Editing Castrate-Resistant Prostate Cancer (section)

====== Cabazitaxel ======
* '''MOA: inhibits microtubule assembly and disassembly; member of the taxane family'''
* '''Indications'''
** '''mCRPC, post-docetaxel'''
* '''TROPIC trial'''
** '''Population:''' 755 '''patients with mCRPC who had progressed after docetaxel-based chemotherapy'''
** Randomized to mitoxantrone + prednisone vs. cabazitaxel + prednisone, each administered every 3 weeks
** Results:
*** Median follow-up: 12.8 months,
*** Cabazitaxel significantly improved OS by 2 months (median OS 15.1 months in the cabazitaxel arm compared to 12.7 months in men receiving mitoxantrone)
*** Cabazitaxel also improved PFS by 1.4 months (2.8 months cabazitaxel vs. 1.4 months mitoxantrone)
*** Cabazitaxel resulted in more-clinically-significant diarrhea, but its primary toxicity is hematologic with 82% of patients developing grade 3 or 4 neutropenia, 8% developing febrile neutropenia and 5% resulting in death. The FDA label indication for this drug recommends prophylactic neutrophil growth factor support in those patients most susceptible to neutropenia, including older individuals and those with significant prior radiotherapy.
** '''De Bono, Johann Sebastian, et al. "Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial." The Lancet 376.9747 (2010): 1147-1154.'''
* '''FDA-approved in 2010 for the second-line treatment of docetaxel-refractory mCRPC'''
* '''Adverse events'''
*# '''Neutropenia (including febrile neutropenia)'''
*# '''Diarrhea'''
** '''Use of growth factor support should be strongly considered when administering cabazitaxel'''

* Given the activity of cabazitaxel in docetaxel-pretreated patients, FIRSTANA assessed whether cabazitaxel 20 mg/m2 (C20) or 25 mg/m2 (C25) is superior to docetaxel 75 mg/m2 (D75) in terms of OS in patients with chemotherapy-naïve mCRPC. C20 and C25 did not demonstrate superiority for OS versus D75 in patients with chemotherapy-naïve mCRPC