1. It's one of those things that benefits a few patients a whole lot, is neutral in most, and is bad in a few more. The thrust to identify an on-patent therapy which is microscopically better in clinical trials of one-size-fits-all (or roll-the-dice) treatment. It's not that every patients survival improves 21%. Some patients win the lottery and have their survival improved by 21% or longer. Some patients get a stroke and die two months earlier. Most patients don't benefit. Of those who do, they might average two months of extra life per patient. Not everybody wins the lottery.

Patient tumors with the same histology do not necessarily respond identically to the same agent or dose schedule of multiple agents. Patients would certainly have a better chance of success had their cancer been chemo-sensitive rather than chemo-resistant, where it is more apparent that chemotherapy improves the survival of patients, and where identifying the most effective chemotherapy would be more likely to improve survival above that achieved with empiric chemotherapy. We lump patients together and treat them with the same drugs and then deal with their variable response to treatment. We're essentially treating different diseases with the same medicine.

Some academic oncology groups had as their major ovarian cancer project, clinical trials to show that Taxotere (Docetaxel) could be the new "standard" therapy. Patients were treated with Taxol + Carboplatin. If (or when) Taxol + Carboplatin didn't work, they'd be crossed over to Taxotere, a drug which is mostly (if not completely) cross resistant with Taxol, delaying the patient's treatment and possibly subjecting them to a horrible death. There were a number of other clinical trials that had the drug Taxotere (Docetaxel) in their repective studies. These kind of chemotherapy studies have never yielded any kind of meaningful advance.

Posted at 7:21PM on Feb 27th 2007 by Gregory D. Pawelski

2. The above commenter reports of stroke with taxotere is misleading at best. There is no evidence that taxotere caused strokes in these patients. I'd like to see the taxotere-stroke association evidence. It's bad enough that the data presented is wrong, but to frighten would-be patients? Please.

Add taxotere to pro-thrombolic thalidomide and you get thromboses, but this is caused by the thalidomide, NOT the taxotere. In one study:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1502338

there was a development of venous thromboembolism in 9 patients and transient ischemic attack or stroke in 3 of the first 43 patients treated with thalidomide and docetaxel, with NO thromboembolic events in patients on docetaxel (taxotere) alone.

Prostate cancer, like all cancers, is prothrombotic, so strokes can obviously come from the cancer alone. Combine taxotere with prothrombotics like thalidomide and, you may incorrectly state that taxotere is the problem.

It behooves us to read research with an educated eye and be careful not to misinform and frighten.

As far as the treatment goes, a longer survival and less pain for a patient facing a very serious disease can be meaningful despite one commenter's statement to the contrary.

Posted at 10:36PM on Feb 27th 2007 by hchcec

3. Contrary to going after the messenger instead of the message, according to cardiologists at MD Anderson, as reported in the journal Circulation, any cancer drug can cause potential heart damage, even death, because many oncologists do not adequately monitor their patients or manage their care to minimize the health risk. And in regards to treatment related side effects of chemotherapy with Taxotere in men with prostate cancer, impaired cardiac left ventricular function. Every patient has different risk factors that will determine how their hearts handle treatment. But that is one small aspect of a number of side effects that could occur. The "real world" side effects are markedly greater than reported in clinical trials. You have to wonder, published clinical trials enroll the "best" patients. What really happens when less than the best patients are enrolled?

Posted at 12:56AM on Feb 28th 2007 by Gregory D. Pawelski

4. I was going after the message (not the messenger) that taxotere causes stroke and death in 2 months. I'd like to know where you read this.

It is well known that some cancer drugs can cause heart damage (that is highly treatable and reversible , by the way, with ACE inhibitors)

http://www.medicalnewstoday.com/medicalnews.php?newsid=47777

but this has nothing to do with stroke.

Please provide the readers with information that taxotere or taxol causes stroke or even heart damage.

And, what are these "real world" side effects that are not evident in the careful work of the doctors and nurses that monitor patients in clinical trials? From your comments cancer patients may not want to try any chemotherapy.

Thank you.

Posted at 8:06AM on Feb 28th 2007 by hchcec

5. my bro in law and sis ... he had surgery for prostrate in early jan 07... his insurance will not cover a specialist in cancer,, his urologist says he must recover from surgery before radiation.
he has the Progressive cancer and doc found cells outside the prostrate but not yet in the nods. he says he probably got 98-99% but one cell will move fast. yet no radiation at this time?

want second opinion but of course insurance is limited.

any experience in this? new to cancer , new to this blog
looking for help.. does this doc sound right.. how long after surgery before radiation or chemo?
anyone.. email please

Posted at 9:21AM on Feb 28th 2007 by linda