Ten years of docetaxel-based therapies in prostate adenocarcinoma: A systematic review and meta-analysis of 2244 patients in 12 randomized clinical trials

Background: Chemotherapy can reduce serum prostate-specific antigen (PSA) levels and relieve pain in some patients with castration-resistant prostate cancer (CRPC). To improve therapeutic efficacy numerous randomized trials have investigated docetaxel-based combination regimens. The present analysis tries to overcome the statistical limitations of the individual trials and investigates the treatment effects in total and in various combination groups. Methods: The Medline, Embase, Cancerlit, and American Society of Clinical Oncology Abstract databases were searched for published randomized placebo-controlled trials evaluating the use of docetaxel-based regimens in patients with CRPC. The outcomes assessed were overall survival, overall response rate, PSA response rate, and adverse effects. Results: Twelve articles (2244 participants) were included in the meta-analysis. The analysis demonstrates a higher PSA response rate from docetaxel-based combinations when compared with docetaxel alone (relative risk [RR] = 1.16; P =.010). The estimated median survival in docetaxel-based combinations was statistically significantly longer than in the docetaxel-alone group (22.0 vs. 18.4 months; P =.037). Grade 3 or 4 neutropenia as well as grade 3 or 4 thromboembolic events were similar in both arms (overall RR, 0.87 [confidence interval (CI) 0.71-1.07]; P =.20 and overall RR 1.52 [0.79 2.90]; P =.21, respectively). Conclusion: The analysis of 12 randomized trials provides evidence in favor of docetaxel-based combination chemotherapy for patients with CRPC and good performance status.