medwireNews: Cabazitaxel could be an option for men with metastatic castration-resistant prostate cancer (mCRPC) who have progressed after treatment with docetaxel and an androgen signaling-targeted agent, suggest trial findings.
As reported at the ESMO Congress 2019 in Barcelona, Spain, the primary endpoint of radiographic progression-free survival (PFS) and other outcomes were significantly better with cabazitaxel than with an alternative androgen signaling-targeted inhibitor.
Speaking to medwireNews, presenting author Ronald de Wit (Erasmus Medical Center, Rotterdam, the Netherlands) commented: “I think this going to change the treatment paradigm of crossing over between androgen signaling-targeted agents, which doesn’t really make sense, and I think we should use cabazitaxel earlier on.”
The phase IV CARD trial enrolled 255 mCRPC patients who had received docetaxel and progressed within a year of treatment with enzalutamide or abiraterone. Participants were randomly assigned to receive either cabazitaxel.
Ronald de Wit tells us why the CARD trial results are likely to change the paradigm for the treatment of metastatic castration-resistant prostate cancer (3:58).
25 mg/m2 every 3 weeks or the other androgen signaling-targeted inhibitor that they had not previously received, and were followed up for a median of 9.2 months.
Radiographic PFS was a median of 8.0 months with cabazitaxel and 3.7 months with the androgen signaling-targeted inhibitor, a significant difference.
The secondary endpoint of overall survival was also significantly improved in the cabazitaxel group, at a median of 13.6 months compared with 11.0 months for the androgen signaling-targeted agent group, giving a hazard ratio (HR) for death of 0.64.
Cabazitaxel treatment was also associated with a significantly longer median PFS (4.4 vs 2.7 months; HR for progression or death of 0.52), and significantly higher rates of prostate-specific antigen response (35.7 vs 13.5%) and tumor response (36.5 vs 11.5%) relative to the androgen signaling-targeted inhibitor.
Commenting on the safety profile, de Wit noted that this was comparable across treatment arms, with grade 3 or worse adverse events observed in 56.3% and 52.4% of patients in the cabazitaxel and androgen signaling-targeted inhibitor treatment arms, respectively.
These results are simultaneously published in The New England Journal of Medicine.
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ESMO Congress 2019; Barcelona, Spain: 27 September–1 October
N Engl J Med 2019: doi:10.1056/NEJMoa1911206