ESMO 2017: Patient preference between Cabazitaxel and Docetaxel for first-line chemotherapy in metastatic castration-resistant prostate cancer: results from the CABADOC randomized trial

Madrid, Spain (UroToday.com) Dr. Karim Fizazi and colleagues presented their results assessing patient preferences for cabazitaxel and docetaxel as first-line chemotherapy in metastatic castration-resistant prostate cancer (mCRPC). Docetaxel and cabazitaxel are taxane chemotherapy agents approved in men with mCRPC after they demonstrated improved overall survival in the first- [1] and second-line [2], respectively. Recent data suggested similar efficacy when used in the first-line setting [3], however, these two taxanes have different safety profiles.  The objective of the current study was to assess patient preference between docetaxel and cabazitaxel, potentially assisting in further differentiating between these two agents.

The CABADOC study is a randomized trial of 195 patients (recruited from June 2014 to October 2016) with a cross-over design (17 centers). Specifically, patients with mCRPC were randomized 1:1 to receive either docetaxel 75mg/m2/q3w x 4 followed by cabazitaxel 25mg/m2/q3w x 4, or the reverse sequence. Randomization was stratified based on prior abiraterone or enzalutamide therapy. The primary endpoint was patient preference between taxanes, assessed in patients who had received at least one cycle of each taxane and who had not experienced a progression after the first taxane. Prescott’s test was used to analyze the primary endpoint taking into consideration the period effects. Among these patients, the median age was 70 years and the median PSA was 49 ng/mL. Patients received 3.8 ± 0.7 and 3.2 ± 1.5 cycles of chemotherapy during the first and the second period, respectively. The eligible population for the primary endpoint comprised 150 patients. Among them, 66 preferred cabazitaxel (44% IC = [36-52]), 40 preferred docetaxel (27% IC = [20-34]), and 44 expressed no preference between taxanes (29% IC = [22-37]) (p = 0.009). A greater proportion of patients preferred the first received taxane (44%, IC = [36-52]) versus the second taxane (27%, IC = [20-34]), or had no preference (29% IC = [22-37]). Less fatigue and improved quality of life were the two main reasons provided by patients for their choice. There were three toxicity related deaths (1.5%). 

In summary, in this patient preference study of men with mCRPC receiving taxane chemotherapy, a higher proportion of men who are candidates to receive a taxane prefer cabazitaxel over docetaxel. Less fatigue and improved quality of life were the main reasons provided by the patients for their choice. Pharmaco-economic analysis and quality of life studies are ongoing in this patient population. 

References:

1. Tannock IF, de Wit R, Berry WR, et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 2004;351:1502-1512.

2. de Bono JS, Oudard S, Ozguroglu M, et al. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: A randomised open-label trial. Lancet 2010;376(9747):1147-1154.

3. Oudard S, Fizazi K, Sengelov L, et al. Cabazitaxel Versus Docetaxel As First-Line Therapy for Patients With Metastatic Castration-Resistant Prostate Cancer: A Randomized Phase III Trial-FIRSTANA. J Clin Oncol 2017 [Epub ahead of print].

Speaker: Karim Fizazi, Institut Gustave Roussy, University of Paris Sud, Villejuif, France

Co-Authors: R. Delva (Angers, France) G. Gravis (Marseille, France) G. Baciarello (Villejuif, France) C. Theodore (Suresnes, France) M. Gross-Goupil (Bordeaux, France) E. Bompas (Saint-Herblain, France) F. Joly Lobbedez (Caen, France) Y. Tazi (Strasbourg, France) T. L'Haridon (La Roche sur Yon, France) T. Nguyen Tan Hon (Besançon, France) P. Barthelemy (Strasbourg, France)S. Culine (Paris, France) J. Berdah (Hyeres, France) M. Deblock (Vandoeuvre les Nancy, France)P. Beuzeboc (Paris, France) A. Fléchon (Lyon, France) C. Cheneau (Lorient, France)G. Martineau (Villejuif, France)I. Borget (Villejuif, France)

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md at the European Society for Medical Oncology Annual Congress - September 8 - 12, 2017 - Madrid, Spain
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