Abstract
Docetaxel is the guideline-recommended first-line chemotherapy in men with castration-resistant prostate cancer (CRPC). Despite its proven survival benefit, however, all patients will experience disease progression after a mean interval of six to eight months. Recently, the US Food and Drug Administration approved cabazitaxel and abiraterone acetate as effective second-line treatment options in this clinical scenario. Compared with mitoxantrone, cabazitaxel improves progression-free survival, overall survival, time to prostate surface antigen (PSA) progression, and time to metastatic progression. On the other hand, cabazitaxel is associated with a significantly higher frequency of grade 3/4 hematotoxic and gastrointestinal side effects than mitoxantrone. In experienced hands, and with the use of proactive therapeutic measures (weekly monitoring, adequate patient counselling, appropriate application of the guidelines on management and prophylaxis of neutropenia and diarrhea), all side effects can be handled easily without harming the patient, as has been shown recently by the analysis of the results of the German and European compassionate use programs. Cabazitaxel is one of the key components in the management of disease progression after docetaxel, and might be of benefit in men with high metastatic burden, rapid PSA doubling time, and minimal side effects during first-line docetaxel therapy.
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