Taxotere-, Zometa-, og palliativ strålebehandling hos pasienter med hormonrefraktær prostatakreft ved Ahus

Abstract

Bakgrunn: Det har vært reist spørsmål om de pasienter som trenger det, får behandling med Taxotere, og andre palliative behandlingstiltak. Vi har derfor kartlagt bruken av Taxotere mht effekt og bivirkninger.

Materiale og metode: En retrospektiv databasert studie (DIPS) er gjort på alle pasienter i kontakt med sykehuset i løpet av 2006 som hadde kombinasjonen av diagnosekode C61 (CaP) og en eller flere metastasekoder (n=69). Sekstien pasienter ble funnet (i 2006). Journaldata ble registrert ut 2007. Av disse pasientene plukket vi ut de som var i hormonrefraktær fase i løpet av observasjonstiden.

Resultater: 48 pasienter (79%) kom i hormonrefraktær fase (HRF), definert som PSA stigning i tre påfølgende blodprøver etter initialt fall på hormonbehandling. Seks av disse hadde ikke symptomer ila observasjonstiden (på smertestillende behandling). Alle pasientene hadde skjelettmetastaser, og 22 (46%) hadde metastaser allerede på diagnosetidspunkt. Andelen Gleason 8-10 (hissig cancer) i materialet var 26 (54%). Andelene T1 var 8 (17%), T2 13 (27%), T3 26 (54%) og T4 1 (2%) (ved diagnosetidspunkt). Palliativ stålebehandling ble gitt til 31 (65%) av pasientene. Fem (10%) fikk palliativ stråling mot prostata, 7 (15%) fikk channelling TUR-P.

Tretten (27%) fikk tilbud om Taxotere. Alle hadde symptomgivende sykdom. Fire fikk ikke behandling pga raskt progredierende sykdom. Ni (19%) pasienter fikk Taxotere.

Ant.pas. (%) Alder (range) Total tid* n = 48 v/ sykd debut v/HRF i mnd til HRF

Taxotere (+Zometa hos 7) 9 (19%) 63.1 (53-75) 67,6 (54-77) 20,4 (14-26) Kun Zometa 19 (40%) 69,0 (55-75) 72,3 (62-82) 19,2 (16-33) Annen pall.beh. 20 (41%) 67,3 (50-79) 71,8 (52-82) 20,4 (17-31) ----------------------------------------------------------------------------------------------------------------- Total: 48 (100%) 67,2 (50-79) 71,2 (52-82) 20,0 (=1 2/3år)

*Gjennomsnittstiden er beregnet fra oppstart hormonbehandling med LHRH analog til PSA begynner å stige. Målt fra oppstart antiandrogenbehandling: 23 mnd, 2 år (range 17-33 mnd).

I snitt gikk det 7 måneder (3-11 mnd) mellom PSA stigning (”HRF”) og oppstart av Taxotere. Fire av 9 (44%) avsluttet behandlingen etter 2-6 beh pga bivirkninger (3 fikk neutropen feber, 1 pga GI-plager og tretthet). Fem av 9 (56%) avslutter behandlingen pga biokjemisk sykdoms-progresjon etter 7-24 behandlinger, i snitt 8 mnd (4-12 mnd) etter oppstart Taxotere. Med unntak av de som fikk neutropen feber, så vi behandlingseffekt på PSA hos alle som fikk Taxotere over noe tid. Vi fant reduksjon i opiatforbruket hos 4/9 (44%) på Taxotere, og 12/19 (63%) på Zometa.

Konklusjon: Taxotere tilbys circa ¼ av pasientene, og kun circa halvparten tåler behandlingen. Palliativ strålebehandling gis i stor utstrekning. Taxotere-pasientene tenderer til å være yngre enn de som får Zometa. Ahus synes å være aktive med hensyn til palliativ, resurskrevende behandling for CaP pasienter, men Taxotere gis sent i forløpet.

Abstract Backgrounds: Some questions have been considered whether patients who need it or not, is given chemotherapy (Taxotere) and other palliative treatments. We have looked upon the use and effect of these treatments. Materials and methods: A retrospective trial has been made, based upon data materials from DIPS, including all patients being in contact with the hospital in 2006, and having a combination of the diagnostic code C61 (CaP) and one or several codes for metastatic disease (n=69). Eight patients (12%) were miscoded (having another type of cancer). Sixtyone patients were found for 2006. Registration of data materials continued to the end of 2007. Results: From our group of patients we found 48 (79%), which were reaching hormone-refractory fase (HRF) during this period. Hormone-refractory phase is defined as an increasingly PSA-value in both of three following bloodsamples, initially after a decrease as a respons of hormone treatment. All the patients got metastases to the skeleton, and 22 (46%) had metastases at the time they were diagnosed. Included in this group of 22, seven (15%) patients also had metastases to their soft tisses when diagnosed. Twentysix patients (54%) did have a Gleason score of 8-10, and those having T1 were 8 (17%), T2 13 (27%), T3 27 (56%) and T4 1 (2%), at the time the diagnose was established. Palliative radiation therapy (RT) was given to 31 (65%) of the patients (6/9 in the Taxotere-group and 15/19 in the Zometa-group, and 10/20 for those getting other palliative treatment). Five patients (10%) got palliative RT directed towards the prostate gland, 7 (15%) got channelling TUR-P. Thirteen patients (27%) were offered Taxotere. All the patients did have a disease showing manifested symptoms. Four of the patients did not get any treatment according to fast progression of the disease. Nine patients (19%) thus got Taxotere treatment, 4/9 (44%) had an increasingly PSA during the courses, while the PSA decreased for 5/9 (56%). 6/48 (12%) of all the patients didn`t have painful metastases and weren`t given Taxotere, nor offered it.

Number (%) Age (range) Total time to HRF n=48 by debut/disease by HRF in months Taxotere (7 given Zometa) 9 (19%) 63,1 (53-75) 67,6 (54-77) 20,4 (14-26) Zometa only 19 (40%) 69,0 (55-75) 72,3 (62-82) 19.2 (16-33) Other pall treatment 20 (41%) 67,3 (50-79) 71,8 (52-82) 20,4 (17-31) Total: 48 (100%) 67,2 (50-79) 71,2 (52-82) 20,0 (14-33) The average time from start of hormone treatment (LHRH agonists) to HRF was 20 months (14-33 months). From start of Casodex treatment average time to HRF was 23 months (17-36). Average time between hormone-refractory phase and time for Taxotere treatment was 7 months (3-11 months). Owing to neutropen fever etc four out of nine quickly ended the chemotherapy. Five out of nine (56%) got 7-24 courses of treatment, and the treatment was completed at an average time of 8 months (4-12), due to biochemical (PSA) progression. Effect on PSA was seen for all the patients on Taxotere, except for those getting neutropen fever. Reduction in the use of opiates was found at 4/9 (44%) in the Taxotere-group, and at 12/19 (63%) in the Zometa-group. Conclusion: Palliative radiation therapy is given at a great extent, and almost all the patients treated with Zometa get this treatment. Taxotere is offered to nearly ¼ of the patients, and half of them tolerates the treatment. The Taxotere patients seem to be younger compared to the Zometa patients. Ahus seems to be very active in giving palliative, resource demanding treatment for the CaP patients, although Taxotere is given late in the course of the disease.