PURPOSE The treatment landscape of metastatic castration-resistant prostate cancer (mCRPC) has evolved with the recent approvals of lutetium Lu 177 vipivotide tetraxetan and poly (ADP-ribose) polymerase inhibitors, adding new layers of complexity to treatment sequencing. Cabazitaxel is an approved option in patients with disease progression on docetaxel. Real-world data on the effectiveness of cabazitaxel by line of therapy remain limited. To address this gap, we evaluated survival outcomes based on line of therapy in patients with mCRPC receiving single-agent cabazitaxel in a large real-world database. METHODS This retrospective study used the US-based Flatiron Health electronic health record–derived deidentified database. Patients who were diagnosed with mCRPC and received single-agent cabazitaxel for the first time were eligible and included. Real-world time to next treatment (rwTTNT) and real-world overall survival (rwOS) were calculated from the date patients initiated the first cycle of cabazitaxel. Survival rates were summarized using medians and 95% CI using the Kaplan-Meier method. RESULTS Among 24,105 patients with metastatic prostate cancer in the data set, 1,315 patients with mCRPC were eligible and included. The median age was 73 years (IQR, 67-78). The majority were non-Hispanic White (62%), treated in community practice (84%), had commercial insurance (81%), and received treatment in fourth line or later (58%). For the overall cohort, the median rwTTNT was 4.7 months (95% CI, 4.4 to 5.0), and the median rwOS was 8.6 months (95% CI, 8.0 to 9.3). The median rwTTNT ranged from 4.2 months to 6.8 months, and rwOS ranged from 6.3 months to 14 months based on the line of therapy. CONCLUSION In this large, real-world study of patients with mCRPC, cabazitaxel retained its effectiveness regardless of its line of therapy.
Ostrowski et al. (Wed,) studied this question.