Survival Outcomes of Cabazitaxel or Subsequent Androgen Receptor Pathway Inhibitor (ARPI) in Post-Docetaxel/ARPI Metastatic Castration-Resistant Prostate Cancer.

[INTRODUCTION] Real-world overall survival (rwOS) are limited in heavily pretreated metastatic castration-resistant prostate cancer (mCRPC) previously treated with both docetaxel and an androgen receptor pathway inhibitor (ARPI).

[METHODS] In the ConcertAI Patient360 database, we identified patients with mCRPC who initiated cabazitaxel or subsequent ARPI (abiraterone or enzalutamide) between 2018 and 2024 after prior treatment with at least one ARPI and docetaxel in the mCRPC setting. Using the Kaplan-Meier method, rwOS (95% CI, months) was estimated from initiation of cabazitaxel or subsequent ARPI until death or end of follow-up.

[RESULTS] Among 517 patients (median age: 68.8 years; white race: 70.0%; baseline prostate specific antigen (PSA) ≥ 100 ng/mL: 38.3%), cabazitaxel was more common (62.5%) than subsequent ARPIs (38.0%; abiraterone: 19.0%; enzalutamide: 18.6%). Cabazitaxel was more frequently used in a later line of therapy (LOT), compared to subsequent ARPIs; and patients receiving cabazitaxel had greater docetaxel exposure prior to or after mCRPC diagnosis, compared to patients with subsequent ARPIs. The study population was heterogeneous, representing varying stages of disease progression and multiple LOT, with a median rwOS of 10.4 months (95% CI, 9.3-11.4). The rwOS rates at 12, 24 and 36 months were 43.9%, 20.5% and 15.7%, respectively. Shorter rwOS was observed among patients with a greater number of prior LOTs, and higher Eastern Cooperative Oncology Group Performance Status (ECOG-PS), higher PSA, or elevated lactate dehydrogenase (LDH).

[CONCLUSION] In this descriptive study of patients with mCRPC previously treated with docetaxel and ARPI, median rwOS following cabazitaxel or subsequent ARPI was less than 1 year, highlighting a substantial unmet medical need among heavily pretreated patients who are candidates for these therapies.