Real-World Comparison of Cabazitaxel Versus 177Lu-PSMA Radiopharmaceutical Therapy in Metastatic Castration-Resistant Prostate Cancer

[Graham49]

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

Journal of Nuclear Medicine January 2025, 66 (1) 61-66; DOI: doi.org/10.2967/jnumed.124....

[Buckmack11]

I would love someone smart interpret the results of this study.

[1031Cancer]

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.

3. Overall Survival (OS):

Median OS:

Cabazitaxel: 14.7 months

177Lu-PSMA: 16.5 months

Combination Therapy (both treatments): 29.6 months

Statistical Significance:

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.

[NemoHic in reply to 1031Cancer]

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.

[Graham49 in reply to NemoHic]

These selection criteria are also applied during clinical trials.

[NemoHic in reply to Graham49]

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.

[j-o-h-n]

AI Overview on Google Foogle

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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.

Good Luck, Good Health and Humor.

j-o-h-n

[gsun in reply to j-o-h-n]

Really makes me want to do chemo…..

[j-o-h-n in reply to gsun]

Good Luck, Good Health and Good Humor.

j-o-h-n

GMTA

[gsun in reply to j-o-h-n]

that’s my shirt!

[j-o-h-n in reply to gsun]

They said you're the kind of guy who'll give you his shirt right off his back......Well, they were right.... Thanks..

Good Luck, Good Health and Good Humor.

j-o-h-n