Chemotherapy in advanced androgen-independent prostate cancer 1990-1999: Adecade of progress?

Background and purpose: A great number of clinical research studies have be en reported in the field of chemotherapy for advanced androgen-independent prostate cancer during the last ten years. The aims of the present review w ere to assess their impact on management of the disease and on survival of patients. Methods: The review of full published reports was facilited by the use of a MEDLINE computer search. Results: Clinical research studies have focused on defining guidelines for eligibility criteria and accurate endpoints for patients to be enrolled ont o clinical trials and developing new agents or combination of drugs includi ng estramustine phosphate. Any combination of current chemotherapy has no i mpact on overall survival of patients. Among drugs in development, only the promising activity observed with docetaxel deserves randomized trials to a ssess its impact on survival. The major innovative advance of the 90s is th e demonstration of the impact of chemotherapy (mitoxantrone + prednisone) o n quality of life as compared to prednisone alone. A greater and longer-las ting improvement in quality of life along with a concomitant decrease in co sts was observed. Conclusions: At the present time, chemotherapy should be considered as a pa lliative treatment in patients with symptomatic androgen-independent diseas e. The enrollment of patients into clinical trials dealing with quality of life as primary endpoint is strongly solicited. A standard methodology shou ld be used in phase II trials with a primary goal of selection of agents wh ich should progress to randomized trials using survival as an endpoint. Hop efully new specific strategies targeted to reverse the molecular changes th at underlie prostate tumorigenesis should rapidly impact the multimodality management of AIPC in the third millenium.