Retrospective Study of Treatment Sequencing

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Survival Outcomes for Sequential Use of New Agents in Metastatic Castration-Resistant Prostate Cancer

Clinical Genitourinary Cancer

TAKE-HOME MESSAGE

Although there are many new treatments for metastatic castration-resistant prostate cancer (MCRPC), including cabazitaxel, enzalutamide, and abiraterone, the optimal sequence is poorly understood. In this retrospective analysis of outcomes from published studies, the authors evaluated individual survival outcomes of 1099 men with MCRPC after docetaxel chemotherapy and either cabazitaxel or a new hormone agent (enzalutamide or abiraterone). From the start of the second-line therapy, there was no difference in cumulative overall survival across agents. However, in patients who progressed after 6 months, the median overall survival was longer in those who received cabazitaxel therapy as part of their therapy instead of back-to-back new hormone agents (29.5 vs 24.8 months; P=.03).

Urologists who treat MCRPC should be aware of differences in treatment agents. In patients who have persistent disease following docetaxel, urologists may wish to avoid back-to-back hormone agents, and, instead, consider integration of cabazitaxel.