Management of Metastatic Castration-Resistant Prostate Cancer with Cabazitaxel

Introduction to Cabazitaxel Efficacy

• The European Society for Medical Oncology recommends cabazitaxel as it improves overall survival compared to mitoxantrone in post-docetaxel mCRPC patients, with Level I evidence and a Grade A recommendation 1, 2, 3, 4
• The National Comprehensive Cancer Network suggests that cabazitaxel does not clear or eliminate bone metastases in metastatic castration-resistant prostate cancer, but it provides significant survival benefit and disease control in patients who have progressed after docetaxel 1, 2, 3

Management of Bone Metastases

• The National Comprehensive Cancer Network recommends denosumab 120 mg subcutaneously every 4 weeks or zoledronic acid to prevent skeletal-related events, though neither eliminates metastases 5, 6
• Radium-223 is recommended for symptomatic bone-predominant disease without visceral metastases, which provides both symptomatic and survival benefit 1, 2, 3
• External beam radiation is suggested for palliation of painful bone metastases 4, 7

Treatment Sequencing and Safety

• The European Association of Urology suggests that after docetaxel failure, cabazitaxel is superior to switching between abiraterone and enzalutamide due to cross-resistance 8
• Cabazitaxel should be offered to patients with good performance status who have progressed after docetaxel, with Level I evidence and a Grade A recommendation 1, 2, 3