Hello, I'm Bret Stetka, Editorial Director at Medscape. Welcome to the F1000 Practice-Changing Minute, where we report commentaries from the Faculty of 1000 on highly-rated studies that may change clinical practice. Our commentary today covers the study Prednisone Plus Cabazitaxel or Mitoxantrone for Metastatic Castration-Resistant Prostate Cancer Progressing After Docetaxel Treatment from de Bono and colleagues published in the Lancet.[1] The Faculty of 1000 Medicine has given this a ranking of Must Read with a factor of 8.
The following F1000 commentaries on this study were written by Drs. Thomas Flaig and Michael Glode of the University of Colorado, Denver School of Medicine in Aurora, Colorado.
In their commentary on this study, Drs Flaig and Glode wrote:
"Doctors now have the option of using cabazitaxel for the treatment of prostate cancer patients with progressive disease after docetaxel-based chemotherapy.
This is the first randomized, phase III study to demonstrate a survival advantage in prostate cancer patients with progressive disease after first-line chemotherapy.
Currently, docetaxel chemotherapy is utilized in patients with metastatic, hormone-refractory prostate cancer, especially when symptomatic. In this setting, docetaxel is commonly palliative and provides an approximate 3-month survival advantage over mitoxantrone chemotherapy, the previous standard chemotherapy used for palliating prostate cancer. However, once patients have progressed from docetaxel chemotherapy, effective medical therapy has not been clearly identified.
In this study, 755 men with metastatic, castrate-resistant, prostate cancer with progressive disease after docetaxel chemotherapy were randomized to cabazitaxel or mitoxantrone, both with prednisone dosed at 10mg a-day. Cabazitaxel was given intravenously as 25mg/meter squared every 21 days. The median survival was improved in the cabazitaxel arm by 2.4 months (15.1 versus 12.7 months).
Important grade 3 or higher toxicities included neutropenic fever (8% versus 1%) and diarrhea (6% versus < 1%) in the cabazitaxel versus the mitoxantrone arms, respectively. The proportion of deaths on study (within 30 days of the last study drug administration) was higher in the cabazitaxel (5%) than the mitoxantrone (2%) group and may be related to an increased proportion of neutropenic infections and significant diarrhea in the cabazitaxel treatment arm.
In conclusion, cabazitaxel is a new option for men with progressive prostate cancer after docetaxel chemotherapy, offering a survival advantage in this setting. A higher incidence of neutropenic fever was observed with cabazitaxel compared to mitoxantrone therapy and the use of prophylactic granulocyte colony-stimulating factor (GCSF) should be pursued in appropriate patients. Additionally, rehydration, anti-diarrheal medication and dose reduction may be needed for treatment-associated diarrhea. Premedication with a corticosteroid and histamine antagonists was performed to minimize the risk of hypersensitivity reactions."
This concludes today’s F1000 Practice-Changing Minute. I am Bret Stetka. Thank you for listening.
source: www.medscape.com
