Researchers Identify mCRPC Drug Sequence Offering the Best Survival
In a retrospective study, patients lived the longest if they received docetaxel followed by cabazitaxel and then abiraterone or enzalutamide.
Researchers who studied various sequences of drugs to treat metastatic castration-resistant prostate cancer (mCRPC) found that docetaxel followed by cabazitaxel and then either abiraterone or enzalutamide offered the best overall survival, according to findings presented at the 2017 Genitourinary Cancers Symposium in Orlando, Florida.
In a retrospective study of 574 mCRPC patients, Nicolas Delanoy, MD, of Georges Pompidou European Hospital in Paris, and colleagues evaluated the impact of 3 different drug sequences: docetaxel followed by cabazitaxel (267 patients, group 1), docetaxel followed by either abiraterone or enzalutamide and then cabazitaxel (183 patients, group 2), and docetaxel followed by cabazitaxel and then either abiraterone or enzalutamide (124 patients, group 3).
The median overall survival from the first docetaxel cycle in groups 1, 2, and 3 was 30.1, 37.1, and 40.1 months, respectively, reported in a poster presentation. Compared with group 1 patients, group 2 and 3 patients had a significant 12% and 40% decreased risk of death.
Results also showed that higher baseline PSA level, shorter response to first androgen deprivation therapy (ADT), and clinical progression are major prognostic factors for overall survival at docetaxel initiation, according to the investigators. Compared with patients who had an ADT response of 12 months or less, those with an ADT response duration of more than 12 months had a significant 48% lower risk of death. Patients who experienced clinical progression had a significant 51% higher risk of death.
At docetaxel initiation, patients had a median age of 67 years and median of 7 docetaxel cycles (7 in groups 1 and 3 and 6 in group 2). The median number of cabazitaxel cycles was 6 (6 in groups 1 and 2, 7 in group 3). The median duration of treatment with either abiraterone or enzalutamide was 5.9 and 4.4 months in groups 2 and 3, respectively.
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- Delanoy N, Angelergues A, Efstathiou E, et al. Sequencing in metastatic castration-resistant prostate cancer (mCRPC): Updated results from the FLAC International Database. Data presented in poster format at the 2017 Genitourinary Cancers Symposium in Orlando, Florida. Poster Session B Board #D7. Abstract 267.