Assessment of Addition Docetaxel to Androgen Deprivation Therapy for Patients with Hormone-sensitive Metastatic Prostate Cancer : Experience of the Oncology/Hematology center of Med VI University Hospital Center, Marrakech

Abstract :

Background: Prostate cancer (PCa) is a major health problem with more than three hundred thousand deaths worldwide. Androgen deprivation treatment (ADT) was the standard for first-line metastatic disease with survival ranging from 31 to 49 months. However, most patients developed ADT resistance with a median sensitivity duration estimated at 36 months. At an early stage, in patients with hormone-sensitive metastatic prostate cancer 3 randomized trials were performed, comparing 2 arms (ADT alone as standard to an experimental arm combining ADT with docetaxel), and have revealed survival outcomes that are not all statistically significant. The aim of this work is to assess the efficiency and the tolerance of the association ADT + docetaxel in the metastatic prostate cancer hormono-sensitive in 1st line.Methods : This is a retrospective study conducted from March 2015 until December 2017 in the Oncology/Hematology Center of the Med VI University Hospital Center in Marrakech. All patients under supervision and treatment for metastatic prostate cancer evaluated after 3, 6,9 and 12 months with a high volume disease are part of our study. Patients were assigned to docetaxel at a dose of 75 mg per square meter of body-surface area given every 3 weeks for six cycles cycles without prednisolone combined to medical castration by goserelin 10.8 mg and zoledronic acid. The parameters studied were epidemiological data, response rate, psa rate, and tolerance.Results : A total of 12 patients under supervision for metastatic prostate cancer were gathered in the Oncology / Hematology Center of the VI Med University Hospital Center in Marrakech. At the end of the 12-month evaluation period , 9 patients (75%) had a clinical benefit (partial response and clinical stability), , 2 patients had radiological progression. The proportion of patients who decreased their PSA level to less than 6 ng per milliliter at 12 months was 42%. A complete clinical response with motor recovery was observed in a patient with spinal metastases and spinal cord compression D5-D7. No death has been recorded. The toxicities mostly encountered were neutropenia with 42% grade 3-4 neutropenia and 17% feile neutropenia, 17% grade 3 allergy reactions , 25% grade 3 diarrhea and 8% grade3 peripheral neuropathy. Conclusion : The results obtained in this small series are encouraging and have demonstrated the efficacy and tolerance of the ADT plus docetaxel combination. Our study suggests the importance of conducting further national studies for this type of patients given the prevalence of metastatic prostate cancer in Morocco

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