ORIGINAL PAPER Rechallenge of docetaxel combined with epirubicin given on a weekly schedule in advanced castration-resistant prostate cancer patients previously exposed to docetaxel and abiraterone acetate: a single-institution experience R. Petrioli • G. Roviello • A. I. Fiaschi • L. Laera • Salvatora T. Miano • G. De Rubertis • G. Barbanti • V. Bianco • S. Brozzetti • E. Francini Received: 22 December 2014 / Accepted: 23 January 2015 Ó Springer Science+Business Media New York 2015 Abstract The aim of this paper was to evaluate the activity and tolerability of weekly docetaxel (D) combined with weekly epirubicin (EPI) in patients with advanced castrate-resistant prostate cancer (CRPC) previously exposed to D and abiraterone acetate (AA). Locally advanced or metastatic CRPC patients with 0–2 perfor- mance status, who had progressed after D and AA therapy, were included in the study. Previous treatment with che- motherapy agent cabazitaxel was also admitted. Treatment consisted of D 30 mg/m 2 intravenously (i.v.) and EPI 30 mg/m 2 i.v., every week (D/EPI). Chemotherapy was administered until disease progression or unacceptable toxicity. In our institution, twenty-six patients received D/EPI: their median age was 72 years (range 59–83 years). Twenty-three (88.5 %) patients had bone metastases. A decrease in PSA levels C50 % was observed in seven patients (26.9 %, 95 % CI: 0.11–0.47); of these, five had achieved a C50 % PSA response during prior first-line D and six had achieved a PSA response during prior AA Among the subjects who were symptomatic at baseline, pain was reduced in nine patients (38.1 %) with a signifi- cant decrease in analgesic use. Median progression-free survival was 4.4 months (95 % CI, 3–5.2), and median overall survival was 10.7 months (95 % CI, 8.9–18.4). Treatment was well tolerated and no grade 4 toxicities were observed. Our findings suggest that weekly D/EPI is fea- sible and active in heavily pretreated advanced CRPC patients and seem to support the hypothesis that the addi- tion of EPI to D may lead to overcome the resistance to D in a subgroup of patients. Keywords Abiraterone Á Epirubicin Á Docetaxel Á Castration-resistant prostate cancer Introduction To date, docetaxel (D) chemotherapy is still the first-line standard of care for advanced castrate-resistant prostate cancer (CRPC) after failure of hormonal manipulation. Abiraterone acetate (AA) is a first-in-class selective irre- versible inhibitor of cytochrome P-450c17 (CYP17), a critical enzyme in extragonadal and testicular androgen synthesis that suppresses AR signalling [1, 2]. AA pro- longed overall survival in chemotherapy-naı ¨ve or D-pre- treated patients and overcame D-resistant cell lines [3, 4]. However, AA resistance inevitably occurs and patients who progress after AA may be considered for another line of treatment as the survival benefit of AA may be accompanied with a significant delay in health-related quality of life deterioration [5]. In this respect, enzaluta- mide (ENZ), an androgen antagonist which binds to androgen receptors and prevents their translocation to the R. Petrioli (&) Á G. Roviello Á L. Laera Á S. T. Miano Medical Oncology Unit, University of Siena, Viale Bracci 11, 53100 Siena, Italy e-mail: r.petrioli@ao-siena.toscana.it A. I. Fiaschi Pharmacology Unit, University of Siena, Siena, Italy G. De Rubertis Á G. Barbanti Urology Unit, Department of Genitourinary Disease, University of Siena, Siena, Italy V. Bianco Á E. Francini Medical Oncology Unit, Policlinico Umberto I Hospital, University of Rome, Rome, Italy S. Brozzetti Department Of Surgery, Policlinico Umberto I Hospital, University of Rome, Rome, Italy 123 Med Oncol (2015) 32:52 DOI 10.1007/s12032-015-0485-2