Treatment of metastatic castration-resistant prostate cancer (mCRPC) with a combination of cabazitaxel and carboplatin showed improved clinical efficacy compared with cabazitaxel alone, according to the findings of a phase 2 trial.

The investigators stated that, to their knowledge, the trial is the first to establish the benefit of combining a platinum agent with a taxane agent in mCRPC using a randomized, prospective trial design.

For the trial, Ana M. Aparicio, MD, of the University of Texas MD Anderson Cancer Center in Houston and colleagues randomly 160 men with mCRPC to receive cabazitaxel alone (79 patients) or cabazitaxel plus carboplatin (81 patients). At a median follow-up of 31 months, the combination arm had significantly longer median progression-free survival compared with the monotherapy arm (7.3 vs 4.5 months). Patients who received the dual regimen had a significant 31% decreased risk of progression compared with those in the cabazitaxel-only recipients, Dr Aparicio and her colleagues reported in Lancet Oncology.

Grade 3-4 adverse events occurred more frequently in the combination than monotherapy arm. The most common were fatigue (occurred in 20% and 9% of the combination and monotherapy arms, respectively), anemia (23% and 4%), neutropenia (16% and 4%), and thrombocytopenia (14% and 1%). No treatment-related deaths occurred.

Subgroup analyses suggest that the combined treatment appeared to benefit patients with aggressive variant prostate cancer features, but not those without.

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“The results of our study support the hypothesis that carboplatin added to cabazitaxel improves median progression-free survival and response in men with metastatic castration-resistant prostate cancer, and they show that the combination was safe and tolerable with appropriate antiemetic and growth factor support,” the authors wrote.

Reference

Corn PG, Heath EI, Zurita A, et al. Cabazitaxel plus carboplatin for the treatment of men with metastatic castration-resistant prostate cancers: a randomized, open-label, phase 1-2 trial [published online September 9, 2019]. Lancet Oncol.  doi: 10.1016/S1470-2045(19)30408-5