Post-docetaxel options for further survival benefit in metastatic castration-resistant prostate cancer: Questions of choice

Abstract

There are currently two medical treatments approved in Canada that offer survival benefits for patients with metastatic castration-resistant prostate cancer that progresses on or after docetaxel-based chemotherapy, and evidence is accumulating on the efficacy of further interventions in this setting. The current and emerging strategies are based on a variety of mechanisms (cytotoxicity, hormonal inhibition, radiopharmacy and immunotherapy) and there is nothing to suggest that patients will be unable to benefit from several or even all of these agents when used sequentially. Given the possibility of multiple lines of treatment for patients whose disease progresses on or after docetaxel, the challenge for clinicians will be to determine the optimum treatment pathway for each individual. That challenge is already being faced, albeit on a limited scale, now that both cabazitaxel (chemotherapy) and abiraterone (hormonal agent) are available for use post-docetaxel.

Figures

Fig. 1

Overall survival in the TROPIC trial of cabazitaxel versus mitoxantrone. Used with permission from The Lancet.

Fig. 2

Subgroup analysis of survival data from the TROPIC trial. Used with permission from The Lancet. ECOG: Eastern Cooperative Oncology Group; PSA: prostate-specific antigen.

Fig. 3

Overall survival in the COU-AA-301 trial of abiraterone versus placebo.Used with permission from The New England Journal of Medicine.

Fig. 4

Subgroup analysis of survival data from the COU-AA-301 trial. Used with permission from The New England Journal of Medicine. ECOG: Eastern Cooperative Oncology Group; BPI: Brief Pain Inventory; PSA: prostate-specific antigen.

Fig. 5

The “cabazitaxel-first” approach to mCRPC management post-docetaxel, as advocated in some centres.,, *The TAX327 trial of docetaxel versus mitoxantrone was conducted in patients with a Karnofsky performance status of ≥60% (able to self care with no more than occasional help). mCRPC: metastatic castration-resistant prostate cancer.