Medicine Matters oncology

Yes, so I think that the CARD study is really a very, very well-designed study in a situation that we encounter a lot with our patients who have had one line of chemotherapy, docetaxel, and one of the novel endocrine agents, abiraterone and enzalutamide. And we've known for quite some time that most patients don't really respond very well to the second novel endocrine agent. And so I think it was a very, very worthwhile thirdline study, and that's one of the really-- that's the first thirdline study that's randomized and prospective in metastatic castration-resistant prostate cancer. So that's really amazing.

And it's important also generally in oncology, as there's not that many thirdline studies. And so it was very, very well-designed, as I said. The patient population in the trial was also really very representative of what you see in your clinical practice, so I think that was very good.

And the question there was, should you give the other novel endocrine agent, like a hormonal agent, or should you give the second chemotherapy cabazitaxel? And the outcome was very clear. So the primary endpoint was radiographic progression free survival, and that was clearly improved.

And what is really fantastic also is that overall survival was the secondary endpoint, but it was also improved. And again, this is the first prospective trial in that situation showing that.

And I think for patients, what's really important is also that pain response was much better with the cabazitaxel. So I guess we have to, as I called it, resist "chemo-phobia" because it also seemed very well-tolerated from what Ron de Wit was showing us in his presentation. So there was not more toxicity in the cabazitaxel arm than in the enza or abi arm, depending on what the patients had before.

So in general, I have to say, yes, this is going to be the new standard for thirdline for patients who are chemotherapy fit. As I said in my discussion, now the question obviously becomes, what are we doing with the patients who are not fit? What are we doing with the patients who are really, really good responders to the first novel endocrine agents? Because they were excluded from this study, and I think there is new research areas that open up for us. But this is a big step because again, it's the first time we have overall survivor benefit and radiographic progression free survival benefit in a thirdline population.