Tannock IF et al. (2004) Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 351: 1502–1512

Mitoxantrone plus a corticosteroid is an established palliative treatment for men with metastatic, hormone-refractory prostate cancer. A recent international study has compared this approach with two docetaxel regimens, in an attempt to improve survival in these patients.

The TAX 327 trial included 1,006 men with advanced prostate cancer, all of whom received daily, low-dose prednisone. In addition, patients were randomized to mitoxantrone (n = 337), docetaxel every 3 weeks (n = 335), or lower doses of docetaxel given weekly (n = 334). Outcomes were compared between the three treatment groups after a median follow-up of approximately 21 months.

Median overall survival was significantly longer in men who received docetaxel every 3 weeks than in those treated with mitoxantrone (18.9 vs 16.5 months; hazard ratio for death 0.76, 95% CI 0.62 to 0.94, P = 0.009). The difference in survival between the weekly docetaxel and the mitoxantrone group was not significant. Reductions in pain, improvements in quality of life and PSA responses were more frequent in both docetaxel groups than in the mitoxantrone group. This was tempered, however, by an increase in low-grade adverse events with docetaxel treatment.

Concluding that docetaxel plus prednisone significantly prolonged survival in this study, the authors suggest that this option is preferable to standard, palliative treatment in most patients. They propose that docetaxel should be given at 3 week intervals for convenience, since the weekly schedule provided no additional benefit.