Emily Menendez

GU Oncology Now

Gene expression profiling has shown that metastatic castration-resistant prostate cancer (mCRPC) cells are deficient in retinoblastoma proteins (RB), resulting in a hypersensitivity to taxanes such as cabazitaxel. Preclinical studies have found that cabazitaxel has superior antitumor efficacy compared with docetaxel for mCRPC. A phase 2, randomized trial investigated the <a href="https://ascopubs.org/doi/abs/10.1200/JCO.22.02639" target="_blank" rel="noopener">potential efficacy of abiraterone acetate/prednisone plus cabazitaxel</a> against abiraterone acetate/prednisone alone to determine if the combination can be utilized as a novel treatment for mCRPC.The trial determined the radiographic progression-free survival (rPFS), prostate-specific antigen (PSA) PFS, overall objective response, and safety of abiraterone acetate/prednisone plus cabazitaxel in 81 patients with mCRPC. Equally allocated patients were administered abiraterone acetate/prednisone followed by switching to cabazitaxel upon radiographic progression in arm 1 of the trial. Patients in arm 2 were treated upfront with abiraterone acetate/prednisone plus cabazitaxel.Patients were stratified into high- or low-risk groups based on the Halabi nomogram. The real-time assessment of RB status and circulating tumor cell (CTC) analysis to correlate with clinical outcomes was exploratory.Treatment in both arms of the study was well-tolerated. The median rPFS of abiraterone acetate/prednisone alone was 6.4 months (95% CI, 3.8-10.6), and median overall survival (OS) was 18.3 months (95% CI, 14.4-37.6). A total of 56% of patients showed &ge;50% decline in PSA.The median rPFS of patients administered abiraterone acetate/prednisone plus cabazitaxel was 14.8 months (95% CI, 10.6-16.4), and the median OS was 24.5 months (95% CI, 20.4-35.0). There was a &ge;50% decline in PSA in 92.1% of patients.Neither RB expression in pretherapy tumor biopsy, CTC, or tissue explants identified those patients who may benefit from abiraterone acetate/prednisone plus cabazitaxel.Abiraterone acetate/prednisone plus cabazitaxel administered earlier in treatment rather than sequentially may benefit some patients, as it was safe, with improved rPFS, OS duration, and a higher proportion of PSA declines. Further research is needed to define the patient population more closely.

Is Abiraterone Acetate More Effective With or Without Cabazitaxel for mCRPC?

Metastatic castration-resistant prostate cancer 

CRPC

As mCRPC cells are deficient in retinoblastoma proteins, they are hypersensitive to taxanes such as cabazitaxel, leading to potential new treatment options.

Is Abiraterone More Effective With Cabazitaxel for mCRPC?

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