Evolution of Treatment for mCRPC

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Raoul Concepcion, MD, notes that patients are classified as having mCRPC if they have a testosterone level less than 50, rising PSA, and a positive radiographic scan (bone scan, CT, or PET). He adds that prior to 2010, the only agent that was approved for mCRPC and associated with a survival benefit was docetaxel; however, there has been a recent surge in the availability of additional therapies.

Oliver Sartor, MD comments that prior to docetaxel, no therapies were available that would prolong survival. With the introduction of docetaxel in 2004, clinicians had an option that provided a survival benefit, paving the way for the introduction of newer agents. Docetaxel still plays an important role in therapy; however, with the advent of additional options (eg, abiraterone, enzalutamide), Sartor notes that the role of docetaxel is less prominent than it has been in the past.

Cabazitaxel is a microtubule inhibitor indicated in combination with prednisone for treatment of patients with mCRPC previously treated with a docetaxel-containing treatment regimen. Sartor notes that although survival is prolonged with cabazitaxel, clinicians are cautious regarding its use due to the risk of febrile neutropenia. However, he notes that in his experience, cabazitaxel is well tolerated, with a lower neuropathy risk and alopecia risk compared with docetaxel.