A recent analysis of a study called the CARD study, published in the Lancet journal shows that the drug cabazitaxel significantly improved pain in men diagnosed with prostate cancer than the drugs enzalutamide or abiraterone.

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Prostate cancer is driven by androgens (male sex hormones) including testosterone. As a result, traditional treatment options aim to find ways to lower levels of the androgens in an individual who has been diagnosed with prostate cancer. This can be done by giving drugs which inhibit the production of androgens or by surgically removing testicles. In men who have developed metastases, the cancer has spread beyond the prostate and therefore, surgical intervention to remove the testicles will not suffice as a treatment option. Chemotherapy and other drug therapy, such as docetaxel, is then the preferred treatment option. Docetaxel has been largely considered an important drug for the treatment of mCRPC. In 2004, phase 3 trials showed that individuals who were given the drug had an increased survival rate than mitoxantrone and prednisone.

CARD study

The CARD study aims to look at individuals with mCRPC who have already been given docetaxel and may not be responding as well to it as they had been initially (docetaxel resistance). The CARD study is a phase 4 study. It observes the outcome of individuals with metastatic, castration-resistant prostate cancer (mCRPC) who were given cabazitaxel versus those given an androgen receptor.

The patients are individuals who had already been treated with docetaxel or grew resistant to hormone therapy. It is also interesting to note that another study reported in The Molecular Cancer Therapeutics journal stated that only around 50 percent of individuals with mCRPC respond to docetaxel, and that most individuals eventually do develop resistance to the drug.

This is not the first time such findings have been reported by researchers. Another report which was published by the New England Journal of Medicine (NEJM) in December 2019 also found similar results. The authors of the study stated that cabazitaxel significantly improved various clinical outcomes which were studied in men diagnosed with mCRPC when compared to abiraterone or enzalutamide. This study too had observed individuals who had earlier been treated with docetaxel.

The CARD study and the drugs observed

Cabazitaxel is an antineoplastic drug given as a chemotherapeutic agent. It is given intravenously and usually given 30 minutes after appropriate pre-medications. Oftentimes, a corticosteroid oral drug is also given twice a day to individuals who are on cabazitaxel. Enzalutamide is an androgen receptor inhibitor which prevents testosterone from reaching prostate cancer cells, thereby inhibiting their growth. It is generally given when there is metastasis of the cancer cells. Abiraterone is a drug given for advanced prostate cancer, wherein the individual has stopped responding to other hormone therapy. This is often termed hormone-resistant or castration-resistant.

It is also important to note that several studies have been done earlier which have proven that cabazitaxel given along with prednisone has significant anti-tumour activity. It has been known to be effective in treating metastatic castration-resistant prostate cancer.

The study was a randomised, phase 4 study which was conducted at 62 clinics over 13 European countries. 303 patients over the age of 18 with ‘confirmed metastatic castration-resistant prostate cancer’ were randomly given a set dose of cabazitaxel and designated premedications or abiraterone and prednisone or enzalutamide. Those receiving cabazitaxel were given 25 mg/m² intravenously every 3 weeks and were also required to take 10 mg of prednisone and a granulocyte colony-stimulating factor (glycoprotein which stimulates the formation of stem cells and granulocytes). Individuals who were given abiraterone had to take 1000 mg of the drug orally plus 5 mg of prednisone twice a day. The individuals taking enzalutamide were given 160 mg of the drug orally once a day.

The study took place between November 2015 and November 2018. A median follow-up was held at 9.2 months.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. Nimeshika is a doctor and a freelance medical journalist.