In patients suffering from metastatic prostate cancer that is resistant to hormone therapy, the first-line treatment is surgical or drug castration. If this fails, there is no known cure.
The combination docetaxel + prednisone is used as a palliative treatment; it prolongs life by around 2.5 months, at the cost of numerous, sometimes severe adverse effects. The combination mitoxantrone + prednisone has not been shown to increase survival.
When hormone therapy fails, cabazitaxel, similar to docetaxel, is now available. Its clinical evaluation is based on a single clinical trial of insufficient quality involving 755 patients treated with corticosteroids and either with mitoxantrone, or with cabazitaxel. The survival time appeared to be about 2.4 months longer, but at the cost of frequently severe and sometimes fatal adverse effects (twice the number of cessations due to adverse effects).
A higher number of treatment-linked deaths was observed in patients on cabazitaxel. The trial’s investigators attributed these to infections, a huge decrease in the number of white blood cells (severe neutropenia), renal failure, cardiac disorders. Furthermore, cabazitaxel exposes patients to a high risk of interactions with a number of drugs. The combination of these factors means that cabazitaxel should be avoided, and only used in the context of rigorous clinical trials. When treatment fails, it is better to concentrate on quality palliative care.
©Prescrire 1 January 2012
"cabazitaxel. Uncertain efficacy, high toxicity" Prescrire Int 2012; 21 (123): 5-7. (pdf, subscribers only)