Daniel J. George, MD, is the Eleanor Easley Distinguished Professor, a professor of medicine, a professor in urology, and a professor in surgery at the Duke University School of Medicine and a member of the Duke Cancer Institute.

Overcoming Barriers to Cabazitaxel and Optimizing Sequencing

This segment addresses practical considerations for using cabazitaxel in mCRPC, focusing on real-world treatment patterns and sequencing strategies. Patient and disease characteristics, along with prior therapies, significantly influence when cabazitaxel is most appropriately utilized.

 A critical discussion point involves impression patterns and prior use of ARPIs/Pluvicto, particularly in patients with visceral disease. Real-world data suggests potential underutilization of cabazitaxel in mCRPC despite evidence supporting its efficacy. The conversation explores strategies to better align treatment decisions with clinical guidelines and emerging data trends.

 When discussing cabazitaxel with patients, physicians should address both benefits and risks transparently. An important consideration highlighted is the 

FDA emphasis on overall survival (OS) versus progression-free survival (PFS)

. This distinction is clinically meaningful, as OS represents the most definitive endpoint for assessing treatment benefit, particularly relevant when counseling patients about realistic expectations and treatment goals.

 Barriers to cabazitaxel use may include perceptions about toxicity, sequencing uncertainty, and competition from newer agents. However, understanding where cabazitaxel provides unique value—particularly regarding OS benefit—can help overcome these barriers.

The segment emphasizes that optimal sequencing requires integrating multiple factors: disease characteristics, prior treatment exposure, patient preferences, and comparative efficacy data. By addressing misconceptions and focusing on meaningful outcomes like OS, clinicians can make more informed decisions about incorporating cabazitaxel into individualized treatment plans for mCRPC patients.

Videos

Evidence-based approaches to cabazitaxel use in mCRPC, addressing treatment sequencing after prior therapies, real-world underutilization trends, patient counseling on benefits and risks, and FDA guidance on dosing strategies to optimize outcomes while managing toxicity.

The Role of Chemotherapy in Today’s mCRPC Landscape

Chemotherapy remains a cornerstone therapy in metastatic castration-resistant prostate cancer (mCRPC) despite the emergence of multiple novel agents including ARPIs, PARP inhibitors, radiopharmaceuticals, and targeted therapies. The discussion emphasizes that chemotherapy's role has evolved but not diminished in clinical practice.

When considering cabazitaxel specifically, patient and disease characteristics are critical factors in sequencing decisions. Key considerations include prior lines of therapy received and real-world treatment patterns observed across different practice settings. The discussion highlights where chemotherapy fits relative to ARPIs, PARP inhibitors, and Pluvicto (lutetium Lu 177 viosotide) in the treatment algorithm.

Several thematic areas were explored regarding chemotherapy's continued relevance:

 The unique mechanisms by which chemotherapy agents work distinguish them from other mCRPC therapies, contributing to their ongoing utility.

 Despite newer options, chemotherapy maintains an important role in the treatment paradigm for appropriately selected patients.

 The distinction between high-volume and low-volume disease impacts treatment selection, with chemotherapy playing different roles depending on disease burden.

 The use of docetaxel earlier in the disease course—specifically in hormone-sensitive prostate cancer (HSPC)—influences later treatment decisions in the mCRPC setting.

The overall message underscores that chemotherapy has adapted to the evolving landscape rather than being displaced by it, with thoughtful patient selection and sequencing being essential to optimize outcomes in mCRPC management.

Evolution of chemotherapy's role in metastatic castration-resistant prostate cancer treatment, including its positioning relative to ARPIs, PARP inhibitors, and targeted therapies, with discussion of treatment sequencing strategies and practical considerations for docetaxel use in high-volume versus low-volume disease.

Andrew John Armstrong, MD, MSc

Articles

Overcoming Barriers to Cabazitaxel and Optimizing Sequencing

The Role of Chemotherapy in Today’s mCRPC Landscape