PSA flare with Jevtana (Cabazitaxel) does not affect results if PSA falls significantly

[JimJimJimJim]

Jim Marshall (not a doctor) said ...

For up to 30% of men, the chemotherapy drug Jevtana (Cabazitaxel) makes the PSA go up for a month or two before it goes down. This rise before a fall is called 'flare'.

 

This study finds that flare did not make a difference. Even if a man had flare, if Cabazitaxel dropped a man's PSA to half what it was, median survival was around 2 years. (Translation: at around 2 years exactly half the men were still alive.)

 

Cabazitaxel is mostly used after most other drugs have been tried. It is generally the last chemotherapy drug used to extend life. 

 

Another chemotherapy drug, Mitoxantrone (sometimes spelt mitozantrone), is sometimes used to alleviate symptoms, but Mitoxantrone does not extend life.

 

... end Jim

 

From European Urology:

 

PROSTATE-SPECIFIC ANTIGEN FLARE INDUCED BY CABAZITAXEL-BASED CHEMOTHERAPY IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER

Antoine Angelergues, Denis Maillet, Aude Fléchon, Mustafa Ozgüroglu, Florence Mercier, Aline Guillot, Sylvestre Le Moulec, Gwenaelle Gravis, Philippe Beuzeboc, Christophe Massard, Karim Fizazi, Thibault de La Motte Rouge, Nicolas Delanoy, Reza-Thierry Elaidi and Stéphane Oudard

European Journal of Cancer, Issue 9, Volume 50, pages 1602 - 1609

Received 25 February 2014, Accepted 2 March 2014, Published online 22-07-2014

ABSTRACT

Background

A prostate-specific antigen (PSA) flare occurs in about 15% of metastatic castration-resistant prostate cancer (mCRPC) patients receiving docetaxel. This flare has no standard definition. Its impact on treatment efficacy is unclear. We sought to evaluate the incidence and characteristics of PSA flare on cabazitaxel, and its impact on survival.

Methods

Multicentre retrospective review of consecutive patients treated with cabazitaxel second-line chemotherapy for mCRPC. Collection of baseline characteristics, disease history and PSA levels before and during cabazitaxel therapy. Overall survival (OS) and radiological/clinical progression-free survival (PFS) for patient groups corresponding to different definitions of PSA flare estimated by the Kaplan–Meier method and compared using the log-rank test.

Results

Overall, 125 patients were included. Median PFS and OS were 6.5 and 13.3 months, respectively. Depending upon the definition used, flare incidence ranged from 8.3% to 30.6%. The flare lasted <2.6 months. A PSA flare followed by a 50% decrease was associated with a median PFS and OS of 11.2 and 25.2 months, respectively. Median PFS and OS for a 30% rather than 50% decrease were 10.4 and 16.5 months. These outcomes were not significantly different from those in patients with immediate PSA decreases of 50% or 30% from baseline, but were significantly better than in patients experiencing no PSA decrease (p = 0.006 and 0.015, respectively, for OS).

Conclusion

The PSA response to cabazitaxel, with or without initial flare, was associated with a strong survival benefit. The taxane-induced flare during the first 12 weeks of therapy can be ignored when evaluating PSA response.

Keywords: Castration resistant prostate cancer, Cabazitaxel, Prostate-specific antigen, Chemotherapy, Cytotoxic agents, Survival rate.

[Barree]

Cabazitaxel in Men with Metastatic Castration-Resistant Prostate Cancer. With or without Prednisone ?

Preliminary results to date show that omitting Prednisone from patients being treated with Cabazitaxel has little or no negative effect on survival or safety but these results are now being tested in the CABACARE trial.

A large scale trial, CABACARE, is underway - where cabazitaxel-treated patients are being  randomized to receive or not receive daily prednisone. This study is currently ongoing at University Federico II of Naples and at other multiple participating centres throughout Italy.

Results are sometime off.