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Docetaxel + Abi/Enz: Other Abi/Enz or Cabazitaxel next?

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Jim Marshall (not a doctor) said ...

 

In his treatment to date, a man has had:

  • Docetaxel chemotherapy; and
  • ONE of Abiraterone or enzalutamide; and

the effect of the Abiraterone/Enzalutamide lasted less than a year.

(Whether he had Docetaxel first or second is not important for this study.)

 

Is he better to have the OTHER one of Abiraterone or Enzalutamide, or move on to the next chemotherapy, Cabazitaxel?

 

The simple answer is that his scans will take longer to show progression and he will live longer, if he moves on to the next chemotherapy, Cabazitaxel. The authors also reported (not in this paper) that the men on Cabazitaxel reported a higher quality of life.

 

Names

Docetaxel = Taxotere

Abiraterone = Zytiga

Enzalutamide = Xtandi

Cabazitaxel = Jevtana

... end Jim

 

N Engl J Med. 2019 Dec 26;381(26):2506-2518. doi: 10.1056/NEJMoa1911206. Epub 2019 Sep 30.

Cabazitaxel versus Abiraterone or Enzalutamide in Metastatic Prostate Cancer.

de Wit R1, de Bono J1, Sternberg CN1, Fizazi K1, Tombal B1, Wülfing C1, Kramer G1, Eymard JC1, Bamias A1, Carles J1, Iacovelli R1, Melichar B1, Sverrisdóttir Á1, Theodore C1, Feyerabend S1, Helissey C1, Ozatilgan A1, Geffriaud-Ricouard C1, Castellano D1; CARD Investigators.In LibraryGet PDF

Collaborators (65)

Author information

Abstract

BACKGROUND:

The efficacy and safety of cabazitaxel, as compared with an androgen-signaling-targeted inhibitor (abiraterone or enzalutamide), in patients with metastatic castration-resistant prostate cancer who were previously treated with docetaxel and had progression within 12 months while receiving the alternative inhibitor (abiraterone or enzalutamide) are unclear.

 

METHODS:

We randomly assigned, in a 1:1 ratio, patients who had previously received docetaxel and an androgen-signaling-targeted inhibitor (abiraterone or enzalutamide) to receive cabazitaxel (at a dose of 25 mg per square meter of body-surface area intravenously every 3 weeks, plus prednisone daily and granulocyte colony-stimulating factor) or the other androgen-signaling-targeted inhibitor (either 1000 mg of abiraterone plus prednisone daily or 160 mg of enzalutamide daily). The primary end point was imaging-based progression-free survival. Secondary end points of survival, response, and safety were assessed.

 

RESULTS:

A total of 255 patients underwent randomization. After a median follow-up of 9.2 months, imaging-based progression or death was reported in 95 of 129 patients (73.6%) in the cabazitaxel group, as compared with 101 of 126 patients (80.2%) in the group that received an androgen-signaling-targeted inhibitor (hazard ratio, 0.54; 95% confidence interval [CI], 0.40 to 0.73; P<0.001). The median imaging-based progression-free survival was 8.0 months with cabazitaxel and 3.7 months with the androgen-signaling-targeted inhibitor. The median overall survival was 13.6 months with cabazitaxel and 11.0 months with the androgen-signaling-targeted inhibitor (hazard ratio for death, 0.64; 95% CI, 0.46 to 0.89; P=0.008). The median progression-free survival was 4.4 months with cabazitaxel and 2.7 months with an androgen-signaling-targeted inhibitor (hazard ratio for progression or death, 0.52; 95% CI, 0.40 to 0.68; P<0.001), a prostate-specific antigen response occurred in 35.7% and 13.5% of the patients, respectively (P<0.001), and tumor response was noted in 36.5% and 11.5% (P=0.004). Adverse events of grade 3 or higher occurred in 56.3% of patients receiving cabazitaxel and in 52.4% of those receiving an androgen-signaling-targeted inhibitor. No new safety signals were observed.

 

CONCLUSIONS:

Cabazitaxel significantly improved a number of clinical outcomes, as compared with the androgen-signaling-targeted inhibitor (abiraterone or enzalutamide), in patients with metastatic castration-resistant prostate cancer who had been previously treated with docetaxel and the alternative androgen-signaling-targeted agent (abiraterone or enzalutamide). (Funded by Sanofi; CARD ClinicalTrials.gov number, NCT02485691.).

 

Copyright © 2019 Massachusetts Medical Society.

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Patrick Turner

To my simple mind, Cabazitaxel offers only slight benefits and I have read so many stories in other Pca chat groups where men tell all things to the world. I could have switched to Cabazitaxel after Docetaxel failed so badly in October 2018, but my oncologist said chemo probably would fail, and it did. All of what I'd read about chemo in articles by researches not funded by any drug companies suggested chemo was not a very good fix for Pca especially when it got into bones. My onco happily gave me a reference to see Theranostics Australia for Lu177 after chemo quadrupled my Psa after 4 shots.

PsMa Ga68 PET / CT scans showed I might get benefit with Lu177.  

A year after starting Lu177, Psa of 25 fell to 0.32 , but is rising, now about 1.5, still quite low, and I may just get more Lu177 if I need it, and there is no suggestion by docs that any chemo will work better than the last lot I endured.

I am now cycling 200km a week at good speed, and I feel quite well. Latest CT scans showed only 2 mets still active. So its wait and see for awhile before deciding what next.  No docs have said I need FDG scans to see what Pca will not respond to Lu177. 

I still have options for treatments after surviving 10 years after diagnosis of a Gleason 9, 9 /9 positive biopsy samples, inoperable, and which had probably spread widely.

My Pca maybe began in 2004, with Psa about 3.0, and that's when I may have had low Gleason score, no spread, and an RP well done by a well practiced surgeon would have prevented the $200,000 costs of all treatment since.

Medicare paid for most of treatments I have had "after the horse has bolted" but I spent about $60,000 without any refund. 

I must pay to stay alive. 

Patrick Turner. 

 

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