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 progress after a mean interval of six to eight months. Recently, the FDA approved cabazitaxel and abiraterone acetate as effective second-line treatment options in this clinical scenario. By comparison 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 (Sanofi) is asscociated with a significantly higher frequency of grade 3 and 4 haematotoxic and gastrointestinal side effects than mitoxantrone. In experienced hands, and with the use of proactive therapeutic measures such as weekly monitoring, adequate patient counselling and appropriate application of the guidelines on management and prophylaxis of neutropenia and diarrhoea — 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 programmes. 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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