Abstract
Background. Docetaxel (DOC) was the first regimen that increased the survival and became the standard-of-care in patients with metastatic castration-resistant prostate cancer (mCRPC). However, it is unclear whether switching to second-line chemotherapy or optimal sequencing of cabazitaxel (CBZ) ensures better clinical outcomes. We aimed to evaluate the efficacy of sequential therapy with DOC and CBZ and the effect of the number of prior DOC cycles on oncological outcomes in patients with mCRPC. Methods. We retrospectively included 46 mCRPC patients who received DOC followed by CBZ at quaternary hospitals in Japan between February 2015 and March 2019. Participants received intravenous DOC (40–75 mg/m2) every 3–4 weeks; CBZ (15–25 mg/m2) was administered every 3–4 weeks. Androgen-deprivation therapy and prednisolone 5 mg (twice daily) were administered throughout both regimens. The primary endpoints were overall (OS) and progression-free survival (PFS). The secondary endpoints were the rates of ≥30% and ≥50% reduction in prostate-specific antigen (PSA) levels at chemotherapy initiation. Results. Participants were divided into two groups according to DOC cycles (Groups A and B: ≤6 and ≥7 DOC cycles, respectively). The rates of ≥30% and ≥50% reduction in PSA levels were higher in Group B than in Group A, but there were no significant differences in both groups. Median OS in Groups A and B was 12.7 and 71.0 months, respectively P < 0.001 ; median PFS in Groups A and B was 3 and 12 months, respectively P < 0.001 . Conclusions. Administration of ≥7 cycles of DOC followed by CBZ may improve oncological outcomes in patients with mCRPC.
Highlights
In Japan, prostate cancer is the fourth commonest cancer in men and the seventh cause of cancer mortality and has shown a rapid increase in prevalence in recent years [1]
We enrolled 46 patients in this study, and patient characteristics are listed in Table 1. e study participants were divided into two groups by the number of cycles of DOC: Group A comprised patients who received ≤6 cycles of DOC followed by CBZ, whereas Group B included patients who received ≥7 cycles of DOC followed by CBZ
Chemotherapy using DOC beyond 10 cycles has been approved for Castration-resistant prostate cancer circulating tumor cells (CTCs) (CRPC) because it is covered by health insurance in Japan [25]. erefore, the treatment strategy for metastatic castration-resistant prostate cancer (mCRPC) in Japan may be unique compared to other countries
Summary
In Japan, prostate cancer is the fourth commonest cancer in men and the seventh cause of cancer mortality and has shown a rapid increase in prevalence in recent years [1]. 80% of patients have decreased levels of prostate-specific antigen (PSA) and have been reported to experience reduction of primary or metastatic sites; most patients experience disease progression, especially metastatic castration-resistant PCa (mCRPC), within a median of 3 years after diagnosis [3]. In Japan, five agents are used for patients with mCRPC to improve oncological outcomes, including overall (OS) and progression-free survival (PFS). Cabazitaxel (CBZ), a secondgeneration taxane, is approved for the treatment of patients with mCRPC who have previously received a DOCcontaining regimen [5]. Docetaxel (DOC) was the first regimen that increased the survival and became the standard-of-care in patients with metastatic castration-resistant prostate cancer (mCRPC). We retrospectively included 46 mCRPC patients who received DOC followed by CBZ at quaternary hospitals in Japan between February 2015 and March 2019. Administration of ≥7 cycles of DOC followed by CBZ may improve oncological outcomes in patients with mCRPC
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