Another chemotherapy agent, Cabazitaxel (Trade name: Jevtana) is administered together with the steroid prednisone. It was approved by the FDA in June 2010 as a second-line chemotherapy to be used in advanced castrate resistant prostate cancer in men who have already been treated with docetaxel and then failed. Cabazitaxel is the first and only chemotherapy agent to have shown any survival benefit for men with advanced castrate resistant prostate cancer since the approval of docetaxel.
Like Taxotere, cabazitaxel is a semi-synthetic analogue of paclitaxel, an extract from the bark of the rare Pacific Yew tree. There is an interesting mechanism that allows cabazitaxel to work when Taxotere has stopped working. Prostate cancer cells learn how to eventually “pump out” the key ingredient of Taxotere—taxane–from the cells. Cabazitaxel disables this pumping process, allowing the taxane to remain inside the cancer cell and effectively kill the cancer cell.
FDA approval of cabazitaxel was based on data from the single company-sponsored phase III TROPIC clinical trial, conducted with 755 men. All who participated in the trial had advanced castrate resistant prostate cancer and all had previously been treated with, and failed, docetaxel. They were randomized to receive either cabazitaxel or mitoxantrone, in combination with prednisone. In this setting, the cabazitaxel demonstrated a median survival advantage of 2.4 months over the mitoxantrone. (Refer to “A Survival Advantage — Is It Worth It and What Does It Mean?” later in this booklet.)
Cabazitaxel presents significant side effects. The most common adverse reactions, seen in 10% or more of the men in the trial included:
- neutropenia (Reoccurring periods of a very low white blood cell count)
- anemia (low red blood cell count)
- leukopenia (low white blood cell count)
- thrombocytopenia (low levels of blood platelets that cause clotting)
- asthenia (lack of muscle strength)
- malaise (dizziness and fatigue)
- abdominal pain
- hematuria (presence of red blood cells in the urine)
- back pain
- anorexia (loss of appetite)
- peripheral neuropathy (pain, numbness and tingling in your arms, hands and feet)
- pyrexia (fever)
- dyspnea (shortness of breath)
- dysguesia (distortion of the sense of taste)
- arthralgia (joint pain)
- alopecia (hair loss)
- renal failure
The most common adverse events leading to discontinuation of the cabazitaxel were neutropenia and renal failure.
*Warning- Cabazitaxel has caused neutropenic deaths (an abnormally low count of neutrophils, a type of white blood cell that helps fight off infections, particularly those caused by bacteria and fungi).
As with most chemotherapy drugs, cabazitaxel kills many white blood cells that then leave a patient significantly more susceptible to life-threatening infections. It is very important that you monitor your blood count assiduously to avoid any dangerous occurrence of neutropenia.
Because of its possible harsh side effects many men choose to use abiraterone and prednisone, or enzalutamide, prior to using cabazitaxel.