Formal discussant Silke Gillessen, MD, of the Division of Cancer Sciences, University of Manchester, United Kingdom, agreed that this study is practice-changing.

Silke Gillessen, MD

“The study was well designed and addressed an unmet clinical need that is commonly seen in the clinic. Until now we had no randomized prospective trial for third-line treatment, and the optimal sequence for using all the agents has been unclear,” she told listeners.

“The majority of patients fit for chemotherapy should get docetaxel and one of the new androgen receptor inhibitor agents some time in the course of their disease. After that, the best treatment option was unknown. These are patients we see in our clinic,” she said.

“The statistics [for this trial] were ambitious, but the results were even better,” Dr. Gillessen commented. “This is the first time we have seen a survival benefit for third-line treatment in a randomized trial.” 

She concluded: “This is new information supporting cabazitaxel as third-line treatment after docetaxel and androgen receptor–targeted therapy for fit patients with progressive disease on prior androgen receptor–targeted therapy within 12 months. Cabazitaxel is approved, and you can implement this in your practice right away. The toxicity seemed similar in both arms, so we should avoid ‘chemophobia.’” 

DISCLOSURE: Dr. Gillessen is a consultant/advisor for Active Biotech, Advanced Accelerator Applications, Amgen, Astellas Pharma, Bayer, Bristol-Myers Squibb, CellSearch, Clovis Oncology, CureVac, Dendreon, ESSA Pharmaceuticals, Ferring, Innocrin, Janssen, MaxiVAX, Millennium, Nectar, Novartis, Pfizer, and Orion; and has patents, royalties, or other intellectual property for a biomarker method (WO 2009138392 A1).