Clinical Practice Guidelines for the management of locally advanced ...

hydrocortisone respectively. Tannock et al documented that treatment with mitoxantrone resulted in a
significant improvement in pain, quality of life and PSA response. There was no survival benefit
although this was not a study endpoint. Kantoff et al reported similar outcomes.
Subsequently, two pivotal large multicentre phase III studies 14,20 have demonstrated a survival benefit
while maintaining improvements in quality of life for patients receiving docetaxel-based
chemotherapy for their CRPC. These two studies form the basis for the current standard of care in
Australia, docetaxel chemotherapy for CRPC.
Tannock et al (TAX 327 study) enrolled 1006 patients who were randomly assigned to docetaxel
30mg/m 2 weekly for five of every six weeks, docetaxel 75mg/m 2 every three weeks or mitoxantrone
12mg/m 2 every three weeks. 14 All patients received 5mg bd of prednisolone. GnRH was continued.
The majority of patients were Karnofsky performance score >70 and nearly half were asymptomatic.
Up to ten cycles were planned for mitoxantrone and the three-weekly docetaxel group where median
cycles completed were 5 and 9.5 respectively. Median survival was superior in the three-weekly
docetaxel arm compared with mitoxantrone arm (18.9 months and 16.5 months; p=0.009). Threeweekly
docetaxel also led to better pain control (35% versus 22%; p = 0.01), improvement in quality
of life (22% improvement versus 13 % improvement; p=0.005) and PSA decline of >50% (48% vs
32% P