In this fairly small real world study the FRAMCAP database was used to compare cabazitaxel versus 177Lu-PSMA therapy in mCRPC patients and patients that had both treatments. Note that those receiving both treatments had a median OS much better than the other treatments separately.
Results: Of 373 patients, 14% received cabazitaxel, 65% received 177Lu-PSMA, and 21% received both.
“Rates of a prostate-specific antigen decline of at least 50% were 32% versus 0% for 177Lu-PSMA versus cabazitaxel. In outcome analyses, significant superior median PFS was observed for 177Lu-PSMA versus cabazitaxel (13.4 mo vs. 7.1 mo, P < 0.001), even after multivariable adjustment (hazard ratio, 0.38; P < 0.001). Regarding OS, rates also significantly differed, with median OS of 14.7 mo versus 16.5 mo versus 29.6 mo for cabazitaxel versus 177Lu-PSMA versus both treatments (P < 0.01). In sensitivity analyses of second- to fourth-line mCRPC treatment, PFS rates and median OS rates for cabazitaxel versus 177Lu-PSMA versus both therapies qualitatively remained the same as for the entire cohort.”
Real-World Comparison of Cabazitaxel Versus 177Lu-PSMA Radiopharmaceutical Therapy in Metastatic Castration-Resistant Prostate Cancer
Mike Wenzel, Florestan Koll, Benedikt Hoeh, Clara Humke, Carolin Siech, Nicolai Mader, Amir Sabet, Daniel Groener, Thomas Steuber, Markus Graefen, Tobias Maurer, Christian Brandts, Severine Banek, Felix K.H. Chun and Philipp Mandel
I used ChatGPT to interpret. Here's the answer. These results present a comparison of two treatments for metastatic castration-resistant prostate cancer (mCRPC): 177Lu-PSMA (lutetium-177–prostate-specific membrane antigen) and cabazitaxel. Here's a clarification of the findings:
1. Prostate-Specific Antigen (PSA) Decline:
177Lu-PSMA: 32% of patients experienced a PSA decline of at least 50%.
Cabazitaxel: 0% of patients experienced this level of PSA decline.
Interpretation: 177Lu-PSMA is significantly more effective in reducing PSA levels, an important marker for prostate cancer progression.
2. Progression-Free Survival (PFS):
Median PFS:
177Lu-PSMA: 13.4 months
Cabazitaxel: 7.1 months
Statistical Significance:
P < 0.001, meaning the difference is highly statistically significant.
Hazard Ratio (HR): 0.38 (P < 0.001), indicating a 62% reduction in the risk of disease progression or death with 177Lu-PSMA compared to cabazitaxel.
Interpretation: 177Lu-PSMA provides significantly better disease control compared to cabazitaxel.
P < 0.01, indicating a statistically significant difference between groups.
Interpretation: Combination therapy provides the longest survival benefit, but 177Lu-PSMA alone offers slightly better survival than cabazitaxel.
4. Sensitivity Analyses:
The results for PFS and OS across different lines of treatment (second- to fourth-line mCRPC therapy) were consistent with the overall cohort results.
Interpretation: These findings are robust and likely applicable across various treatment settings.
Summary:
177Lu-PSMA outperforms cabazitaxel in terms of PSA response and PFS, and it offers slightly better OS when used alone.
Combination therapy provides the most substantial OS benefit, suggesting a potential advantage in combining both treatments in certain patient scenarios.
Use care in interpreting observational studies like this. The dual cabazitaxel/177Lu-PSMA treatment may have been only given to the those who were overall thought to be healthier and better able to tolerate the more aggressive treatment.
Patients who are entered into a clinical trial are deemed healthy enough to tolerate both the control and test treatments prior to randomization. That way the control and test populations are as similar as possible after randomization. In observational studies there is no such randomization and the two populations may be much different. Observational studies have far too much potential bias to allow strong conclusions to be drawn, particularly with small populations. It's an interesting result that may warrant additional study, but no one should be convinced that they will die in half the time if they get cabazitaxel or 177Lu-PSMA individually based on this paper.
Cabazitaxel, also known as Jevtana, is a chemotherapy drug used to treat advanced prostate cancer:
How it works
Cabazitaxel is a microtubule inhibitor that prevents cancer cells from dividing and growing.
How it's given
Cabazitaxel is administered intravenously as a liquid over the course of an hour. Treatment cycles are typically three weeks long, and up to 10 cycles may be given.
Who it's for
Cabazitaxel is used to treat men with prostate cancer that has spread to other parts of the body and is resistant to castration. It's often used in patients who have already been treated with other anticancer drugs, like docetaxel.
Side effects
Side effects can vary from person to person and include:
Risk of infection
Breathlessness and looking pale
Loss of appetite and weight loss
Gastrointestinal (GI) hemorrhage and perforation
Peripheral neuropathy
Severe hypersensitivity reactions like hypotension, bronchospasm, and generalized rash/erythema
Cabazitaxel is also being studied for the treatment of other types of cancer.
Cabazitaxel (intravenous route) - Mayo Clinic
Cabazitaxel injection is given together with a steroid medicine (eg, prednisone) to treat men with metastatic (cancer that has alr...
Mayo Clinic
Cabazitaxel (Jevtana) | Cancer information | Cancer Research UK
Cancer Research UK
Definition of cabazitaxel - NCI Dictionary of Cancer Terms
A drug used with prednisone to treat prostate cancer that has spread to other parts of the body and is castration resistant (has n...
National Cancer Institute
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Cabazitaxel belongs to the group of medicines called antineoplastics (cancer medicines). It interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected, other unwanted effects will also occur.
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