradiol. In this trial, the investigators wanted to determine whether the combination of these 2 drugs improved survival in patients with advanced prostate cancer, as compared with what had been standard treatment: mitoxantrone and prednisone.
Trial eligibility requirements included progressive metastatic androgen-independent prostate cancer (defined as a measurable lesion that increased in size within 4 weeks, a worsening bone scan within 42 days of registration, or 2 consecutive increasing serum prostate-specific antigen [PSA] measurements ≥7 days apart); adequate organ function; good performance status; no brain metastasis; no history of recent myocardial infarction or deep venous thrombosis requiring full-dose anticoagulation; …
