Click Here to Return to Information Resources

May 2002

Moreover, in the Education Book for ASCO 2002, the ‘Sessions by Topic" listed 16 Topic Categories and prostate cancer is not one of them. Our relevant articles are listed under ‘Patient Management’.

The ASCO presentations are in three volumes: Volume 1 contains the abstracts that are presented either orally or via posters; Volume 2 is ‘Publish Only’ abstracts; another book is an Educational Book consisting of essays/reports of subjects of general interest to oncologists, as well as specific diseases and treatments.

Note that in addition to prostate cancer abstracts I have included abstracts relating to advanced/metastatic breast cancer because, in my opinion, the two diseases are similar in many respects and the treatments are often identical. Likewise, I have included some abstracts regarding other cancers because I believe the chemotherapy agent combinations are of interest to us. I have categorized the abstracts from both Volume 1 and 2 as follows:

Taxotere (docetaxel)

Taxol (pacitaxel)

Novantrone (mitoxantrone)

Adriamycin (doxorubicin)

Xeloda (capecitabine)

Acronyms---these are necessary to read abstracts.

RR = response rate; the % of patients with >50% PSA reduction.

MDR = median duration of response; usually in months.

MDS = median duration of survival; usually in months.

MTD = maximum tolerated dose.

po = orally; by mouth.

bid = twice/day.

tid = three times/day.

Q = frequency of cycle; usually in days.

TX = treatment.

D = days of TX.

707----(AIPC); weekly (6/8) calcitriol @ 0.5 mcg/kg (D 1) + Taxotere @ 36

mg/m2 (D 2); 39 patients; 77% RR and 59% > 75% PSA reduction; 23% reached a PSA < 4.0; MDR 10.32 months; MDS not reached---conclusion: high-dose calcitriol may enhance the activity of weekly Taxotere without significant increase in toxicity. Note: single agent Weekly Taxotere has a RR of 38-46% RR; but this is a heavy dose/week. This trial is significant for HRPC patients.

730----(AIPC); weekly (3/4) Taxotere @ 30 mg/m2 with or without 200 mg thalidomide daily; 75 patients; 37% RR for those receiving Taxotere alone; 51% RR for those receiving Taxotere + daily thalidomide---the addition of an angiogenesis inhibitor may enhance the activity of cytotoxic agents.

773----(high-risk TX naive PCa - neo-adjuvant); 21 patients; Q21; Taxotere @ 70 mg/m2 + Emcyt @ 280 mg tid D1-3; average of 5 cycles (3-6); median bPSA 16.1 (2.4-175); 100% RR; median PSA nadir 0.7; and all then elected a ‘curative’ therapy.

779----(HRPC); 38 patients; Q21; Emcyt @ 280 mg po tid D1-5 + Taxotere @ 70 mg/m2 D2 + Carboplatin AUC 5 D2 + G-CSF on D6 until ANC > 5000/ul; 71% RR and 54% had > 75% PSA reduction; MDR 4.8 months---platinum agents have modest but potentially additive benefits. Note: the RR is comparable to Q21 Taxotere + Emcyt, but the MDR is much less as Petrylak/Saverese have MDR of ~12 months without the Carboplatin.

790----(HRPC); 10 patients; weekly (2/3) IV Emcyt MTD @ 1000 mg/m2 + Taxotere @ 20 mg/m2; RR 80%; MDR 12 weeks (4-20); IV Emcyt is safe and effective, even after oral Emcyt + Taxotere. Note: the RR is comparable to other such Emcyt + Taxotere weekly protocols, but the MDR is much shorter.

2434---(neo-adjuvant TX for high-risk localized PCa; no prior or concurrent HB); 14 patients; Q21; Taxotere @ 35 mg/m2 + Novantrone @ 2-6 mg/m2; MTD 4 mg/m2; 89% RR in 9 patients; all patients had RP following chemo; recruiting for PH II.

2438---(chemo naive HRPC); 18 patients; Q21 Taxotere @ 25 mg/m2 D1 and 8 + Navelbine (vinorelbine) @ 20 mg/m2 D1 and 8; 53% RR and 41% > 75% PSA reduction.

2441---(symptomatic HRPC); 16 patients; Q28; Taxotere @ 35 mg/m2 D2,9, & 16 + Emcyt @ 140 mg tid D1 to 3, 8 to 10, and 15 to 17; 75% RR; no DVTs/PEs.

2449---(clinically deteriorating HRPC); 13 patients; Q21;
Taxotere @ 100 mg/m2 + ciprofloxin @ 500 mg bid D1-14; 61% PR; higher dose Taxotere is effective, but with significant cumulative toxicity.

2452---(advanced HRPC); 22 patients; Q21; Taxotere @55 mg/m2 + ketoconazole after D8 @ escalating doses 200 mg/day to 1200 mg/day; tumor responses were seen at all doses.

2457---(metastatic HRPC); 8 patients; weekly (6/8) Taxotere @ escalating doses of 20 mg/m2 to 30 mg/m2 + Emcyt @ 280 mg po tid D1 & 2 + SR 89 @ 4 mCi as one dose in first week; 86% RR + reduction in need for pain meds; MDR 23 weeks.

2459---(chemo naive HRPC); 30 patients; Q21; Taxotere @ 60 mg/m2 D 1 + Navelbine (vinorelbine) @ 15 mg/m2 D1 and 8 + Neupogen (filgrastim) on D 2 to 6 and 9 to 13; 29% RR; MDR 6 months; tumors become resistant to taxanes, addition of Navelbine appears to improve activity as first-line or salvage TX---BLA note: I doubt this finding---it doesn’t seem very impressive to me as single agent Taxotere has better results.

2460---(HRPC); Q21; 21 patients; Taxotere @ 60-75 mg/m2 + Exisulind @ 150-250 mg bid D1 to 21; 44% RR; Exisulind (oral) induces apoptosis in cancer cells; PH II is planned---(BLA comment)--but, the response is similar to single agent Taxotere.

2472---(HRPC); 14 patients; Q21; Taxotere @ 70 mg/m2 + Emcyt @ 280 mg/8 hr. D2 to 6; RR 67% and 42% had > 75 % PSA reduction---BLA note: this is the same protocol as is reported for several years in many abstracts/reports.

2477---(HRPC); 29 patients; Q21; Taxotere @ 60 mg/m2 + Emcyt @ 280 mg/day for 5 days + G-CSF from D5; 86% RR and 62% had > 75% PSA reduction and 28% had > 90% PSA reduction; BLA note: good responses to a rather standard protocol.

2482---(HRPC); 9 patients; dose escalation for toxicity; weekly (3/4) Taxotere + Novantrone (mitoxantrone)--RR 44%---MTD for PH II = weekly Taxotere @ 35 mg/m2 + Novantrone @ 4 mg/m2.

2667---(metastatic non-small cell lung cancer); Q21; 57 patients; Taxotere @ 75 mg/m2 + Carboplatin @ AUC 6 mg/ml.min; 37% RR; MDR 17 weeks.

Summary of Taxotere: as can be seen, the 2002 abstracts were not very creative TXs and do not offer much new to reduce our cancer burden or extend survival.

244----(advanced breast and ovarian cancer); dose and schedule study for long-term administration of chemo; conclusions: long-term single agent Taxol on Q21 or weekly schedules is feasible and most patients showed high compliance to the TX.

811----(advanced ovarian cancer); 80 patients; weekly (6/8) Taxol @ 100 mg/m2 + Carboplatin @ AUC 2; RR 72%; conclusions: platinum + Taxol is the new standard regimen for advanced ovarian cancer and this weekly schedule is efficacious and well-tolerated.

1953--(metastatic BCa); 14 patients; weekly (3/4) Taxol @ 80 mg/m2 + Carboplatin @ AUC 2; 50% RR + 20% had stable disease; protocol is active and well-tolerated.

1967---(advanced BCa); 100 patients; weekly Q4 wks; Taxol @ 100-135 mg/m2 + Carboplatin @ AUC 2; 62% RR; MDS 16 months; adequate for adjuvant setting for elderly patients.

2021---(metastatic BCa); 32 patients; weekly Taxol @ 70 mg/m2; 25% RR; MDR 5.9 months; active in heavily pre-TXd patients; BLA note---compare to 1967 above: larger Taxol doses + Carboplatin = much improved RR.

2066---(advanced BCa); 6 patients; toxicity study of weekly Taxol @ 60 mg/m2 + Novantrone @ 5 mg/m2 + GM-CSF (a biological response modifier) @ 250 mcg/m2 D2-5; results: regular scheduling of GM-CSF allowed delivery of optimal dose intensity of Taxol + Novantrone.

2440---(HRPC); 85 patients; Q4 wks.; Taxol @ 80 mg/m2 + Carboplatin @ AUC 2 D2, 9, 16 + Emcyt po @ 280 mg tid on D1-3, 8-10, and 15-16; 61% PR; conclusion: highly effective.

2463---(HRPC); 42 patients; Q4 wks.; Taxol @ 50 mg/m2 D1, 8, and 15 + VP-16 (etoposide) @ 100 mg po D1-14 + Emcyt @ 280 mg po tid D1-14; Objective Response 37%---- ‘relatively toxic’---BLA note: hell, I guess ‘relatively toxic’, look at the Emcyt dose.

Summary of Taxol----not much new or even reported; I think the relevance of these abstracts is the new (?) paradigm of adding Carboplatin to the taxanes with positive synergistic responses.

786---(HRPC with painful bone mets); 26 patients; weekly (3/4) Novantrone @ 12 mg/m2 + DPPE (Tesmilifine) @ 5.3 mg/kg/80 min.; DPPE = histamine antagonist chemopotentiator; enhances the anticancer effects of cytotoxic agents and may overcome multidrug resistance phenotypes; 50% RR and >75% PSA reduction; 68% had improved pain and reduced analgesia; MDS 18 months; BLA note: single agent Novantrone has 18-34% RR and MDS 10-12 months--adding DPPE has definite enhanced response rate, survival, and pain relief; but remember, Novantrone is highly myelotoxic and cardiotoxic.

2444---(HRPC); 28 patients; Q21; Novantrone @ 12 mg/m2 D1 + Navelbine (vinorelbine) @ 20 mg/m2 ev D1 + Prednisone @ 10 mg/day every day for 21 days; 53% RR; MDR 8.3 months (0.7-23.7)---BLA note: this protocol doubles the RR vs. single agent Novantrone.

2473---(HRPC); 52 patients; Q21; Novantrone @12 mg/m2 D2 & 22 + Navelbine (vinorelbine) @ 25 mg/m2 D2, 9, 22, and 29 + Emcyt @ 140 mg po tid D1-3, 8-10, and 21-23; 23$ RR; BLA note: compare this to 2444 above = half the results thereof. ??

Summary of Novantrone- after I exhausted single agent Taxotere (17 months’ response), I began single agent Novantrone @ 11 mg/m2---bPSA 26 and after 6 TXs, PSA 11.2 = response. From the above abstracts, it seems to be advantageous to add DPPE or Navelbine for a greatly enhanced response from Q21 Novantrone.

2195---(jaundiced MBCa with extensive liver mets); weekly Adriamycin @ 10 mg/wk for 2 weeks, one week rest; clinical condition improved noticeably after 17 weeks and no ascites (accumulation of fluid in peritoneal cavity) and bilirrubin normalized.

As can be seen, very little work was done with Adriamycin, which is a major TX for PCa and BCA.

2435---(HRPC); Q2 wks; 22 patients; VP-16 50 mg/day po D1-7 + Ellence (epirubicin) @ 30 mg/m2 D1 + low dose Decadron; 41% RR and 36% had > 75% PSA reduction; MDR 5 months (4-9); MDS 12.5 months (3-35)---BLA note: Ellence is commonly used in BCa = anthracycline.

2431---(new D2 PCa); Q21 then one week off; 20 patients; VP-16 @ 50 mg/m2/day po + Emcyt @ 10 mg/kg/day po; median PSA nadir = 0.45 ng/ml; undetectable PSA in 4 patients; measurable disease response was 64%.

Note: Xeloda is an oral prodrug of 5-FU that is selectively tumor and system activated/converted in the cell to its toxic moiety by naturally produced enzymes; it yields substantially higher concentrations of 5-FU in tumors (but not in normal tissues) than IV versions of 5-FU.

247----(advanced BCa); Q21; 126 patients; Xeloda @ 1250 mg/m2 bid D1-14, one week off; tumor response 29%; MDR 5.0 months; MDS 15.2 months.

2023---(metastatic BCa heavily TXd); Q21; 20 patients; Xeloda @ 1000 mg/m2 po bid D1-14 + Idamycin (idarubicin = decades old chemo agent used mostly in leukemia) @10 mg/m2/day D1, 3, and 5 + Cytoxan @ 100 mg/m2/day po D1-14; partial response 15%; 405 stable disease; moderately active.

2030---(metastatic BCa heavily TXd with anthracyclines and taxanes); Q21; 24 patients; Xeloda @ 2500 mg/m2 po D1-14 + Navelbine (vinorelbine) @ 25 mg/m2 IV D1 and 8; overall RR 52%; MDR 168 days; effective in heavily anthracycline and taxane TXd patients.

2151---(advanced cancers); Q28; 18 patients; dose escalation--Xeloda @ 1000-1331 mg/m2/day po + Cytoxan @ 50-125 mg/m2/day---theory: totally oral TX; Cy up-regulates tumor TP activity resulting in increased activation of Xeloda at the tumor site; results = poor and conclusion that there is no clear interaction CY and Xeloda---how would you like to have been in this bizarre experiment?

2379---(metastatic colorectal cancer); Q21;54 patients; Xeloda @ 2500 mg/m2/day D1-14, one week off; overall RR 47%. (BLA note: 5-FU is the standard TX for colorectal cancer but due to its poor bioavailability, Xeloda is more effective as a prodrug).

2442---(metastatic HRPC); Q21; Xeloda @ 1250 mg/m2 bid po D1-14, one week off; 12% RR; MDR 9 weeks (7-14). BLA note: 5-FU is not effective with PCa?

The ASCO 2002 Educational Book has two interesting articles regarding trials:

Abrams JS and Cummins C in Implementing Clinical Trials in Your Practice: Getting Started and What’s New, pp. 273-282 presents oncologists with a road map to begin participating in trials. On average it takes 14 years for a new anticancer drug to navigate the path of clinical trials to approval. To collapse this time frame, government and corporate sponsors (read this as drug companies) are recruiting community oncologists to conduct the patient oriented trials. This article provides guidance for finding lists of trials, how to manage the mountain of paper-work involved, how to report to the various governing bodies during the trial, the intricacies of relationships with the governing bodies, and financial disclosure/conflicts of interest requirements.

Cohen GI in Cancer Clinical Trials: A Primer for Participation of Community Physicians, pp. 283-289 discusses the fact that most oncologists are never formally taught the principles of clinical trial design and patient enrollment. Originally clinical trial development and conduct was exclusively that of academic institutions; but today, 65-70% of all accruals to clinical trials originate from community practices. A survey reports that a patient’s motivations to participate in a clinical trial are: 1) a perception of access to higher quality care; 2) they will get better/more attention from the medical care team, 3) they hope that the knowledge gained will help other people, and 4) the opportunity to receive novel therapies which might prove to be more effective than standard therapies.

However, less than 3% of adult cancer patients enroll in studies. Why?: --1) they question the motivation and bias of the doctors involved in the study (conflicts of interest, ethics, informed consent procedures), 2) fear that trials are just the need to publish, 3) financial rewards to the doctor/institution rather than advancing science/treatments (many pharmaceutical trials can pay $5,000 to 6,000 for accruing a patient--thus, this might be a motivation for a doctor to accrue patients, rather than an interest in science/patient treatments), 4) fear of placebos, 5) insurance will not cover their care during/after a trial, and 6) belief that standard treatments are better than experiments.

In rather simple but explicit terms, this article leads the community doctor through suggestions to address these problems with patients.

980----addresses the question of whether trial informed consent forms in Phase I trials adequately inform the patient of the uncertainty of benefit and the research aims of the experiment. This abstract says that 92% of the consent forms clearly define the risk. BLA note: this seems to be self-serving as it doesn’t address whether the patient understood the risk/aims of the trial.

In an excellent article in CA; Vol 52/No. 3; May/June 2002 Davis TC et al. state that consent forms for oncological protocols are written at a level that is difficult for most patients to read and most patients believe that the purpose of the consent forms is to protect the doctor rather than to inform patients about the risks and benefits of treatments or procedures.

987----addresses the barriers to clinical trial accrual: 1) ineligible after screening, (72%), 2) medical disqualifications (53%), 3) travel distance, 4) randomization (placebo), 5) do not want to be treated with experiments, and 6) fear of toxicities.

988----survival benefits of clinical trials vs. conventional therapy; conclusion: two year survival was 4-13% higher with treatment on clinical trials (conventional survival 40%; PH I trial 50%; PH II trial 44%; PH III trial 53%).

1036---informed consent in clinical trials---patient accrual can be improved by studying the doctor interactions with patients during the recruiting stage and explaining the informed consent forms.

2617---barriers and facilitators to enrollment in cancer trials---the use of clinical research associates (CRAs) can overcome ‘physician related factors’ as barriers to accrual.

12-----(AD PCa); PSA-expressing vaccina virus + fowlpox virus; Q6 wks.; 17.2% had progressing disease; 53% had no PSA progression; 78.1% had no disease progression; MDR 9.2-9.7 months.

29----(advanced solid tumors); Bander/Nanus monoclonal antibody huJ591; 6 patients; huJ591 specifically targets vascular endothelial cells of renal, bladder, and colon cancer and may be an approach to label the MoAB with RT or cytoxins to reach these solid tumors.

322---(advanced cancer); angiostatin injected subcutaneous 2X/day; 29% had stable disease > 5 months; 17% had stable disease > 7 months.

323---(refactory solid tumors); 28 patients; endostatin as a daily bolus or as continuous infusion demonstrate that concentrations of endostatin without toxicity are achievable in man sufficient for biological and clinical evidence of antiangiogenic activity. ??

400---(advanced solid tumors); dose escalation trial of Taxoprexin (lipsomally encapsulated Taxol); 12 patients; Q21; Taxoprexin @ 660/880 mg/m2 + Carboplatin @ AUC 5; no neuropathy or alopecia (hair loss).

708---(HRPC); 288 patients; randomized study = a) placebo, b) Atrasentan @ 2.5 or 10.0 mg; significant survival benefit seen in both Atrasentan arms = Atrasentan groups median survival = 583 days vs. 478 days for the placebo group.

729---(HRPC w/metastatic disease); 34 patients; GVAX Vaccine (irridated, allogeneic PCa cell lines genetically modified to secrete human GM-CSF); dose escalation; recruiting for a new trial with TX @ 100 to 200 million cells injected Qmonth for 6 months; MDR @ lower dose = 85 days vs. 140 days @ higher dose; conclusion: GVAX Vaccine delays progression and prolongs survival.

731---(HRPC); Provenge (dendritic cells pulsed ex-vivo with an antigen-cytokine fusion protein); PH I and II trials reflected that Provenge ‘..induces clinical response and may prolong time to disease progression.’; PH III was a dose escalation trial and indicates that Provenge is safe, well-tolerated, and induces antigen-specific immunity; ‘Evaluation of the primary efficacy endpoint requires occurrence of additional events.’---does anybody know what the hell this is all about?

732---(metastatic HRPC); 9 patients; Q21; PH I Epithone (a new class of non-taxane tubulin polymerization agents) @ 35-40 mg/m2 + Emcyt @ 280 mg po tid D1-5; 56% RR + soft tissue regression and bone met improvement.

782---(metastatic HRPC); 17 patients; GM-CSF @ 250 mg 3X/week sc + thalidomide @ 100 to 200 mg.day; overall RR 38%; TX has activity and is well tolerated.

1838--(recurrent PCa; no mets allowed); 6 patients; Q 8 wks.; Low dose IL-2 (promotes production of lymphocytes) daily for 56 days + huJ591 monoclonal antibody @ 25 mg/m2 on D 22, 29, 36; patients who respond at 8 weeks can receive another cycle---3 completed an 8 week cycle; 2 patients had PSA stabilized---BLA note: a very difficult experiment to tolerate and certainly not a magic bullet----

1862--(advanced malignancies); 16 patients; Q21; PH I dose escalation; lipsome encapsulated Taxol @ 100 to 300 mg/m2---enrollment continues--(the encapsulation of the agent in a lipsome allows the chemo to be tumor specific and has prolonged action at the tumor site, and not on normal tissue = less system toxicity--?).

2147--(variety of cancers); toxicity trial of lipsome encapsulated Novantrone; 6 patients; lower toxicity notwithstanding higher doses (vs. normal Novantrone) suggest improved pharmacodynamics---dose escalation continues.

2433--(HRPC); PH II multicenter, open-label, randomized study; 31 patients enrolled--accrual continues; weekly (6/8); SGN-15 (Adriamycin immunoconjugate) = an antibody joined to Adriamycin that targets the Lewis antigen) @ 200 mg/m2 + Taxotere @ 35 mg/m2 vs. Taxotere only; no previous Taxotere or Novantrone allowed; TX has acceptable toxicities. Note: this experiment is directed at only one blood group that expresses the Lewis antigen (one of 14 such specific groups).

2454--(HRPC overexpression of EGFR); in vitro and in vivo experiment; ABX-EGF (human monoclonal antibody against epidermal growth factor receptor); suggests that ABX-EGF may result in direct inhibition of tumor proliferation and angiogenesis; one PCa patient demonstrated a minor response.

2468--(metastatic HRPC); 22 patients; ZD0773 (a new generation platinum that overcomes platinum resistance mechanisms) @ 120 mg/m2; RR 18%; conclusion: ZD0473 is active in HRPC with mets. ??

Summary of Experimental Agents = no magic bullets in these bizarre trials.

701---a significant association was found between expression of epidermal growth factor receptor (EGRF) in high Gleason score and correlates with disease relapse and progression to AIPC.

709---Small/Kantoff et al. suspended a PC SPES trial due to contamination by a ‘compound resembling DES’ that varied from lot-to-lot; before suspension, results were 45% RR for the arm on PC SPES (3 caps tid) vs. 21% RR for the arm on 3 mg DES/day.

722---most deaths among PCa patients are now due to non-prostate cancer causes.

1416--aerobic exercises reduce bone mineral density decline in BCa patients receiving chemo.

1460--this trial did not suggest any role for oral Glutamine, compared to placebo, for preventing the development, or alleviating the severity, of Taxol-induced myalgias (muscular pain)/arthralgais (joint pain).

1515--re PSA-itis; PSA-related anxiety represents a substantial problem for patients with metastatic prostate cancer.

1801--curcumin can inhibit chemotherapy-induced apoptosis; BCa patients in chemo should avoid dietary supplementation with curcumin and limit their exposure to curcumin-containing foods.

1827--in vitro; Zometa (zoledronic acid) and COX-2 both are growth inhibitors for PCa; combining them has an additive inhibitory effect compared to either agent alone.

1880--(advanced metastatic cancer); 13 patients; thalidomide has shown to inhibit angiogenesis, induce apoptosis, and provide immunomodulatory effects; in a dose escalation trial, thalidomide was adequately tolerated @ 100 to 200 mg/day---with significant drowsiness and weakness.

1952--with metastatic BCa, nail changes can be attributed to the antiangiogenic effect of weekly Taxotere.

2432--median survival has not improved over the past three decades for distant stage PCa.

2437--Casodex @ 150 mg/day, alone or as adjuvant TX of curative intent, significantly reduces the risks of objective disease and PSA progression in patients with localized and locally advanced disease, and with high and low Gleason grades.

2446--the vitamin D receptor is a promising target for PCa TX; 22 HB naive patients; calcitriol @ 0.5 mcg/kg po once/week reduced the PSA in 3/22 patients: 47%, 28%, and 10%.

2451--37 patients progressing on AAW; Decadron (dexamethasone) @ 2 mg po/day; 43% RR, MDR 5 months, MDS 48.5 months.

2455--25 HRPC patients; Decadron @ 1 mg/day started week 1 + Rocaltrol (vitamin D) @ 50 mcg/day added on week 5 + Carboplatin @ AUC 2 at week 6; 92 % had TX response; median duration 12 months.

2462--Irofulven was synthesized a decade ago from toxins of the poisonous jack-o-lantern mushroom; it is used in pancreatic cancer and is believed to have efficacy in ovarian and PCa, especially when these cancers are resistant to cisplatin and Taxol; 30 patients; Q28; Irofulven @ 24 mg/m2 IV D 1 and 15; 20% RR; overall response 22-26%; accruing for inrofluvan + other agents.

2464--small cell PCa has a more favorable response to cisplatin + VP-16.

Bill Aishman

May 2002

NOTE: I am not a doctor and can not render medical advice. I am not a medical researcher. I am a prostate cancer patient and I performed this layman’s analysis for my own decision-making purposes. In conjunction with a medical team, every cancer patient must make their own decisions regarding treatment options. I make no claim that this analysis is definitive or complete. I invite any and all additive contributions to my analysis that will provide patients a framework which will enhance their ability to make informed decisions regarding the use of chemotherapy protocols in their struggle with prostate cancer.

 [Top]