Improved pain response with cabazitaxel vs ARTA in mCRPC

In addition to extending survival, cabazitaxel also improves pain and quality of life (QoL) compared with abiraterone or enzalutamide in men with metastatic castration-resistant prostate cancer (mCRPC), results from the phase III CARD* trial showed.

A total of 255 patients (median age 70 years) with mCRPC who had progressed despite previous treatment with docetaxel and an androgen receptor-targeted agents (ARTA; abiraterone or enzalutamide) were randomized 1:1 to receive cabazitaxel (25 mg/m² Q3W) plus prednisone QD and granulocyte colony-stimulating factor (G-CSF); or either enzalutamide (160 mg QD), or abiraterone** (1,000 mg QD) plus prednisone. About 67 percent of patients reported moderate to severe pain at randomization.

Previously published results on overall survival (OS) favoured cabazitaxel over ARTA (median 13.6 vs 11.0 months; hazard ratio [HR], 0.64; p=0.0078), as did radiographic progression-free survival (rPFS; median 8.0 vs 3.7 months; HR, 0.54; p<0.0001). [N Engl J Med 2019;381:2506-2518]

“CARD met its primary objective; cabazitaxel more than doubled rPFS vs abiraterone or enzalutamide [and also] reduced the risk of death by 36 percent vs abiraterone or enzalutamide,” presented Professor Karim Fizazi from the Institut Gustave Roussy, Villejuif, and University of Paris, Paris, France, at ASCO GU 2020.

In the present study, 45 percent of cabazitaxel recipients achieved pain response, defined as a ≥30 percent decrease from baseline in average BPI-SF*** pain intensity score at two consecutive assessments with no increased use of analgesics, compared with 19.3 percent of ARTA recipients (p<0.0001). [ASCO GU 2020, abstract 16]

Probability of no pain progression^# was also superior with cabazitaxel vs ARTA at 12 months (66.2 percent vs 45.3 percent; HR, 0.55; p=0.0348). Time to first symptomatic skeletal event was also improved with cabazitaxel vs ARTA (median not reached vs 16.7 months; HR, 0.59; p=0.05).

Health-related quality of life (HRQoL), assessed using the FACT-P^## questionnaire, was numerically, but not significantly, greater with cabazitaxel compared with ARTA, with a greater probability of no deterioration at 3 months for overall FACT-P score (86.2 percent vs 74.0 percent), as well as markers such as emotional wellbeing (91.1 percent vs 82.6 percent), functional wellbeing (73.7 percent vs 65.3 percent), physical wellbeing (76.0 percent vs 71.4 percent), and prostate-specific concerns (83.6 percent vs 68.4 percent).

Improvement from baseline in total FACT-P score occurred in 25.0 and 22.8 percent of cabazitaxel and ARTA recipients, respectively. Deterioration from baseline in FACT-P score occurred in 22.2 and 24.6 percent of cabazitaxel and ARTA recipients, respectively, with a median 14.8 and 8.9 months to deterioration in those respective groups (HR, 0.72; p=0.2072).

“Cabazitaxel improves pain, time to pain progression, and time to symptomatic skeletal events. Changes in QoL domains numerically favoured cabazitaxel,” said Fizazi.

“All together, this data support the use of cabazitaxel over abiraterone or enzalutamide as a new standard of care in men previously treated with docetaxel and who had progressed within a year of treatment with the alternative AR access targeted agent,” he concluded.