Quality of Life in Second-Line Treatment of Metastatic Castration-Resistant Prostate

Found a very interesting article on a trial done in Switzerland regarding quality of life in MCRPC patients who took different second-line treatments after ADT and Docetaxel chemotherapy. So many of the guidelines for second-line treatments I've found refer to "Chemotherapy-Naive" patients.

Here, they are comparing those who used Cabazitaxel chemotherapy as second-line to "other treatments" which were mostly Zytiga from what I could see. At the time of study, Enzalutamide was not yet licensed in Switzerland so not included. It's a very interesting article so thought I would share it.

clinical-genitourinary-canc...

[ctarleton]

Thanks Gregg,

Sounds like some quality of life more often stayed the same or went down upon starting either the chemo Jevtana (cabaxitaxel) or on Zytiga (abiraterone acetate) plus Prednisone, and that at the margins, perhaps Zytiga had an edge.

[Hidden in reply to ctarleton]

One of the underlying tenets of the article is that the goal of treatment for CRPC is palliation. Therefore, quality of life is the primary endpoint of treatment. I have to disagree with that aspect because even though the treatments are not curative, we can extend survival time. I can't see calling life-extending treatments palliative. I do think the discussion about quality of life is an important one, partcularly with treatments that have similar outcomes in terms of survival benefit.

Another interesting aspect of the article is the discussion of Cabazitaxel as second-line treatment for CRPC for patients who had prior treatment with Docetaxel. I really haven't read much about that since the focus still seems to be on the majority of CPRC patients who are chemotherapy-naive.

Cabazitaxel is only approved as a second-line chemotherapy after the TROPIC trial in 2010. Later on in FIRSTANA, Cabazitaxel proved no better the Docetaxel as a first-line chemotherapy agent.

Many Medical Oncologists would prefer to rechallenge Docetaxel first before going on to Cabazitaxel.

[Ldb01 in reply to Hidden]

My hubby has CRPRC with bone mets. The first MO treated with Docetaxel once a week for three weeks. Did 5 cycles and pet scan showed no improvement with increased mets. We changed doctors. New MO has now changed chemo to Cabazitaxel once every 21 days. So far side effects have been much worse than on Docetaxel. Our medical insurance said Cabazitaxel is a third line treatment and did not want to approve it. MO appealed and now they are paying. So we wait and see what next scan reveals. They refuse surgery.

[bjorner3 in reply to Ldb01]

I just got my first infusion of docetaxel. They tell me I WILL lose my hair as well as my finger nails. Dud you husband experience this with his 5 infusions? Thanks and hoping for the best for your husband!

[Ldb01 in reply to bjorner3]

Hi there Bjorner3, my husband has only lost the hair on his legs, underarms (a bit on the forearms). All his hair "downstairs" is still there. He is bald but the the hair that he does have has not fallen out. Also he has thick eyebrows which have thinned a little but still look normal. The hair loss has not been as dramatic as most people say it will be. I have heard that most patients lose their hair if the cancer is in the chest and head but it might differ for everybody. Wishing you good luck withe the chemo. Are you getting it every 21 days or once a week ?

[Ldb01 in reply to Ldb01]

Sorry no loss of finger nails at all. Apparently they can put ice packs on your hands so that you don't lose nails but we have not had to do that as yet.

[bjorner3 in reply to Ldb01]

i get it every three weeks. It is my 8th different drug being used to try to control tumor growth. best of continued good health to you and your husband! thanks!