A population-based analysis of the effectiveness of docetaxel for castration-sensitive prostate cancer (CSPC).
Bibliographic record
Abstract
e17026 Background: Phase III clinical trials have demonstrated efficacy for the addition of docetaxel (DOC) to androgen deprivation therapy (ADT) in the treatment of metastatic CSPC. The effectiveness of DOC with ADT in the general patient (pt) population remains undefined. Methods: A population-based retrospective review was conducted of pts with mCSPC who received DOC in British Columbia from 04/2015 to 02/2017. Results: 156 pts received DOC in the mCSPC setting. Baseline characteristics: median age 67 years (44-86); visceral metastases in 11%; high volume disease in 80%; de-novo metastatic disease in 76%. All 6 DOC cycles were delivered in 81% of cases; it was stopped early for: toxicity 10%, pt preference 3% or disease progression 6% cases. Dose reductions and delays were required in 39% and 16% cases. Grade 3-5 adverse events were noted in 40% cases, with 18% febrile neutropenia (FN). Patients with high-volume disease were more likely to develop FN (HR 8.6, p = 0.038); there was no effect from age, baseline performance status, PSA, visceral involvement, or time from ADT start to docetaxel. With a median follow-up of 23 months (m), 116 pts remain alive. Overall survival: median not reached, 1-year 91%; Time to Treatment Failure (TTF): median 14.6 m, 1-year 59%; Time to Treatment for CRPC (TTC): median 20.0 m, 1-year 72%. On multivariate analysis, number of bone metastases > 3 was the only factor predicting TTF (HR 11.0, p < 0.001) and TTC (HR = 16.1, p < 0.001). Of 95 pts who progressed to CRPC, 84 required treatment (88%), with most pts receiving either abiraterone (ABI) or enzalutamide (ENZA, 90%) with a PSA decline ≥50% occurring in 44% of pts. Median time to treatment failure 3.4 m. with no difference between ABI and ENZA. Conclusions: Effectiveness of docetaxel with ADT in a general population of patients with mCSPC was associated with poorer outcomes and high rates of toxicity, relative to reported phase III studies. Pts with high volume disease are at higher risk of FN, and > 3 bone metastases predicted more rapid progression. Response rates to first-line treatment for mCRPC with abiraterone or enzalutamide appear similar to those previously reported.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".