ASCO GU 2021: Cabazitaxel Multiple Rechallenge in Metastatic Castration-Resistant Prostate Cancer: A Therapeutic Option to Increase Overall Survival?

(UroToday.com) The field of advanced prostate cancer has rapidly progressed over the past 15 years. Prior to the publication of TAX-327, there were no proven life-prolonging therapies for patients with metastatic castration-resistant prostate cancer (mCRPC). Since that time, there have been many new agents that have proven survival benefits including taxane-based chemotherapy, agents targeting the androgen axis, and bone-targeting agents. However, many patients will exhaust efficacious treatment options. Cabazitaxel is typically used in the second-line chemotherapy setting. In a plenary abstract presentation in the Poster Highlights Session: Prostate Cancer session at the 2021 ASCO Genitourinary Cancers Symposium (ASCO GU), Dr. Pobel and colleagues assess the feasibility and efficacy of cabazitaxel multiple rechallenges in patients with mCRPC.

The authors performed a multicenter, retrospective cohort study including patients treated at 9 centers in France who received 3 lines or more of cabazitaxel between February 2012 to July 2020. A variety of cabazitaxel schedules were utilized including 25 mg/m2 q3w, 20 mg/m2 q3w, 16 mg/m2 q2w and 10 mg/m2 weekly. The authors assessed efficacy by examining overall survival (OS) and progression-free survival (PFS) from each cabazitaxel line start as well as toxicity based on grade ≥ 3 adverse events.

The authors included 22 patients who received multiple lines of cabazitaxel. The median follow-up from the diagnosis of mCRPC was 94.7 months. At the time of initial prostate cancer diagnosis, the median age was 59.5 years old, median ISUP score was 4, and median PSA was 55 ng/ml. 

 

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The median number of cabazitaxel cycles varied between lines: in the first line setting, median number of cycles was 7, 6 at first rechallenge, and 5 for subsequent rechallenges. 

From mCRPC diagnosis, the median OS was 105 months. Further, the median PFS from cabazitaxel initiation was 11.8 months at first use, 9.6 for first rechallenge and 5.6 in second rechallenge. 

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Among 22 included patients, there was one case of febrile neutropenia and 6 events of grade ≥ 3 toxicity.

The authors concluded that repeated rechallenges with cabazitaxel may extend OS with manageable toxicities for patients with mCRPC. 

Presented by: Cedric Pobel, MD, Department of Medical Oncology, European Hospital Georges Pompidou & University of Paris
Co-authors: Edouard Auclin, Diego Teyssonneau, Brigitte Laguerre, Mathilde Cancel, Elouen Boughalem, Johanna Noel, Pierre Emmanuel Brachet, Denis Maillet, Philippe Barthelemy, Carole Helissey, Constance Thibault, Stephane Oudard

Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center, @WallisCJD on Twitter during the 2021 American Society of Clinical Oncology Genitourinary Cancers Symposium (#GU21), February 11th-February 13th, 2021

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