A phase 2 trial of salvage radiation and concurrent weekly docetaxel after a rising prostate-specific antigen level after radical prostatectomy

William C Jackson, Felix Y Feng, Stephanie Daignault, Maha Hussain, David Smith, Kathleen Cooney, Kenneth Pienta, Shruti Jolly, Brent Hollenbeck, Karin B Olson, Howard M Sandler, Michael E Ray, Daniel A Hamstra, William C Jackson, Felix Y Feng, Stephanie Daignault, Maha Hussain, David Smith, Kathleen Cooney, Kenneth Pienta, Shruti Jolly, Brent Hollenbeck, Karin B Olson, Howard M Sandler, Michael E Ray, Daniel A Hamstra

Abstract

Purpose/objectives: We sought to assess the utility of docetaxel administered concurrently with salvage radiation therapy (SRT) following postprostatectomy biochemical failure (BF).

Methods and materials: Men with postprostatectomy BF were accrued on a single-arm phase 2 clinical trial. SRT doses ranged from 64.8 to 70.2 Gy and were delivered in 1.8-Gy fractions to the prostate bed alone as the clinical target volume with a +1-cm uniform planning target volume expansion. The primary endpoint was progression-free survival at 4 years compared with the Stephenson nomogram estimate. Kaplan-Meier methods were used to assess late toxicity, BF, and distant metastases. An unplanned matched-pair analysis was performed with 19 patients treated with SRT alone.

Results: Nineteen men were accrued and treated. Median follow-up was 4.8 years. Median pre-RT prostate-specific antigen level was 0.7 ng/mL (interquartile range, 0.4-1.3 ng/mL). All 8 cycles of docetaxel were completed in 17 (89%) patients. Acute grade 1-4 toxicities were observed in 79%, 50%, 58%, and 11%, respectively. A total of 68% of acute grade 1 toxicities were related to fatigue, urinary, or bowel symptoms. For grade 2 toxicities, 76% were related to neutropenia, fatigue, or urinary symptoms. Acute grade 3 and 4 toxicities were most commonly neutropenia (84% and 100%, respectively). All late toxicities were grade 1 to 2 with 89% related to bowel or urinary function. Predicted 4-year progression-free survival was 39% and observed was 42% (90% confidence interval [CI], 24-60). Matched-pair analysis demonstrated no significant improvement in BF (P = .96, hazard ratio, 0.98; 90% CI, 0.4-2.3) or distant metastases (P = .09; hazard ratio, 0.3; 90% CI, 0.07-1.2), and no difference between late bowel (P = .60) or urinary toxicity (P = .41).

Conclusions: Docetaxel can safely be administered concurrently with SRT without significantly impacting posttreatment toxicity. Neutropenia was the most significant acute toxicity. Given the small sample size, no clear clinical benefit was observed. Larger studies are needed to determine the efficacy of concurrent docetaxel in this setting.

Figures

Figure 1
Figure 1
(A) Freedom from grade 2+ late urinary toxicity (P = .41) and (B) late rectal toxicity (P = .60). Freedom from (C) biochemical progression (HR, 098 [90% CI, 0.41-2.35], P = .9648) and (D) from metastasis (HR 0.29 [90% CI, 0.07-1.22], P = .918. CI, confidence interval; HR, hazard ratio; SRT, salvage radiation therapy.

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