Video: Prostate Cancer Chemotherapy Basics | Ask a Prostate Expert, Mark Scholz, MD
Ask a Prostate Expert | Transcription
Alex: Alright, Dr. Scholz. So our topic today is chemotherapy. Can you explain what chemotherapy is and how it works in prostate cancer patients?
Dr. Scholz: Sure. Actually, chemotherapy for prostate cancer is fairly straightforward because there's not a lot of different agents. In other types of cancers sometimes there maybe half a dozen or more types of chemotherapy. Chemotherapy just means a medicine to treat cancer. It's usually infused intravenously, but they have chemotherapy in pills too. It's—think of it as a sort of a cell poison and chemotherapy medications tend to poison the cells that are growing quickly. So, the most common chemotherapy for prostate cancer is Taxotere. Probably the second most utilized is a medicine called Jevtana which is a medicine very similar to Taxotere. Both of these medicines are infused every three weeks and they have a variety of different side effects. Generally, not too bad. And both of them are very effective. Both have been shown to prolong survival. Jevtana has been shown to prolong survival even after the use of Taxotere. And the third type of chemotherapy that we are using more and more is a medicine called carboplatin which is FDA-approved for the treatment of lung cancer, ovarian cancer, and generally is covered for off-label use in prostate cancer. So, we don't have a lot of agents, but the ones we have are quite good.
Alex: So, with carboplatin, what effects are you seeing in comparison to Jevtana and Taxotere?
Dr. Scholz: So, their effects tend to be similar. All types of chemotherapy—practically all of them—can cause fatigue after each injection that may last for two to five to seven days and they all—all the ones I mentioned—can cause hair loss in some people (it's not universal) and all of them have a potential for lowering blood counts. White count which could lead to infections; red count which can lead to anemia, and platelet counts which if severely suppressed can lead to bleeding. So, that all needs to be managed and the dosage of the medicine is adjusted based on how the body weight and the height of the patient to try and make sure that they get a precise amount that won't lead to those kinds of problems.
Alex: And as far as the sequencing goes, is it Taxotere, Jevtana, and then carboplatin as a resort if Jevtana isn't working?
Dr. Scholz: So, the insurance companies generally push for Taxotere first because it's generic and less expensive. There are some head to head trials between Jevtana and Taxotere showing that the anti-cancer effects are about the same; however, it appears that the Jevtana is a little bit milder in terms of side effects. So, the policy is mostly dictated by finances where Taxotere is given and if that stops working or if the side effects seem to be excessive, then people can switch over to Jevtana. If insurance companies paid for Jevtana upfront, I'd probably just use that first. Carboplatin is often reserved for people who have been on these medicines and then they stop working and physicians will then add some carboplatin to the Jevtana or the Taxotere to try and get the PSA to drop again, but it's not unreasonable to consider taking the carboplatin plus the Jevtana or plus the Taxotere right upfront because it's probably a somewhat more efficacious combination than using the medicines by themselves. There is a little bit more incidence of side effects when you give them in combination, but it's not particularly bad.