Second-line Treatment for mCRPC: Taxanes or Androgen Receptor Therapy?

By Emily Menendez - March 23, 2023

A recent study published in Clinical Genitourinary Cancer compared the activity of taxanes (TAX) with second-line androgen-receptor therapy (ART) in patients with metastatic castration-resistant prostate cancer (mCRPC) who had been treated with first-line ART to find the optimal therapeutic sequence of mCRPC.

The study evaluated 175 patients with chemotherapy-naïve mCRPC who had been treated with first-line enzalutamide or abiraterone. Of the total number of patients, 69 (39%) and 30 (17%) were treated with second-line TAX or ART, respectively, while 76 (43%) patients did not receive further treatment. Progression-free survival (PFS) and overall survival (OS) were compared between the patients who were treated with second-line ART or TAX.

At the start of first-line therapy, the median PFS and OS were 13 months and 34 months, respectively. No significant difference was found between enzalutamide or abiraterone. From the beginning of second-line therapy, the median PFS and OS were 6 months and 18 months, respectively. Compared with ART, docetaxel had significantly higher prostate-specific antigen (PSA, ≥50%; 29% vs 0%; P<.001) and radiological (21% vs 0%; P<.001) responses.

PFS was longer in patients who received TAX compared with those who received ART (6.7 months vs 4 months; hazard ratio, 0.63; 95% CI, 0.41-0.96; P=.034), but there was no significant difference in OS (19 months vs 12 months; P=.1). After propensity score adjustment, PFS (P=.2) and OS (P=.1) rates were similar in patients who received second-line TAX and ART.

The study found that TAX provides higher PSA and radiological responses than ART overall in the second-line setting, but PFS and OS are similar. Further studies may help to determine the best treatment sequence for patients with mCRPC.