Cabazitaxel: Evidence and clinical experience

Cabazitaxel, a novel taxane that lacks susceptibility to the drug-resistance mechanism seen with previous drugs in the same class, has demonstrated a survival benefit in metastatic castrate-resistant prostate cancer (mCRPC), plus a manageable toxicity profile. It is the first active treatment to receive a European licence for the second-line treatment of mCRPC post-docetaxel. Novel non-chemotherapeutic treatments for this indication are at various stages of development and regulatory status. These new and emerging treatments bring a potential opportunity to extend the lives of patients with mCRPC, and improve quality of life in this setting, but they also raise pertinent questions about the optimal timing and sequencing of their use. Based on my clinical experience with cabazitaxel, first as a phase III trialist, and then as a participant in an expanded-access programme, I believe that the chemotherapeutic option should be offered before non-chemotherapeutic agents, where the patient's performance status allows, so that there is an opportunity to gain the potential benefits of this treatment within the likely therapeutic window. Other second-line/third-line treatments, notably the hormonal agent abiraterone, are likely to remain useful even after a decline in the patient's performance status.