Cabazitaxel Plus Prednisone for Metastatic Castration-resistant Prostate Cancer Progressing After Docetaxel: Results from the German Compassionate-use Programme

Abstract Background Cabazitaxel (Cbz) is an approved second-line treatment in metastatic castration-resistant prostate cancer (mCRPC) following docetaxel therapy with a significant survival benefit compared with mitoxantrone. However, grade 3/4 toxicities were reported in 82% of patients. Objective To report on the safety results of mCRPC patients treated within a compassionate-use programme in Germany. Design, setting, and participants A total of 111 patients with a mean age of 67.9 yr (range: 49–81 yr) and progressive mCRPC were included. Patients had received a mean number of 12.7±10.8 cycles (range: 6–69 cycles) of docetaxel with a mean cumulative dose of 970.9mg/m 2 ; mean time from last docetaxel application to progression was 6.95 mo (range: 2–54 mo). Of the patients, 31.5% progressed by prostate-specific antigen (PSA) increase only; the remainder had a combination of PSA increase and clinical progression. Intervention Cbz at a dosage of 25mg/m 2 intravenously every 3 wk combined with 5mg of oral prednisone twice a day. Outcome measurements and statistical analysis Treatment-associated toxicity was the primary study end point; progression-free and overall survival were secondary end points. A descriptive statistical analysis was performed. Results and limitations Patients received a mean number of 6.5±2.2 cycles of Cbz and a mean cumulative dose of 160.3±51.5mg/m 2 . Grade 3 and 4 treatment-emergent adverse events were recorded in 34 patients (30.6%) and 18 patients (16.2%), respectively. Grade 3/4 anaemia, neutropenia, and thrombocytopenia were reported in 4.5%, 7.2%, and 0.9% of the patients, respectively. Neutropenic fever was reported in 1.8% of the patients. Grade 3/4 gastrointestinal toxicity was identified in 4.5% of the patients. Three patients died because of Cbz-related toxicity. Granulocyte colony-stimulating growth factors were used in 17.1% of patients. The limitations are due to the nonrandomised nature of the trial. Conclusions Treatment with Cbz is tolerable and is associated with a low incidence of serious adverse events in a real-world patient population with CRPC. The outcome of serious adverse events can be minimised with proactive treatment management and conscientious monitoring.