New life-prolonging treatments including docetaxel (D), cabazitaxel (C), abiraterone (A) and enzalutamide (E) have revolutionised the management and outcomes of patients with mCRPC. The question remains of the optimal sequence and often, this decision is physician-dependent, made based on non-randomised comparisons. This study is aimed at evaluating the outcomes in patients receiving cabazitaxel and its' potential relevance on therapeutic sequencing.
A retrospective study of thirty three mCRPC patients treated with cabazitaxel after progression during or following docetaxel treatment at the Rosemere Cancer Centre. Data relating to patient's characteristics, treatments and clinical outcomes were collected from medical records and anonymised for analysis.
Thirty three patients analysed received a median (range) of 3 (2-4) different life-prolonging therapies. The median (interquartile range, IQR) age of patients commencing on cabazitaxel was 71.1 (67.4–75.1) years. Cabazitaxel was second line therapy after docetaxel in 24/33 (72%) patients. Median (IQR) time from mCRPC diagnosis to start of cabazitaxel was 1.5 (1.0-2.0) years. The tabulated data describes the number of treatment used with the following sequences: 7 patients received 2 therapies (DC); 22 patients received 3 therapies (DAC: n = 7; DCA: n = 15); 4 patients received 4 therapies (DCAE: n = 1; DACE: n = 1; DCEA: n = 1; DAEC: n = 1). Overall survival was longer, with a 14 months addition in patients receiving second-line cabazitaxel compared to third-line following docetaxel and abiraterone.
|Number of life-extending drugs||Median [95% CI] OS from mCRPC diagnosis|
|2||DC: N = 7, 29.4 months [21.4-80.1]|
|3||DAC: N = 7, 26.2 months [22.1-40.4] DCA: N = 15, 40.0 months [24.3-57.6]|
|4||N = 4, 32.1 months [15.1- ]|
This real life sequencing data from our centre shows promising results for median overall survival benefit when cabazitaxel is optimally prescribed as second line therapy post docetaxel in a sequencing schedule. To further validate the data, the multicenter ECLIPSE study is ongoing.
Clinical trial identification
A. Birtle: member of the advisory board of Sanofi. All other authors have declared no conflicts of interest.