{"entity":{"id":"card","kind":"trial","name":"CARD","aka":["CARD","cabazitaxel against a second androgen receptor pathway inhibitor"],"tldr":"Settled the commonest argument in advanced prostate cancer. When one hormone tablet stops working quickly, switching to the other one is much worse than moving to chemotherapy.","summary":"By 2019 most men with castration-resistant prostate cancer were being offered abiraterone or enzalutamide, and when one failed, the other. CARD tested whether that switch is as good as chemotherapy.\n\nIt randomised 255 men who had received docetaxel and progressed within 12 months on abiraterone or enzalutamide to cabazitaxel 25 mg/m2 every 3 weeks with prednisone and granulocyte colony-stimulating factor, or to the other androgen receptor pathway inhibitor.\n\nAt a median 9.2 months, imaging-based progression or death had occurred in 95 of 129 men (73.6 percent) on cabazitaxel against 101 of 126 (80.2 percent) on the second inhibitor, hazard ratio 0.54 (95 percent confidence interval 0.40 to 0.73, p<0.001). Median imaging-based progression-free survival was 8.0 against 3.7 months. Median overall survival was 13.6 against 11.0 months, hazard ratio 0.64 (0.46 to 0.89, p=0.008). Progression-free survival was 4.4 against 2.7 months (0.52, 0.40 to 0.68, p<0.001), PSA response occurred in 35.7 against 13.5 percent (p<0.001) and tumour response in 36.5 against 11.5 percent (p=0.004).\n\nAdverse events of grade 3 or higher occurred in 56.3 percent on cabazitaxel and 52.4 percent on the second inhibitor, so the chemotherapy was not meaningfully more toxic in this population. CARD is the clearest evidence in prostate cancer that switching within a drug class after early failure is a waste of time.","status":"positive","asOf":"2026-09-25","links":[{"label":"ClinicalTrials.gov NCT02485691","url":"https://clinicaltrials.gov/study/NCT02485691"},{"label":"CARD (New England Journal of Medicine 2019)","url":"https://doi.org/10.1056/NEJMoa1911206"},{"label":"NICE TA391: cabazitaxel for hormone-relapsed metastatic prostate cancer treated with docetaxel","url":"https://www.nice.org.uk/guidance/ta391"}],"tags":[],"related":[],"cancers":["prostate","prostate-mcrpc"],"sections":[],"technologies":["cytotoxic-chemotherapy","androgen-deprivation"],"targets":["androgen-receptor"],"drugs":["cabazitaxel","abiraterone","enzalutamide","prednisone"],"companies":["sanofi"],"institutions":[],"pathways":[],"terms":["arpi","castration-resistance","ar-v7"],"trials":["tropic","proselica","therap","vision"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT02485691","phase":"3","setting":"Metastatic castration-resistant prostate cancer previously treated with docetaxel and with progression within 12 months on abiraterone or enzalutamide: cabazitaxel 25 mg/m2 every 3 weeks with prednisone and granulocyte colony-stimulating factor, against the other androgen receptor pathway inhibitor, with imaging-based progression-free survival as the primary endpoint","sponsor":"Sanofi","result":"Median imaging-based progression-free survival 8.0 against 3.7 months (hazard ratio 0.54, 95 percent confidence interval 0.40 to 0.73) and overall survival 13.6 against 11.0 months (0.64, 0.46 to 0.89) for cabazitaxel against a second androgen receptor pathway inhibitor.","yearReported":2019,"enrolled":255,"enrolledBasis":"randomised","enrolledNote":"255 men underwent randomisation; the trial was designed around this size because the effect it sought was large.","outcomes":[{"endpoint":"Imaging-based progression-free survival (median)","primary":true,"unit":"months","arms":[{"name":"Cabazitaxel with prednisone","n":129,"value":8},{"name":"Second androgen receptor pathway inhibitor","n":126,"value":3.7}],"hr":0.54,"ci":[0.4,0.73],"p":"<0.001","source":"https://doi.org/10.1056/NEJMoa1911206"},{"endpoint":"Overall survival (median)","unit":"months","arms":[{"name":"Cabazitaxel with prednisone","n":129,"value":13.6},{"name":"Second androgen receptor pathway inhibitor","n":126,"value":11}],"hr":0.64,"ci":[0.46,0.89],"p":"0.008","source":"https://doi.org/10.1056/NEJMoa1911206"},{"endpoint":"PSA response","unit":"%","arms":[{"name":"Cabazitaxel with prednisone","n":129,"value":35.7},{"name":"Second androgen receptor pathway inhibitor","n":126,"value":13.5}],"p":"<0.001","source":"https://doi.org/10.1056/NEJMoa1911206"}],"replication":"Consistent with TheraP and VISION, which both beat a second androgen receptor pathway inhibitor or best supportive care with a radioligand in a similar population."},"route":"/trials/card/","neighbours":{"cancer":[{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"technology":[{"id":"androgen-deprivation","kind":"technology","name":"Androgen deprivation & AR pathway inhibitors","route":"/technologies/androgen-deprivation/"},{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"target":[{"id":"androgen-receptor","kind":"target","name":"Androgen receptor","route":"/targets/androgen-receptor/"}],"drug":[{"id":"abiraterone","kind":"drug","name":"Abiraterone acetate","route":"/drugs/abiraterone/"},{"id":"cabazitaxel","kind":"drug","name":"Cabazitaxel","route":"/drugs/cabazitaxel/"},{"id":"enzalutamide","kind":"drug","name":"Enzalutamide","route":"/drugs/enzalutamide/"},{"id":"prednisone","kind":"drug","name":"Prednisone","route":"/drugs/prednisone/"}],"company":[{"id":"sanofi","kind":"company","name":"Sanofi","route":"/companies/sanofi/"}],"term":[{"id":"arpi","kind":"term","name":"Androgen receptor pathway inhibitor (ARPI)","route":"/terms/arpi/"},{"id":"ar-v7","kind":"term","name":"AR-V7 splice variant","route":"/terms/ar-v7/"},{"id":"castration-resistance","kind":"term","name":"Castration-resistant prostate cancer (CRPC)","route":"/terms/castration-resistance/"},{"id":"prostate-crpc-sequencing","kind":"term","name":"What follows what in castration-resistant prostate cancer","route":"/terms/prostate-crpc-sequencing/"}],"trial":[{"id":"affirm","kind":"trial","name":"AFFIRM","route":"/trials/affirm/"},{"id":"proselica","kind":"trial","name":"PROSELICA","route":"/trials/proselica/"},{"id":"psmafore","kind":"trial","name":"PSMAfore","route":"/trials/psmafore/"},{"id":"therap","kind":"trial","name":"TheraP (ANZUP 1603)","route":"/trials/therap/"},{"id":"tropic","kind":"trial","name":"TROPIC","route":"/trials/tropic/"},{"id":"vision","kind":"trial","name":"VISION","route":"/trials/vision/"}]}}