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Ask Dr. Snuffy Myers video: Taxotere early rather than late


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I summarize good videos because I can search through the printed text at any time I might need it in the future. Words in videos are lost forever.

There is now a wide range of drugs available now to treat hormone refractory prostate cancer.

But some men do not get to use them because they are too ill to qualify.

Because docetaxel chemotherapy has modest benefits, many oncologists have waited until the patient is symptomatic before starting. So they have palliation rather than survival in mind. Dr Snuffy Myers believes this is not appropriate. The drug is approved for survival, not palliation, and has not been clinically trialled for palliation.

New additional problem – many men treated only upon symptomatic progression are in no shape to get any other treatment after Taxotere.

When to start treatment – still controversial, but Dr Snuffy Myers believes certainly:

• at evidence of metastatic disease such as bone scan abnormality.

• if refractory to hormonal therapy (including second line hormonal therapy.

• and in his clinic, men with rapidly rising PSA while on hormonal therapy.

This is always qualified by the health status of the man – for instance a man with peripheral neuropathy from diabetes would have this worsened by Taxotere and may limit his mobility, so Taxotere use would be delayed.

In his opinion many community oncologists are waiting far too long to start Taxotere, creating a circumstance where other drugs cannot be used.

For instance, Dr Snuffy Myers has seen many patients started on Taxotere too late who were then too sick to be started on:

• Jevtana (Cabazitaxel) a better taxane chemotherapy than Taxotere, approved for after Taxotere.

• Zytiga (abiraterone acetate) a form of hormonal therapy approved after Taxotere, which does not turn the cancer around overnight, so is not effective if the patient is not in good shape.

• Provenge (sipuleucel-T), which provides a survival advantage, is a disaster in end-stage prostate cancer. You don't want to use it on a patient who is bed-ridden with pain.

All these drugs are only accessible to the patient if Taxotere is started early.

And some very exciting drugs in the pipeline:

• MDV3100, a form of hormonal therapy likely to gain approval for use after Taxotere.

• XL184 (Cabozantinib) which resolved bony disease in a phase II clinical trial – very exciting.

But all of these things can only be available at a community level if oncologists move their thinking from palliation to survival, because all these drugs extend survival. Though only 3-6 months, getting 4 in sequence is adding 2-3 years.

Note: I am not a doctor.

These are my notes for my interest.

They may not accurately reflect the original.

See the original yourself by searching Google for

"starting taxotere for pca"

(the double quotes are necessary)

Or this link:

http://askdrmyers.wordpress.com/2011/08 ... e-for-pca/

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