ASCO 2020: CARD: Overall Survival Analysis of Patients with Metastatic Castration-Resistant Prostate Cancer Receiving Cabazitaxel versus Abiraterone

( The CARD trial, initially presented at ESMO 2019 and subsequently published, addressed the question of appropriate third line therapy in mCRPC for patients who had previously received docetaxel and also progressed on an anti-androgen therapy (either abiraterone or enzalutamide) within 12 months. Patients meeting these criteria were randomized to cabazitaxel (25 mg/m2 every 3 weeks) or the alternative anti-androgen therapy. This study showed a statistically significant improvement in radiographic progression-free survival and overall survival in the cabazitaxel treated group.

In this poster, Bertrand F. Tombal, MD, PhD, and co-authors present analyses aimed at evaluating the robustness of the survival benefit observed in the CARD study by (1) utilizing a multivariable Cox proportional hazards model to assess the impact of baseline prognostic factors on survival and (2) evaluating overall survival from various treatment time points in each treatment arm. The methods for these analyses are shown below. 

CARD trial methods

With regards to univariate and multivariate analyses of baseline prognostic factors, univariate analysis showed the following factors had a statistically significant association with survival: treatment with cabazitaxel, neutrophil-to-lymphocyte ratio, hemoglobin, PSA, LDH, Alkaline phosphatases, and neutrophil count. In multivariate analysis, neutrophil-to-lymphocyte ratio, hemoglobin and PSA were significantly associated with overall survival. Importantly, in this multivariate analysis, the association between cabazitaxel treatment and improved overall survival remained statistically significant. 

multivariate analysis of OS stepwise selection model

The association with cabazitaxel treatment and overall survival was measured from the following starting time points: (1) time of metastatic disease diagnosis, (2) time of mCRPC diagnosis, (3) time of initiation of first life extending therapy, (4) time of initiation of second life extending therapy. All time points were numerically associated with improved overall survival relative to the control arm.

OS CARD trial

In conclusion, these analyses confirm the robustness of the statistically significant association between improved overall survival and treatment with cabazitaxel after docetaxel and progression on anti-androgen therapy within 12 months. 

Presented by: Bertrand F. Tombal, MD, PhD, Professor and Chairman of the Division of Urology and Associate Professor of Physiology at the Université catholique de Louvain (UCL), Brussels, Belgium

Written by: Alok Tewari, MD, PhD, Medical Oncology Fellow at the Dana-Farber Cancer Institute, at the 2020 American Society of Clinical Oncology virtual annual meeting (#ASCO20), May 29th-May 31st, 2020

Related Content: 
Watch: Clinical Implications of the CARD Trial - Cora Sternberg
Watch: The Clinical Implications and Heath-related Quality of Life Benefits: Reviewing the CARD Study Results in Men with mCRPC - Neal Shore

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