Doctors have recently learned, however, that chemotherapy may be more effective at controlling metastatic prostate cancer as an initial treatment, rather than when the cancer has become resistant to hormone therapy. “In just over the past few years, chemotherapy has a new role for us in this patient population,” says Mark Pomerantz, MD, a medical oncologist at the Dana-Farber Cancer Institute in Boston. RELATED: Multidisciplinary Prostate Cancer Clinics Improve Care
Types of Chemotherapy for Prostate Cancer
Chemotherapy drugs for prostate cancer are typically given into a vein as an intravenous (IV) infusion over a period of several hours. This can be done in a doctor’s office, chemotherapy clinic, or in a hospital setting. Some drugs are given as a pill. Chemotherapy is given in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often two or three weeks long. The length of treatment for advanced prostate cancer is based on how well it is working and what side effects you have. (2)
What Chemotherapy Drugs Are Used to Treat Prostate Cancer?
The chemotherapy drugs used for prostate cancer are typically used one at a time. These drugs include:
docetaxel (Taxotere)cabazitaxel (Jevtana)mitoxantrone (Novantrone)estramustine (Emcyt)
In most cases, the first chemotherapy drug given to patients with metastatic prostate cancer is Taxotere. If Taxotere doesn’t work or stops working, the next chemotherapy drug doctors typically try is Jevtana, although doctors may try other drugs or treatment options. (2) RELATED: Cancer Risk Genes: Everything You Need to Know About CDH1
Can Chemotherapy Prolong Life?
Chemotherapy appears to have more significant survival benefits for men who are newly diagnosed with metastatic prostate cancer and have not yet done hormone therapy (referred to as “hormone-sensitive”). Research also suggests that when chemotherapy is given at the same time as hormonal therapy, it can help make the hormonal therapy more effective. “Chemotherapy appears to help delay the development of resistance to the hormone treatment,” explains Dr. Pomerantz. “This prolongs response time and delays the progression of the cancer.” A landmark study from 2015 found that men with newly diagnosed metastatic, hormone-sensitive prostate cancer lived nearly 14 months longer when they received a chemotherapy drug along with hormone therapy compared with those who received hormone therapy alone. (3) A variety of chemotherapy known as platinum-based chemotherapy is currently being studied for use in metastatic prostate cancer patients. These drugs include:
carboplatin (Paraplatin)cisplatin (Platinol)oxaliplatin (Eloxatin)
“While studies done with these drugs so far have been of limited size, platinum appears to be helpful for a subtype of prostate cancer patients with BRCA1 and 2 mutations,” explains Pomerantz. Patients with advanced disease who are not responding to standard chemotherapy can talk to their doctors about whether they might be candidates for platinum chemotherapy. While platinum chemotherapy is not yet approved for prostate cancer treatment by the U.S. Food and Drug Administration, under specific situations, it can sometimes be considered by doctors for patients with advanced prostate cancer. (4) RELATED: Type 2 Diabetes Linked to 11 Cancers in Men, 13 in Women
Possible Side Effects of Chemotherapy
Chemotherapy drugs attack cells that are dividing. They’re effective against cancer because cancer cells divide and multiply quickly. But chemotherapy doesn’t just kill dividing cancer cells; it kills healthy cells such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, as they divide as well. This can lead to side effects. (2) The side effects of chemotherapy depend on the type and dose of drugs given and how long they are taken. Side effects can include:
Hair lossMouth soresLoss of appetiteNausea and vomitingDiarrheaIncreased risk of infections (due to too few white blood cells)Easy bruising or bleeding (from too few blood platelets)Fatigue (from too few red blood cells)Numbness, tingling, or burning sensations in the hands or feet, known as peripheral neuropathy (due to nerve damage)
Discuss any side effects that you experience with your cancer team so they can be treated promptly. There are often ways to lessen these side effects with supportive care such as medication to reduce nausea. In some cases, the dose of the chemotherapy or the timing of your treatments may need to be adjusted.
