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Showed that a second taxane still works after docetaxel has stopped working, adding about two and a half months of life, and that it suppresses the bone marrow hard.
TROPIC randomised 755 men whose prostate cancer had progressed during or after docetaxel to cabazitaxel 25 mg/m2 (378) or mitoxantrone 12 mg/m2 (377) every 3 weeks, both with prednisone 10 mg daily.
At the final analysis, median survival was 15.1 months (95 percent confidence interval 14.1 to 16.3) with cabazitaxel and 12.7 months (11.6 to 13.7) with mitoxantrone, hazard ratio for death 0.70 (0.59 to 0.83, p<0.0001). Median progression-free survival was 2.8 months (2.4 to 3.0) against 1.4 months (1.4 to 1.7), hazard ratio 0.74 (0.64 to 0.86, p<0.0001).
The haematological cost is what determines who can have it. Grade 3 or higher neutropenia occurred in 303 of 378 men on cabazitaxel (82 percent) against 215 of 377 (58 percent), and febrile neutropenia in 28 (8 percent) against five (1 percent). Grade 3 or higher diarrhoea occurred in 23 (6 percent) against one.
In England NICE TA391 recommends cabazitaxel with prednisone or prednisolone after docetaxel only if the man has an ECOG performance status of 0 or 1, has had at least 225 mg/m2 of docetaxel, and stops at progression or after a maximum of 10 cycles, with the commercial arrangement in place.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
755 randomised.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survival (median)primary | Cabazitaxel 25 mg/m2 with prednisone | 378 | 15.1 months | 0.7 (0.59 to 0.83) | <0.0001 | link |
| Mitoxantrone with prednisone | 377 | 12.7 months | ||||
| Progression-free survival (median) | Cabazitaxel 25 mg/m2 with prednisone | 378 | 2.8 months | 0.74 (0.64 to 0.86) | <0.0001 | link |
| Mitoxantrone with prednisone | 377 | 1.4 months | ||||
| Grade 3 or higher neutropenia | Cabazitaxel 25 mg/m2 with prednisone | 378 | 82% | - | - | link |
| Mitoxantrone with prednisone | 377 | 58% |
Shares TAX 327, Mitoxantrone, Prednisone, Castration-resistant prostate cancer (CRPC).
Shares AFFINITY, TAX 327, Prednisone, Castration-resistant prostate cancer (CRPC).
Shares Cabazitaxel, Mitoxantrone, Sanofi, Prednisone.
Shares TAX 327, What follows what in castration-resistant prostate cancer, Prednisone, Castration-resistant prostate cancer (CRPC).
Shares TAX 327, Prednisone, Castration-resistant prostate cancer (CRPC), Metastatic castration-resistant prostate cancer.
Shares AFFINITY, Castration-resistant prostate cancer (CRPC), Metastatic castration-resistant prostate cancer, Prostate cancer.
Shares Mitoxantrone, Prednisone, Castration-resistant prostate cancer (CRPC), Metastatic castration-resistant prostate cancer.
Shares What follows what in castration-resistant prostate cancer, Prednisone, Castration-resistant prostate cancer (CRPC), Metastatic castration-resistant prostate cancer.