Quality of life in patients with metastatic prostate cancer under cabazitaxel treatment

The study compared the quality of life (QoL) of patients with metastatic castration-resistant prostate cancer (mCRPC) treated with cabazitaxel (Jevtana) compared to abiraterone (Zytiga) or enzalutamide (Xtandi). The authors found that cabazitaxel did not reduce QoL in such patients.

Patients with mCRPC no longer respond to hormonal therapy that lowers the levels of androgens (male sex hormones). These patients are often prescribed androgen-receptor inhibitors (ARI) such as abiraterone or enzalutamide. They can also be prescribed chemotherapy drugs such as taxanes. These include cabazitaxel and docetaxel (Taxotere). 

Cabazitaxel was shown to improve survival in patients with mCRPC who were previously treated by docetaxel and a first ARI (abiraterone or enzalutamide) in a recent study, compared to the alternative ARI. However, the impact of this treatment on the QoL of patients is unknown.

The study included 250 adult patients with mCRPC. Their cancers spread outside of the prostate despite being under treatment with docetaxel and an ARI (abiraterone or enzalutamide). 126 patients received cabazitaxel and 124 received the alternative ARI. They were followed up for 9.2 months on average. QoL was assessed by medical questionnaires reported by patients.

46% of patients on cabazitaxel and 19% on abiraterone or enzalutamide experienced pain response. Pain response was defined as a 30% or higher reduction in pain intensity scores. Pain worsened in 23% of patients receiving cabazitaxel, compared with 25% of patients on abiraterone or enzalutamide. Patients under cabazitaxel treatment were estimated to have a 45% longer time to pain worsening compared to abiraterone or enzalutamide.

Symptomatic skeletal events (SSEs) occur due to cancer spread to the bones. SSEs included bone pain, new fractures, spinal cord deformation, and orthopedic surgery for fixing bone damage. 19% of patients on cabazitaxel and 28% on enzalutamide or abiraterone had SSEs. Patients on cabazitaxel had a 41% longer time until developing SSEs compared to the abiraterone/enzalutamide group.

The average time until a worsening of QoL scores was 14.8 months with cabazitaxel and 8.9 months with enzalutamide or abiraterone. Cabazitaxel was associated with a 28% longer time to QoL score deterioration compared to abiraterone or enzalutamide.

The study concluded that cabazitaxel improved pain-related outcomes and QoL compared to abiraterone or enzalutamide in patients with mCRPC.

This study was funded by Sanofi, the manufacturer of cabazitaxel.