Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Clinical Research
  • Published:

Real-world utilization and outcomes of docetaxel among older men with metastatic prostate cancer: a retrospective population-based cohort study in Canada

Prostate Cancer and Prostatic Diseases volume 26, pages 74–79 (2023)Cite this article

Subjects

Abstract

Background

The adoption of docetaxel for systemic treatment of metastatic prostate cancer (PCa), in both castration-sensitive (mCSPC) and castration-resistant (mCRPC) settings, is poorly understood. This study examined the real-world utilization of docetaxel in these patients and their outcomes.

Methods

A retrospective population-based study used administrative data from Ontario, Canada, to identify men aged ≥66 years who were diagnosed with de novo mCSPC or mCRPC between 2014 and 2019 and received docetaxel. The study assessed treatment tolerability and toxicity, and survival in both cohorts. Descriptive and comparative statistical analysis were conducted.

Results

The study identified 11.2% (399/3556) and 13.2% (203/1534) patients diagnosed with de novo mCSPC and with mCRPC who received docetaxel respectively. The median age in both cohorts was 72 years (IQR: 68–76). Overall, 43.9% (n = 175) patients with de novo mCSPC and 52.1% (n = 85) with mCRPC completed ≥6 cycles of docetaxel. Over two-fifth also needed dose adjustments in both cohorts. Hospitalization or emergency department visit for febrile neutropenia were noted in 15.8% (n = 63) of de novo mCSPC patients and similarly in 19% (n = 31) of mCRPC cohort. The median survival of PCa patients who completed ≥6 cycles of docetaxel was significantly longer relative to those who completed <4 cycles: 32.7 vs. 23.5 months (p < 0.001) for mCSPC and 20.5 vs. 10.7 (p = 0.012) for mCRPC respectively.

Conclusions

In this population-based study of elderly patients with metastatic PCa, treatment with docetaxel was associated with poor tolerability and higher toxicity compared with clinical trials. Receipt of limited cycles and reduced overall dose of docetaxel were associated with inferior overall survival.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Docetaxel treatment characteristics in de novo CSPC (n = 399), by days from ADT initiation to start of chemotherapy.
Fig. 2: Median survival*, by cohort and by cycle number of docetaxel.

Similar content being viewed by others

Data availability

Health administrative databases for Ontario, Canada, are housed at IC/ES (www.ices.on.ca, accessed on 31 March 2020).

References

  1. Advanced/Metastatic Prostate Cancer: Clinical Practice Guideline GU-010, version 2: Alberta Health Services. 2020. https://www.albertahealthservices.ca/assets/info/hp/cancer/if-hp-cancer-guide-gu010-met-prostate.pdf.

  2. Canadian Cancer Statistics Advisory Committee. Canadian Cancer Statistics: Toronto, ON: Canadian Cancer Society; 2019. cancer.ca/Canadian-Cancer-Statistics-2019-EN.

  3. Siegel DA, O’Neil ME, Richards TB, Dowling NF, Weir HK. Prostate Cancer Incidence and Survival, by Stage and Race/Ethnicity—United States, 2001–2017. MMWR Morb Mortal Wkly Rep. 2020;69:1473–80. https://www.cdc.gov/mmwr/volumes/69/wr/mm6941a1.htm#contribAff.

  4. So AI, Chi KN, Danielson B, Fleshner NE, Kapoor A, Niazi T, et al. Canadian Urological Association—Canadian Urologic Oncology Group guideline on metastatic castration-naive and castration-sensitive prostate cancer. Can Urol Assoc J. 2020;14:17–23.

    PubMed  Google Scholar 

  5. Mosillo C, Iacovelli R, Ciccarese C, Fantinel E, Bimbatti D, Brunelli M, et al. De novo metastatic castration sensitive prostate cancer: state of art and future perspectives. Cancer Treat Rev. 2018;70:67–74.

    Article  PubMed  Google Scholar 

  6. Sweeney CJ, Chen YH, Carducci M, Liu G, Jarrard DF, Eisenberger M, et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med. 2015;373:737–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Clarke NW, Ali A, Ingleby FC, Hoyle A, Amos CL, Attard G, et al. Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial. Ann Oncol. 2019;30:1992–2003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Fizazi K, Tran N, Fein L, Matsubara N, Rodriguez-Antolin A, Alekseev BY, et al. Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med. 2017;377:352–60.

    Article  CAS  PubMed  Google Scholar 

  9. Parker CC, James ND, Brawley CD, Clarke NW, Hoyle AP, Ali A, et al. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet. 2018;392:2353–66.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chi KN, Agarwal N, Bjartell A, Chung BH, Pereira de Santana Gomes AJ, Given R, et al. Apalutamide for metastatic, castration-sensitive prostate cancer. N Engl J Med. 2019;381:13–24.

    Article  CAS  PubMed  Google Scholar 

  11. Davis ID, Martin AJ, Stockler MR, Begbie S, Chi KN, Chowdhury S, et al. Enzalutamide with standard first-line therapy in metastatic prostate cancer. N Engl J Med. 2019;381:121–31.

    Article  CAS  PubMed  Google Scholar 

  12. Gravis G. Systemic treatment for metastatic prostate cancer. Asian J Urol. 2019;6:162–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tannock IF, de Wit R, Berry WR, Horti J, Pluzanska A, Chi KN, et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med. 2004;351:1502–12.

    Article  CAS  PubMed  Google Scholar 

  14. Malone S, Shayegan B, Basappa NS, Chi K, Conter HJ, Hamilton RJ, et al. Management algorithms for metastatic prostate cancer. Can UrolAssoc J. 2019;14:50–60.

  15. Saad F, Aprikian A, Finelli A, Fleshner NE, Gleave M, Kapoor A, et al. 2021 Canadian Urological Association (CUA)-Canadian Uro Oncology Group (CUOG) guideline: Management of castration-resistant prostate cancer (CRPC). Can Urol Assoc J. 2021;15:E81–90.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lowrance WT, Breau RH, Chou R, Chapin BF, Crispino T, Dreicer R, et al. Advanced prostate cancer: AUA/ASTRO/SUO Guideline PART II. J Urol. 2021;205:22–9.

    Article  PubMed  Google Scholar 

  17. Schaeffer E, Srinivas S, Antonarakis ES, Armstrong AJ, D’Amico AV, Davis BJ, et al. Prostate cancer, Version 2.2021, NCCN clinical practice guidelines in oncology. 2021. https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf.

  18. EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam 2020: Arnhem, The Netherlands: EAU Guidelines Office; 2020. http://uroweb.org/guidelines/compilations-of-all-guidelines/.

  19. Wallis CJD, Malone S, Cagiannos I, Morgan SC, Hamilton RJ, Basappa NS, et al. Real-world use of androgen-deprivation therapy: intensification among older Canadian men with de novo metastatic prostate cancer. JNCI Cancer Spectr. 2021;5:pkab082. https://doi.org/10.1093/jncics/pkab082.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Freedland SJ, Sandin R, Sah J, Emir B, Mu Q, Ratiu A, et al. Survival outcomes in patients with metastatic castration-sensitive prostate cancer (mCSPC): a real-world evidence study. J Clin Oncol. 2021;39(6_suppl):46. https://doi.org/10.1200/JCO.2021.39.6_suppl.46.

  21. Eichler HG, Abadie E, Breckenridge A, Flamion B, Gustafsson LL, Leufkens H, et al. Bridging the efficacy-effectiveness gap: a regulator’s perspective on addressing variability of drug response. Nat Rev Drug Discov. 2011;10:495–506.

    Article  CAS  PubMed  Google Scholar 

  22. Nordon C, Karcher H, Groenwold RH, Ankarfeldt MZ, Pichler F, Chevrou-Severac H, et al. The “efficacy-effectiveness gap”: historical background and current conceptualization. Value Health. 2016;19:75–81.

    Article  PubMed  Google Scholar 

  23. Lavoie JM, Zou K, Khalaf D, Eigl BJ, Kollmannsberger CK, Vergidis J, et al. Clinical effectiveness of docetaxel for castration-sensitive prostate cancer in a real-world population-based analysis. Prostate. 2019;79:281–7.

    Article  CAS  PubMed  Google Scholar 

  24. Rulach RJ, McKay S, Neilson S, White L, Wallace J, Carruthers R, et al. Real-world uptake, safety profile and outcomes of docetaxel in newly diagnosed metastatic prostate cancer. BJU Int. 2018;121:268–74.

    Article  CAS  PubMed  Google Scholar 

  25. Kushnir I, Koczka K, Ong M, Canil C, Bossé D, Sabri E, et al. The timing of docetaxel initiation in metastatic castrate-sensitive prostate cancer and the rate of chemotherapy-induced toxicity. Med Oncol. 2019;36:18.

    Article  PubMed  Google Scholar 

  26. Fu SYF, Barlow P, Jacobs CM, Hanning FJ, Fong PCC. Real world experience of docetaxel in elderly patients with advanced prostate cancer. J Clin Oncol. 2018;36(6_suppl):313. https://doi.org/10.1200/JCO.2018.36.6_suppl.313.

  27. Maia MC, Pereira AAL, Lage LV, Fraile NM, Vaisberg VV, Kudo G, et al. Efficacy and safety of docetaxel in elderly patients with metastatic castration-resistant prostate cancer. J Glob Oncol. 2018;4:1–9.

    PubMed  Google Scholar 

  28. Templeton AJ, Vera-Badillo FE, Wang L, Attalla M, De Gouveia P, Leibowitz-Amit R, et al. Translating clinical trials to clinical practice: outcomes of men with metastatic castration resistant prostate cancer treated with docetaxel and prednisone in and out of clinical trials. Ann Oncol. 2013;24:2972–7.

    Article  CAS  PubMed  Google Scholar 

  29. Kushnir I, Mallick R, Ong M, Canil C, Bossé D, Koczka K, et al. Docetaxel dose-intensity effect on overall survival in patients with metastatic castrate-sensitive prostate cancer. Cancer Chemother Pharmacol. 2020;85:863–8.

    Article  CAS  PubMed  Google Scholar 

  30. Gravis G, Fizazi K, Joly F, Oudard S, Priou F, Esterni B, et al. Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer (GETUG-AFU 15): a randomised, open-label, phase 3 trial. Lancet Oncol. 2013;14:149–58.

    Article  CAS  PubMed  Google Scholar 

  31. Franke RM, Carducci MA, Rudek MA, Baker SD, Sparreboom A. Castration-dependent pharmacokinetics of docetaxel in patients with prostate cancer. J Clin Oncol. 2010;28:4562–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

IQVIA team was hired by Janssen Inc. to assist with writing and editing the paper. We would like to thank Bo Zhang for the analysis of the data and Yang Yun Li for her assistance with the study logistics. CJDW had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This study contracted ICES Data & Analytic Services (DAS) and used de-identified data from the ICES Data Repository, which is managed by ICES with support from its funders and partners: Canada’s Strategy for Patient-Oriented Research (SPOR), the Ontario SPOR Support Unit, the Canadian Institutes of Health Research and the Government of Ontario. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). Parts of this material are based on data and information compiled and provided by CIHI.

Funding

This research was funded by Janssen Inc. grant numbers NOPRODPCR0001.

Author information

Authors and Affiliations

  1. St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada

    Bobby Shayegan

  2. Mount Sinai Hospital, Toronto, ON, Canada

    Christopher J. D. Wallis

  3. Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada

    Robert J. Hamilton

  4. The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada

    Scott C. Morgan, Ilinas Cagiannos & Shawn Malone

  5. Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada

    Naveen S. Basappa

  6. Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC, Canada

    Cristiano. Ferrario

  7. Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada

    Geoffrey T. Gotto

  8. London Regional Cancer Program, London, ON, Canada

    Ricardo Fernandes

  9. Radiation Oncology, Rush University Cancer Center, Chicago, IL, USA

    Soumyajit Roy

  10. BC Cancer Agency, University of British Columbia, Surrey, BC, Canada

    Krista L. Noonan

  11. Jewish General Hospital, McGill University, Montreal, QC, Canada

    Tamim Niazi

  12. Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada

    Sebastien J. Hotte

  13. Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC, Canada

    Fred Saad

  14. Janssen Inc., Toronto, ON, Canada

    Huong Hew, Laura Park-Wyllie & Katherine F. Y. Chan

Authors
  1. Bobby Shayegan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher J. D. Wallis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert J. Hamilton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Scott C. Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ilinas Cagiannos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Naveen S. Basappa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cristiano. Ferrario
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Geoffrey T. Gotto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ricardo Fernandes
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Soumyajit Roy
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Krista L. Noonan
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tamim Niazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Sebastien J. Hotte
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Fred Saad
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Huong Hew
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Laura Park-Wyllie
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Katherine F. Y. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Shawn Malone
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Concept and design: All authors. Acquisition, analysis, or interpretation of data: CJDW, KFYC, LPW, SM, BS. Drafting of the paper: CJDW, KFYC, LPW, SM, and BS. Critical revision of the paper for important intellectual content: All authors. Statistical analysis: CJDW, KFYC, and LPW. Administrative, technical, or material support: CJDW, KFYC, and LPW. Supervision: BS and SM.

Corresponding author

Correspondence to Christopher J. D. Wallis.

Ethics declarations

Competing interests

BS: Honoraria: Abbvie, Astellas Pharma; Bayer; Janssen; Knight Pharmaceuticals; TerSera. Consulting or Advisory role: Abbvie, Astellas Pharma; Bayer; Janssen; Knight Pharmaceuticals; TerSera Speakers’ Bureau: Abbvie, Astellas Pharma; Bayer; Janssen; Knight Pharmaceuticals; TerSera. Research Funding: Astellas Pharma; Janssen; Merck. CJDW: Consulting or Advisory role: Janssen Oncology. RJH: Honoraria: Abbvie; Amgen; Astellas Pharma: Bayer; Janssen. Research Funding: Bayer; Janssen. Travel, Accommodations, Expenses: Janssen. SCM: Consulting or Advisory role: Astellas Pharma; Bayer; Janssen; TerSera. IC: Honoraria: Abbvie; Ferring. Travel, Accommodations, Expenses: TerSera. NSB: Honoraria: Astellas Pharma; Eisai; Ipsen; Janssen; Merck; Pfizer. Consulting or Advisory role: Astellas Pharma; AstraZeneca; Bayer; Bristol-Myers Squibb; Eisai; Ipsen; Janssen; Merck; Pfizer; Roche Canada. Travel, Accommodations, Expenses: Eisai. CF: Honoraria: Astellas Pharma; AstraZeneca; Bayer; Lilly; Merck; Novartis; Pfizer. Consulting or Advisory role: AstraZeneca; Odonate Therapeutics; Pfizer; Roche. Speakers’ Bureau: Janssen. Research Funding: Astellas Pharma; AstraZeneca; Immunomedics; Janssen; Merck; Novartis; Pfizer; Roche; Sanofi; Seattle Genetics. GTG: Honoraria: Amgen; Astellas Pharma; Bayer; Janssen; Merck. Consulting or Advisory role: Amgen; Astellas Pharma; Bayer; Janssen; Merck. Expert Testimony: Janssen. Travel, Accommodations, Expenses: Janssen. RF: Honoraria: Bayer; Merck; Pfizer. Consulting or Advisory role: Bayer; Janssen; Novartis Canada Pharmaceuticals Inc; Pfizer. Travel, Accommodations, Expenses: Janssen. SR: Grant: Abbvie-Canadian Association of Radiation Oncology Urologic Radiation Oncology Award (ACURA) research grant for PCa. KLN: Consulting or Advisory role: AstraZeneca; Bristol-Myers Squibb; Ipsen; Janssen; Janssen Oncology; Merck; Pfizer; Roche Canada; Sanofi. Speakers’ Bureau: Merck. TN: Honoraria: Abbvie; Astellas Pharma; Bayer; Janssen Oncology; Sanofi; Tersera. Consulting or Advisory role: Abbvie; Bayer; Janssen Oncology; Sanofi; Tersera. Research Funding: Astellas Pharma (Inst); Bayer (Inst); Sanofi (Inst); Tersera (Inst). Travel, Accommodations, Expenses: Janssen Oncology; Sanofi; Tersera. SJH: Honoraria: Astellas Scientific and Medical Affairs Inc; Bayer; Janssen Oncology; Merck . Consulting or Advisory role: Astellas Pharma; AstraZeneca; Bayer; Bristol-Myers Squibb; Eisai; Ipsen; Janssen; Merck; Pfizer; Roche Canada. Research Funding: Astellas Pharma (Inst); AstraZeneca (Inst); Ayala Pharmaceuticals (Inst); Bristol-Myers Squibb (Inst); Clovis Oncology (Inst); Janssen Oncology (Inst); Merck (Inst); Pfizer (Inst); Roche/Genentech (Inst); Seattle Genetics (Inst); SignalChem (Inst). Travel, Accommodations, Expenses: Eisai. FS: Honoraria: Abbvie; Astellas Pharma; AstraZeneca; Bayer; Janssen Oncology; Myovant Sciences; Pfizer; Sanofi. Consulting or Advisory role: Abbvie; Astellas Pharma; AstraZeneca/MedImmune; Bayer; Janssen Oncology; Myovant Sciences; Pfizer; Sanofi. Research Funding: Astellas Pharma (Inst); AstraZeneca (Inst); Bayer (Inst); Bristol-Myers Squibb (Inst); Janssen Oncology (Inst); Pfizer (Inst); Sanofi (Inst). HH: Employment—Janssen. LPW: Employment—Janssen. KFYC: Employment—Janssen. SM: Honoraria: Astellas Pharma; Bayer; Janssen; Sanofi. Travel, Accommodations, Expenses: Sanofi; Tersera.

Ethics approval and consent to participate

Research ethics approval from Advarra IRB (Pro00037601). Patient consent was waived because ICES is a named prescribed entity, under section 45(1) of the Personal Health Information Protection Act, 2004, it has statutory authority to conduct health services research without consent using anonymized administrative data.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shayegan, B., Wallis, C.J.D., Hamilton, R.J. et al. Real-world utilization and outcomes of docetaxel among older men with metastatic prostate cancer: a retrospective population-based cohort study in Canada. Prostate Cancer Prostatic Dis 26, 74–79 (2023). https://doi.org/10.1038/s41391-022-00514-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41391-022-00514-9

This article is cited by

Search

Advanced search

Quick links