Drug sequencing in prostate cancer

With an increasing number of drugs to choose from to manage prostate cancer, the order in which they should be used in often unclear.

A recently published study in the New England Journal of Medicine (DOI: 10.1056/NEJMoa1911206) shows the benefit of using cabazitaxel in patients with metastatic castration-resistant prostate cancer who were previously treated with docetaxel and either of the androgen inhibitors, abiraterone or enzalutamide, and had disease progression within 12 months.

In the study 255 patients who had progressed received either cabazitaxel or abiraterone or enzalutamide (depending which drug they had received previously).

After a median follow-up of 9.2 months, imaging-based disease progression or death was reported in 95 of 129 patients (73.6%) in the cabazitaxel group, compared with 101 of 126 patients (80.2%) in the group that received an androgen inhibitor (HR, 0.54; 95% confidence interval [CI], 0.40 to 0.73; p<0.001). The median imaging-based progression-free survival was 8 months with cabazitaxel and 3.7 months with the androgen inhibitor. The median overall survival was 13.6 months with cabazitaxel and 11 months with the androgen inhibitor (hazard ratio for death, 0.64; 95% CI, 0.46 to 0.89; p=0.008).

Adverse events were slightly higher in patients receiving cabazitaxel than in those receiving an androgen inhibitor.

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