Cabazitaxel versus docetaxel in men with advanced, hormone-resistant prostate cancer

The authors aimed to determine whether cabazitaxel (Jevtana) was superior to docetaxel (Taxotere) in improving overall survival in patients with advanced, hormone-resistant prostate cancer who had not received previous treatment with chemotherapy.

The authors concluded that cabazitaxel was not superior to docetaxel in men with advanced, hormone-resistant prostate cancer naïve to chemotherapy, but had overall fewer side effects.

Advanced prostate cancer is cancer that has spread outside of the prostate gland into surrounding organs. Hormone therapy is the standard treatment used in advanced cancer. It targets the male sex hormones active in prostate cancer, such as testosterone. In some cases, men may become resistant to hormone therapy. This is known as hormone-resistant cancer. Chemotherapy is another option available to men with advanced prostate cancer. Docetaxel is often the first chemotherapy used. Cabazitaxel is often used following docetaxel. It is not clear whether cabazitaxel would be effective as the first chemotherapy used in  men with advanced, hormone-resistant prostate cancer.

The aim of this study was to determine whether cabazitaxel was superior to docetaxel in improving overall survival (time from treatment until death from any cause) in men with advanced, hormone-resistant prostate cancer.

1,168 men were enrolled in this study. 389 men in group 1 received 20mg/m² of cabazitaxel, 388 men in group 2 received 25mg/m² of cabazitaxel, and 391 men in group 3 received 75mg/m² of docetaxel.

The average overall survival (OS – time from treatment until death from any cause) in group 1 was 24.5 months. OS was 25.2 months in group 2 and 24.3 months in group 3. The average progression-free survival (PFS – men who did not experience disease progression after treatment) was 4.4 months in group 1. PFS was 5.1 months in group 2 and 5.3 months in group 3. There were no significant differences in OS or PFS between groups. Tumor response (such as shrinkage) was higher in group 2 compared to group 3.

Severe side effects were experienced by 41.2% in group 1, 60.1% in group 2 and 46% in group 3. The most common side effects in group 2 were diarrhea, fever and blood in the urine. The most common in group 3 were nail disorders, hair loss, fluid in the tissues and lower limbs, and nerve damage. 

The authors concluded that cabazitaxel was not superior to docetaxel in men with advanced, hormone-resistant prostate cancer naïve to chemotherapy, but had overall fewer side effects.