What is the duration of cabazitaxel (generic name: cabazitaxel) administration in metastatic prostate cancer?

From the Guidelines

Cabazitaxel should be administered until disease progression or unacceptable toxicity occurs in metastatic prostate cancer, with no predetermined fixed duration of therapy, at a dose of 20 mg/m² every 3 weeks, as this regimen has been shown to be noninferior to the higher dose of 25 mg/m² in terms of overall survival, while reducing the incidence of grade 3/4 adverse events 1.

Key Considerations

• The standard regimen consists of cabazitaxel 20 mg/m² intravenously every 3 weeks, along with daily oral prednisone 10 mg, and treatment continues as long as the patient is deriving clinical benefit and tolerating the medication well.
• Patients should be monitored regularly with PSA measurements, imaging studies, and clinical assessments to evaluate response, and dose modifications may be necessary based on individual tolerance.
• Common side effects include neutropenia, fatigue, diarrhea, and neuropathy, and G-CSF prophylaxis should be considered, especially in elderly patients or those with high risk of neutropenic complications.

Treatment Duration and Discontinuation

• The decision to discontinue treatment should be based on a comprehensive assessment of disease status, quality of life, and patient preference.
• Cabazitaxel should be stopped on clinical disease progression or intolerance, and supportive care should include antiemetics, symptom-directed antidiarrheal agents, and prophylactic white blood cell growth factor use, particularly in this heavily pretreated, high-risk population 1.

Special Considerations

• Cabazitaxel has been shown to have clinical activity in patients with chemotherapy-naïve metastatic CRPC, and may be considered for patients who are not candidates for docetaxel, who cannot tolerate docetaxel, or who have pre-existing mild peripheral neuropathy 1.
• Cabazitaxel should not be used in patients with severe hepatic dysfunction, and should be used with caution in patients with mild to moderate hepatic impairment 1.

From the Research

Duration of Cabazitaxel Treatment

• The standard duration of cabazitaxel treatment is every 3 weeks, with a dose of 25 mg/m2 2.
• There is evidence to suggest that extending cabazitaxel treatment beyond 10 cycles may be beneficial for patients with metastatic castration-resistant prostate cancer 3, 4, 5, 6.
• Studies have shown that patients who received more than 10 cycles of cabazitaxel had improved overall survival, PSA response, and progression-free survival compared to those who received 10 cycles or less 4, 5.
• The incidence of severe adverse events was similar between patients who received more than 10 cycles and those who received 10 cycles or less 4, 5.
• Cabazitaxel-related toxicities, such as peripheral neuropathy, may occur after the initial cycles and do not increase cumulatively, but may be partially reversible with a drug holiday 6.

Treatment Outcomes

• PSA response, progression-free survival, and overall survival were better among patients treated with more than 10 cycles of cabazitaxel compared to those treated with 10 cycles or less 4, 5.
• The median overall survival was significantly higher in patients who received extended duration of treatment, with a median OS of 14 months compared to 7 months in patients treated with 4-10 cycles 5.
• There was no significant difference in overall survival between patients who had a normal versus high alkaline phosphatase at baseline 5.