Docetaxel Chemotherapy for Metastatic Prostate Cancer
Docetaxel Regimen
Indication: Typically used for hormone-resistant metastatic prostate cancer. Can be used in combination with androgen deprivation therapy (ADT) and androgen receptor pathway inhibitor (ARPI) for patients with high volume or de novo metastatic hormone sensitive prostate cancer.
Dosage: 75 mg/m² intravenously every 3 weeks for a total of 6 cycles (18 weeks).
Premedication: Corticosteroids (e.g., dexamethasone) are administered to reduce side effects like hypersensitivity and fluid retention.
Survival Advantage
Overall Survival (OS): Provides a survival benefit compared to ADT alone.
Median overall survival improvement of 10–15 months, particularly in high-volume disease.
Patients with high-volume disease (extensive metastases) derive the greatest benefit.
Specific Benefits
Improved Disease Control: Longer time to disease progression and castration resistance.
Prolonged Survival: Increased overall survival, especially in high-volume disease.
Reduced Symptom Burden: Delays complications such as bone pain and fractures.
Synergistic with ADT: Enhances the efficacy of ADT.
Risks and Probabilities
Common Side Effects
Neutropenia: ~32–39% (febrile neutropenia ~6%).
Fatigue: ~30%.
Alopecia: ~65–75%.
Nausea/Vomiting: ~12–15%.
Peripheral Neuropathy: ~10–15% (usually mild to moderate).
Diarrhea: ~5–10%.
Nail Changes: ~10%.
Serious Risks
Febrile Neutropenia: ~6–8% (use of prophylactic G-CSFs recommended).
Hepatotoxicity: ~5–10% (elevated liver enzymes).
Cardiotoxicity: Rare (~1%).
Rare but Severe Risks
Hypersensitivity Reactions: Managed by corticosteroid premedication.
Secondary Malignancies: Rarely reported but possible.
Patient Selection Considerations
Best Candidates: Good performance status (ECOG 0–1), adequate organ function, and high-volume disease.
Caution: Use in elderly, frail patients, or those with significant comorbidities (cardiac or hepatic disease).
