associated with three-weekly docetaxel com-

cisplatin, using PSA and palliation endpoints,

pared with

mitoxantrone

has

persisted

after

have demonstrated greater evidence of benefit.27

3 years follow-up with a slightly increased median

Treatments under investigation include the first

survival difference of 3 months.24 Furthermore,

orally available platinum drug satraplatin, com-

in patients with symptomatic osseous metastases

binations of docetaxel with another agent and

due to HRPC, either docetaxel or mitoxantrone

the tyrosine kinase receptor inhibitors sunitinib

with prednisone or hydrocortisone are possible

and sorafenib. Cyclophosphamide seems to be

therapeutic options.20

an interesting agent for the treatment of doc-

Nevertheless, answers to the questions which

etaxel-resistant HRPC.28 Furthermore, a phase I

need to be treated, when to initiate docetaxel-

trial reported that the combination of thalido-

based chemotherapy and on the duration of

mide and oral cyclophosphamide is well tole-

therapy remains unclear.In the updated survival

rated and appears to be associated with

analysis of

TAX

327,

patients with

PSA

biochemical response in patients with HRPC.29

level < 114

ng/mL

and PSA

doubling

time

(PSADT) ³55 days

have

a

median OS of

Conclusion

24.7 months, while those with PSA level ³114 ng

/mL and a PSADT < 55 days have a median OS of

Chemotherapy should be considered as a treat-

only 13.8 months. The investigators suggest that

ment option for patients with HRPC. Hopefully

in patients with fast disease progression chemo-

one or more combinations with docetaxel or

therapy may be started earlier when metastases

new agents with improved survival benefit and

are not yet symptomatic.25 However, the optimal

reasonable tolerability will be developed for

timing of docetaxel-based chemotherapy is still

treating HRPC in the near future. The optimal

debated. Regarding the duration of treatment,

timing of docetaxel-based chemotherapy is still

studies investigating interruptions in treatment

unknown. Therefore, the benefits of early che-

schedules for patients who experience an initial

motherapy should be carefully balanced against

response to chemotherapy are needed to define

its potential toxicity risk. In addition, further

the future role of intermittent chemotherapy for

investigation through randomized clinical trials

the treatment of prostate cancer. This approach

is warranted to define the precise role of neoad-

with chemotherapy holidays may avoid or delay

juvant and adjuvant chemotherapy in high-risk

the development of progressive toxicity.26

populations with prostate cancer.