{"entity":{"id":"paper-tannock-tax-327-docetaxel-prednisone-nejm-2004","kind":"paper","name":"TAX 327: docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer","aka":["TAX 327","Tannock 2004 docetaxel prostate"],"tldr":"The first treatment ever shown to help men live longer once prostate cancer stopped responding to hormones. Docetaxel every three weeks added about two and a half months to median survival compared with the older drug, and made pain and quality of life better as well.","summary":"Ian Tannock and colleagues randomised 1,006 men with metastatic hormone-refractory prostate cancer, all taking 5 mg of prednisone twice daily, to mitoxantrone every three weeks, docetaxel every three weeks, or weekly docetaxel. The primary endpoint was overall survival, with pain, prostate-specific antigen and quality of life as secondary endpoints, each compared against mitoxantrone.\n\nMitoxantrone had been approved in 1996 on palliation alone: it relieved pain and did not extend life. TAX 327 is where prostate cancer got a drug that did both, and where the three-weekly schedule beat the weekly one, which is why the three-weekly schedule is the one still used. Twenty years later docetaxel is given much earlier, at the first diagnosis of metastatic disease, on the strength of CHAARTED and STAMPEDE.","asOf":"2026-09-25","links":[{"label":"N Engl J Med 2004","url":"https://doi.org/10.1056/nejmoa040720"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/15470213/"},{"label":"Europe PMC","url":"https://europepmc.org/article/MED/15470213"}],"tags":["prostate-evidence"],"related":["paper-petrylak-swog-9916-docetaxel-estramustine-nejm-2004","paper-de-bono-tropic-cabazitaxel-lancet-2010","paper-chaarted-nejm-2015","chemotherapy-roadmap","prostate-roadmap"],"cancers":["prostate","prostate-mcrpc"],"sections":["chemotherapy"],"technologies":[],"targets":[],"drugs":["docetaxel","mitoxantrone","prednisone"],"companies":[],"institutions":[],"pathways":[],"terms":["castration-resistance","psa","quality-of-life","hazard-ratio"],"trials":[],"people":["ian-tannock","nicholas-james"],"bottlenecks":["b-resistance","b-toxicity-qol"],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2004,"doi":"10.1056/nejmoa040720","pmid":"15470213","authors":"Tannock IF, de Wit R, Berry WR, et al.","paperType":"rct","findings":["Median survival 16.5 months with mitoxantrone, 18.9 months with docetaxel every three weeks and 17.4 months with weekly docetaxel.","Hazard ratio for death with three-weekly docetaxel 0.76 (95 percent confidence interval 0.62 to 0.94; P equals 0.009); with weekly docetaxel 0.91 (0.75 to 1.11; P equals 0.36).","A decrease in serum prostate-specific antigen of at least 50 percent in 32 percent, 45 percent and 48 percent of the three groups respectively (P less than 0.001 for both docetaxel comparisons).","Predefined reductions in pain in 22 percent, 35 percent (P equals 0.01) and 31 percent (P equals 0.08).","Improvements in quality of life in 13 percent, 22 percent (P equals 0.009) and 23 percent (P equals 0.005); adverse events were more common in the docetaxel groups."],"whatItMeans":"The end of therapeutic nihilism in castration-resistant prostate cancer. It is also the trial that set the field's expectation of what a positive result looks like in this disease: a hazard ratio near 0.75 and a median gain measured in months, not years.","caveats":["Median survival gain of 2.4 months against mitoxantrone, at the cost of more adverse events.","The control was mitoxantrone, a drug approved for palliation and never shown to extend survival, so the comparison is against a low bar.","The trial population was fitter than the average man with castration-resistant disease; performance status 2 patients were a minority."],"changedPractice":true,"participants":1006},"route":"/key-papers/paper-tannock-tax-327-docetaxel-prednisone-nejm-2004/","neighbours":{"paper":[{"id":"paper-chaarted-nejm-2015","kind":"paper","name":"CHAARTED: chemohormonal therapy in metastatic hormone-sensitive prostate cancer","route":"/key-papers/paper-chaarted-nejm-2015/"},{"id":"paper-petrylak-swog-9916-docetaxel-estramustine-nejm-2004","kind":"paper","name":"SWOG 9916: docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer","route":"/key-papers/paper-petrylak-swog-9916-docetaxel-estramustine-nejm-2004/"},{"id":"paper-de-bono-tropic-cabazitaxel-lancet-2010","kind":"paper","name":"TROPIC: prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel","route":"/key-papers/paper-de-bono-tropic-cabazitaxel-lancet-2010/"}],"roadmap":[{"id":"chemotherapy-roadmap","kind":"roadmap","name":"Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs","route":"/roadmaps/chemotherapy-roadmap/"},{"id":"prostate-roadmap","kind":"roadmap","name":"Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch","route":"/roadmaps/prostate-roadmap/"}],"cancer":[{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"}],"drug":[{"id":"docetaxel","kind":"drug","name":"Docetaxel","route":"/drugs/docetaxel/"},{"id":"mitoxantrone","kind":"drug","name":"Mitoxantrone","route":"/drugs/mitoxantrone/"},{"id":"prednisone","kind":"drug","name":"Prednisone","route":"/drugs/prednisone/"}],"term":[{"id":"castration-resistance","kind":"term","name":"Castration-resistant prostate cancer (CRPC)","route":"/terms/castration-resistance/"},{"id":"hazard-ratio","kind":"term","name":"Hazard ratio (HR)","route":"/terms/hazard-ratio/"},{"id":"psa","kind":"term","name":"PSA (prostate-specific antigen)","route":"/terms/psa/"},{"id":"quality-of-life","kind":"term","name":"Quality of life","route":"/terms/quality-of-life/"}],"person":[{"id":"ian-tannock","kind":"person","name":"Ian F. Tannock","route":"/people/ian-tannock/"},{"id":"nicholas-james","kind":"person","name":"Nicholas James","route":"/people/nicholas-james/"}],"bottleneck":[{"id":"b-resistance","kind":"bottleneck","name":"Acquired resistance to every therapy","route":"/bottlenecks/b-resistance/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}]}}