Current Evidence on Cabazitaxel for Prostate Cancer Therapy: A Narrative Review

Area of Science:

• Oncology
• Pharmacology

Background:

• Prostate cancer (PC) incidence is rising in Japan.
• Androgen deprivation therapy (ADT) is standard for castration-sensitive PC (CSPC), but resistance leads to metastatic castration-resistant PC (mCRPC).
• Taxane-based therapies (docetaxel, cabazitaxel) are mainstays for mCRPC.

Purpose of the Study:

• To review evidence on taxane-based therapies, focusing on cabazitaxel in Japanese patients.
• To address the evolving role and sequencing of taxanes with androgen receptor signaling inhibitors (ARSIs) in metastatic CSPC (mCSPC).
• To identify patient populations benefiting from taxane-based therapy.

Main Methods:

• Review of clinical and real-world evidence on taxane-based therapies, particularly cabazitaxel.
• Analysis of treatment sequencing in the context of new ARSI combinations for mCSPC.
• Evaluation of cabazitaxel's efficacy and safety profile, including neutropenia management.

Main Results:

• Cabazitaxel demonstrates efficacy in mCRPC patients previously treated with ARSI and docetaxel, outperforming a second ARSI (CARD study).
• Cabazitaxel's safety, especially neutropenia, is manageable with G-CSF prophylaxis, dose adjustments, and interval variations.
• Neutropenia can be a prognostic indicator for treatment effectiveness, necessitating adequate dose intensity.

Conclusions:

• Cabazitaxel is a valuable option for heavily pretreated mCRPC patients.
• Optimal sequencing of taxanes and ARSIs in mCSPC requires further investigation.
• Understanding PC biology and collecting real-world data are crucial for improving treatment outcomes and safety.