Pain progression at initiation of cabazitaxel in metastatic castration-resistant prostate cancer (Mcrpc): A post hoc analysis of the proselica study

Nicolas Delanoy, Debbie Robbrecht, Mario Eisenberger, Oliver Sartor, Ronald de Wit, Florence Mercier, Christine Geffriaud-Ricouard, Johann de Bono, Stéphane Oudard

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In the PROSELICA phase III trial (NCT01308580), cabazitaxel 20 mg/m2 (CABA20) was non-inferior to cabazitaxel 25 mg/m2 (CABA25) in mCRPC patients previously treated with docetaxel (DOC). The present post hoc analysis evaluates how the type of progression at randomization affected outcomes. Methods: Progression type at randomization was defined as follows: PSA progression only (PSA-p; no radiological progression (RADIO-p), no pain), RADIO-p (±PSA-p, no pain), or pain progression (PAIN-p, ±PSA-p, ±RADIO-p). Relationships between progression type and overall survival (OS), radiological progression-free survival (rPFS), and PSA response (confirmed PSA decrease ≥ 50%) were analyzed. Results: All randomized patients (n = 1200) had received prior DOC, and 25.7% had received prior abiraterone or enzalutamide. Progression type at randomization was evaluable in 1075 patients (PSA-p = 24.4%, RADIO-p = 20.8%, PAIN-p = 54.8%). Pain progression was associated with clinical and biological features of aggressive disease. Median OS from CABA initiation or date of mCRPC diagnosis, all arms combined, was shorter in the PAIN-p group than in the RADIO-p or the PSA-p groups (12.0 versus 16.8 and 18.4 months, respectively, p < 0.001). In multivariate analysis, all arms combined, PAIN-p was an independent predictor of poor OS (HR = 1.44, p < 0.001). PSA response, rPFS, and OS were numerically higher with CABA25 versus CABA20 in patients with PAIN-p. Conclusions: This post hoc analysis of the PROSELICA phase III study shows that pain progression at initiation of CABA in mCRPC patients previously treated with DOC is associated with a poor prognosis. Disease progression should be carefully monitored, even in the absence of PSA rise.

Original languageEnglish (US)
Article number1284
Pages (from-to)1-13
Number of pages13
JournalCancers
Volume13
Issue number6
DOIs
StatePublished - Mar 2 2021

Keywords

  • Cabazitaxel
  • Chemotherapy
  • Clinical progression
  • Metastatic castration-resistant prostate cancer
  • Pain
  • Taxanes
  • Type of progression

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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