Expanding Treatment Options for Older Adults With Prostate Cancer
Mené sur 196 patients atteints d'un cancer métastatique de la prostate résistant à la castration (âge médian : 74,6 mois), cet essai de phase III évalue la toxicité, du point de vue de la survenue d'une neutropénie de stade III ou supérieur, du cabazitaxel, dispensé selon deux schémas posologiques (16 mg/m2 bi-hebdomadaire ou 25 mg/m2 tri-hebdomadaire), en combinaison avec le facteur G-CSF
In this issue of JAMA Oncology, Oudard et al report the results of the CABASTY randomized clinical trial, a study that compares the rate of neutropenic fever, adverse events, and disease control outcomes between the standard-dose and an alternate reduced-dose schedule of cabazitaxel in an older adult population of patients with prostate cancer. The study was based on previously reported data that defined an every-2-weeks reduced-dose docetaxel regimen for older adult patients that appears to be equally effective in terms of cancer control but less toxic in terms of complication rate. CABASTY met its primary end point, with rates of grade 3 or higher neutropenia or neutropenic adverse events being superior with a cabazitaxel dosage of 16 mg/m2 plus granulocyte colony–stimulating factor every 2 weeks vs 25 mg/m2 plus granulocyte colony–stimulating factor every 3 weeks (5.1% vs 62.5%, respectively). Importantly, disease control end points of median radiographic progression-free survival (10.25 months vs 7.82 months, P = .89, in the triweekly vs biweekly regimens, respectively) and median overall survival (14.1 months for both arms, P = .39) were similar between groups. Additional end points of importance include a higher rate of grade 3 or higher adverse events in the triweekly regimen (72.9% vs 56.1% for triweekly vs biweekly regimens, respectively) and a similar rate of adverse events leading to treatment discontinuation (33.3% vs 31.6% in the triweekly vs biweekly regimens, respectively).
JAMA Oncology , commentaire, 2022