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Cabazitaxel More Effective Than ADT: Prostate Cancer

Prostate cancer.

Researchers recently discovered that cabazitaxel, compared with abiraterone or enzalutamide, is a potentially more effective drug to use in the fight against metastatic castration-resistant prostate cancer.

Androgen-deprivation therapy (ADT), such as abiraterone or enzalutamide, hinders the body from producing testosterone, which fuels prostate cancer cells. However, resistance often occurs when this type of therapy is used. Cabazitaxel, an anti-microtubule chemotherapy drug, works by inhibiting cancerous cell growth, ultimately killing malignancies.

For this multicenter, randomized, open-label, clinical trial study, results of which are published in The New England Journal of Medicine, 255 patients with histologically confirmed prostate cancer were enrolled. In order to be eligible for the study, patients had to have castrate levels of serum testosterone (<0.5 ng per milliliter [1.73 nmol per liter]), been previously treated with three or more cycles of docetaxel, disease progression, or had the appearance of two new bone lesions or a rising prostate-specific antigen level; lastly, patients had to have disease progression during 12 months of treatment on an ADT such as abiraterone or enzalutamide, before or after docetaxel therapy. Patients were randomized in a 1:1 ratio to receive either 25 mg/m2 of intravenous cabazitaxel every three weeks, plus prednisone daily and granulocyte colony-stimulating factor or an ADT they had not received yet (either 1,000 mg of abiraterone plus prednisone daily or 160 mg of enzalutamide daily).

After a median follow-up of 9.2 months, imaging-based progression or death occurred in 73.6% of patients in the cabazitaxel group compared with 80.2% in the ADT group. Median imaging-based progression-free survival and median overall survival was determined to be 8.0 months and 13.6 for patients on cabazitaxel and 3.7 months and 11.0 months for patients on ADT. Cabazitaxel was also associated with an improved median progression-free survival compared with ADT (4.4 vs 2.7 months). A little over half of patients in both groups experienced an adverse event of grade 3 or higher.

"Cabazitaxel significantly improved a number of clinical outcomes, as compared with the [ADT] (abiraterone or enzalutamide), in patients with metastatic castration-resistant prostate cancer who had been previously treated with docetaxel and [ADT] (abiraterone or enzalutamide)," concluded the study authors.

For More Information

de Wit R, de Bono J, Sternberg CN, et al (2019). Cabazitaxel versus abiraterone or enzalutamide in metastatic prostate cancer. N Engl J Med. [Epub ahead of print] DOI:10.1056/NEJMoa1911206

Image Courtesy of Wikimedia Commons. Licensed under CC BY-SA 4.0

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