Docetaxel and prostate cancer

Prostate cancer is currently the most-frequency malignancy in men, and the second cause of death from cancer in the Western world. Once the disease has metastasized, palliative treatment is the rule. First-sine therapy consists in surgical or chemical castration, associated or not with anti-androgens. This treatment approach is active in 80% cases but failures occur within 12-18 months. When the disease becomes refractory to hormone therapy, few alternatives are available. The combination of mitoxantrone-steroids improves clinical symptoms, namely by reducing pain, but does not improve patient survival. Both docetaxel and estramustine act through microtubules and synergistic interactions have been shown between these two compounds. Recently, several studies have demonstrated the efficacy of a combination of estramustine and taxanes, and in particular docetaxel. Phase II trials using docetaxel monotherapy have demonstrated responses rates concerning PSA of 45 to 58% and objective response of 33% and 40%. Combination with estramustine increases the biochemical response rate from 45% and 74%. A randomized phase II trial revealed the superiority of this combination compared to mitoxantrone in terms of response rate and clinical benefit. The results of phase III trials are still not available, in particular as concerns survival, but the combination docetaxel-estramustine appears very promising, even though the ideal therapeutic protocol is still under evaluation.