Oncologic Response and Hospitalization Rate of Patients Receiving Cabazitaxel in the Fourth-Line and Beyond in Castration-Resistant Prostate Cancer: Analysis of a Retrospective Cohort and a Structured Literature Review

Abstract

Background: Limited data are available for the use of agents in metastatic castration-resistant prostate cancer (mCRPC) beyond the third-line. We provide data during treatment with cabazitaxel (CAB), helping to improve the informed-consent process. Patients and Methods: We retrospectively reviewed patients treated with fourth-line or beyond CAB for mCRPC after failure of previous therapies with docetaxel, abiraterone acetate, enzalutamide and/or radium-223. The progression-free survival (PFS) and the overall survival (OS) were estimated using the Kaplan-Meier method and compared to published data based on a structured literature review. The hospitalization rate was recorded. Factors influencing 6-months OS were analyzed. Results: Fifteen patients were identified at 4 institutions and included in the analysis. The median PFS was 104 days (range 47-397 days). The median time to death was 10 months (range 2-16). PFS and OS data are in accordance with 17 published patients so far. During the therapy, eleven (73%) of the patients were hospitalized. Prostate-specific antigen (PSA, 500 units; hazards ratio [HR] 1.491, 95% CI 1.000-2.0175), white blood cell count (HR 0.425, 95% CI 0.108-0.952), hemoglobin (HR 0.6014, 95% CI 0.2942-1.0758), and alkaline phosphatase (100 units; HR 1.0964, 95% CI 1.000-1.2859) correlate with 6-months OS. Conclusions: CAB beyond the third-line is often accompanied by hospitalization. PFS is a significant proportion of the median time of OS. The baseline laboratory might be a good indicator for the decision between CAB and best-supportive care.

Sequential Therapy of Metastatic Castration-Resistant Prostate Cancer: New Possibilities

“…пациентов из Регистра рака предстательной железы показал, что использование абиратерона или энзалутамида во 2-й линии терапии после доцетаксела ассоциировано с клинически значимым улучшением качества жизни по сравнению с применением кабазитаксела во 2-й линии [43]. Однако более позднее назначение кабазитаксела также нежелательно в виду резкого повышения частоты осложнений, обусловленных развитием токсичности у ослабленных пациентов [44].…”

Contemporary Treatment Patterns and Oncological Outcomes of Metastatic Hormone-sensitive Prostate Cancer and First- to Sixth- line Metastatic Castration-resistant Prostate Cancer Patients

“…Moreover, it seems that differences in treatment sequences may also affect oncological outcomes [10] . Furthermore, even after receiving multiple therapy lines, mCRPC patients harbor acceptable life expectancy, which might decrease after every therapy line [11] , [12] . However, with the approval of novel treatment options, increasing life expectancy in general, and adoption and improvement of health care systems, trends in systemic mCRPC treatments may differ significantly between more historical and more contemporarily treated mCRPC patients.…”