SAN FRANCISCO—Men with metastatic castration-resistant prostate cancer (mCRPC) previously treated with docetaxel and an androgen-signaling-targeted agent (ARTA)—either abiraterone or enzalutamide—experience greater reductions in pain when treated with cabazitaxel rather than switching to the other ARTA, according to new study findings presented at the 2020 Genitourinary Cancers Symposium.

The new findings emerged from an evaluation of changes in pain and health-related quality of life (HRQoL) in the CARD trial, in which investigators randomly assigned 255 men with mCRPC who previously had received docetaxel and either abiraterone or enzalutamide to receive cabazitaxel or the alternative ARTA. The results of that trial, published in the New England Journal of Medicine in 2019, showed that cabazitaxel therapy was associated with superior radiographic progression-free and overall survival.

Of the 255 men, 172 (67.5%) had moderate to severe pain at randomization. Pain response and HRQoL were evaluable for 111 men (86%) and 108 (83.7%) for cabazitaxel and 114 (90.5%) for ARTA recipients. For the new analysis, a team led by Karim Fizazi, MD, PhD, of Institut Gustave Roussy, University of Paris Sud, Villejuif, France, defined pain response as a greater than 30% decrease from baseline in Brief Pain Inventory-Short Form (BPI-SF) pain intensity score with no analgesic use. Dr Fizazi and his colleagues assessed HRQoL using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire.

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Pain response rates were significant higher for cabazitaxel than ARTA (45.9% vs 19.3%), the investigators reported. The probability of not having pain progression after 12 months also was significantly greater for the cabazitaxel recipients (66.2% vs 45.3%). Cabazitaxel-treated patients had a significant 45% decreased risk of pain progression after 12 months compared with ARTA recipients.

Cabazitaxel and ARTA patients experienced similar trends in HRQoL, Dr Fizazi’s team reported. An improvement in total FACT-P score was baseline was reported by 25% and 22.8% of the cabazitaxel and ARTA groups, respectively. FACT-P score was maintained or improved for 75% of the cabazitaxel arm and 75.4% of the ARTA recipients.

“I think it’s a good study and a very important one, and I wish it had been done a lot earlier,” said Cy A. Stein, MD, PhD, a medical oncologist at City of Hope, a comprehensive cancer center in Duarte, California, who was not involved in the research. “It makes no sense to go from oral to oral [medication] when you have a drug like cabazitaxel, which can provide responses. This trial has really borne out that kind of thinking.”

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Fizazi K, Kramer G, Eymard JC, et al. Pain response and health-related quality of life (HRQL) in patients with metastatic castration-resistant prostate cancer (mCRPC) receiving cabazitaxel (CBZ) versus abiraterone or enzalutamide in the CARD study. Presented at the 2020 Genitourinary Cancers Symposium held February 13 to 15 in San Francisco. Abstract 16.

de Wit R, de Bono J, Sternberg CN, et al. Cabazitaxel versus abiraterone or enzalutamide in metastatic prostate cancer. N Engl J Med. 2019;381:2506-2518.  doi: 10.1056/NEJMoa1911206