Taxotere was originally approved in the U. S. for the treatment of advanced or metastatic breast cancer after failure of prior chemotherapy, as well as for patients with locally advanced or metastatic non-small-cell lung cancer. Today, Taxotere is the standard of care for men with advanced prostate cancer.
What can be done to prolong the life of a man who has advanced prostate cancer? More than three decades ago, chemotherapy was tried in an effort to delay the progression of advanced prostate cancer, but the results were extremely disappointing. This was due in great part to the fact that the drugs being used were not designed for prostate cancer. This crude chemotherapy was the last chance at survival for men who were in pain and extremely weak -- poor candidates for such treatment to begin with.
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However, that was yesterday's approach. We are in a new era, using "smart" drugs that block important molecular steps in prostate cancer cell growth. In an effort to prolong the lives and ease the pain of advanced prostate cancer patients, researchers have been working to find compounds that will successfully counter this deadly force.
The drug Taxotere (docetaxel, Sanofi-Aventis) was the first agent to have a positive impact for men with advanced cancer. Taxotere is now the standard of care for men with metastatic hormone-refractory prostate cancer because this drug has demonstrably improved quality of life (by reducing pain) and can extend the life of the advanced prostate cancer patient.
Taxotere is a drug in the taxoid class of chemotherapeutic agents that inhibits cancer cell division by inhibiting the effects of Bcl-2, a protein that is thought to prevent cancer cells from dying. The drug essentially "freezes" the cell's internal skeleton, which is comprised of microtubules. These are hollow tubular structures, composed of the protein tubulin, that help maintain the shape and movement of a living cell and the transport of material within it. These microtubules assemble and disassemble during a cell cycle. Taxotere promotes their assembly but then prevents their disassembly; if cancer cells cannot divide, the result is cancer cell death. Once exposed to Taxotere, these cancer cells do die.
At least 50% of the patients who use the drug will get a remission of some duration. In the studies, the men who received Taxotere-based therapy lived, on average, about three months longer when compared to men who received the old drug combination of prednisone (a corticosteroid) and the cancer medication Novantrone (mitoxantrone), which was approved by the FDA in 1996 as a treatment for the pain of metastatic prostate cancer.
A common side effect from chemotherapy with Taxotere is numbness and tingling of the fingers and toes. Luckily, this does not usually interfere with the activities of daily living. Other side effects can include nausea and vomiting, which are typically mild, hair loss (25% of patients will go bald), increased chance of bleeding or infection, and anemia. However, with improvements in supportive care, including anti-nausea and anti-anxiety medications, most side effects are reversible, short-lived, and present only for the duration of therapy. Many men are able to complete all courses of the therapy.
Taxotere, like hormonal therapy, kills a significant number of cancer cells, but not all of them. The population of cells that is not killed may take a short or long time to finally return, depending on how severely they are stressed. Decreases in PSA are an important indicator that the drug is working. However, if a man is having side effects and his PSA is not dropping, within six to nine weeks we know that this is not the right agent, and some other therapy needs to be initiated if the patient is interested in continuing treatment.
