Efficacy of cabazitaxel, abiraterone, enzalutamide and docetaxel sequence in men with metastatic castration-resistant prostate cancer (mCRPC) in real life practice: The multinational, retrospective, observational CATS study

Abstract

Background: Optimal sequencing of new androgen-receptor targeted agents (ART) abiraterone and enzalutamide with docetaxel (D) and cabazitaxel (C) is unknown. In this large retrospective cohort of mCRPC patients, we evaluated the impact of 3 different sequences: D -> C-> ART (group 1), or D -> ART -> C (group 2), or ART -> D -> C (group 3) Methods: Records of 560 consecutive mCRPC patients were retrospectively collected in 31 centres in 7 European countries from Jan 2011 to Jan 2016. Disease history and clinical characteristics at initiation of each therapy were collected. PSA response ≥ 50%, radiological or clinical progression-free survival (PFS) and overall survival (OS) with each treatment sequence were evaluated. Results: At sequence initiation, patient characteristics were similar between the 3 sequences: median age was 67 years, 95% were ECOG 0-1, 59% had high disease volume, 42.6% had pain and 8% had visceral metastases. Median number of D cycles was 6 in the 3 groups. Median numbers of C cycles were 7, 6 and 5 in groups 1, 2 and 3 respectively. Median duration of follow-up was 33.7, 31.1, and 23.7 months in groups 1, 2 and 3. Main results are provided in the table. Conclusions: PSA responses were generally similar for each treatment line in the 3 groups. No significant difference in OS was observed between the 3 sequences in this retrospective cohort. D showed a longer radiological or clinical PFS when given in first line. The activity of C was not influenced by ART. Sequencing should be based on individual disease characteristics and patients' status and preference. (Table presented).