A 67-Year-Old Man With Metastatic Castrate-Sensitive Prostate Cancer - Episode 4

CARD Trial: Cabazitaxel After AR-Targeted Therapy in mCSPC

June 17, 2020
Charles Ryan, MD

Charles Ryan, MD: This puts us into the situation that was highlighted by the CARD study, a major study published in the New England Journal of Medicine within the last year or so. This was 1 where they really wanted to study whether we should do cabazitaxel or another AR [androgen receptor]–targeted drug in this setting.

The CARD study enrolled patients on a 1-to-1 fashion who had previously received a therapy, who had previously received docetaxel, and who had already received either abiraterone or enzalutamide. They were randomized to receive cabazitaxel at 25 mg/m2 every 3 weeks, which is 1 of the dose regimens that we can do, or the other AR-targeted therapy.

In this case, if we were enrolling the patient on the CARD study, he would be randomized to receive either enzalutamide or cabazitaxel. It’s really testing the second AR-targeted drug versus chemotherapy.

Transcript edited for clarity.


Case: A 67-Year-Old Male with Metastatic Castrate-Sensitive Prostate Cancer

Initial presentation

  • A 67-year-old active man presented with intermittent back pain and loss of appetite
  • PMH: unremarkable
  • FH: the patient’s father suffered a myocardial infarction at age 69; paternal grandmother had dementia; no known family history of cancer
  • PE: DRE revealed asymmetric enlarged prostate; PE otherwise unremarkable

Clinical workup

  • Core needle biopsy with TRUS showed adenocarcinoma of prostate
    • Stage T2N0M1b
    • Grade group 3
  • Bone scan reveal 3 spinal lesions (T10, L2, L3) and 1 near the left iliac crest
  • Abdominal and pelvic CT scan showed no other organ metastases
  • PSA 24.9 ng/mL

Treatment and Follow-Up

  • The patient was counselled on treatment options; he expressed concern regarding long-term AR exposure
  • DOCE + ADT was initiated, 6 cycles were well-tolerated; PSA 6.2 ng/mL
  • 2-year follow-up PSA 10.8 ng/mL; continued treatment regimen
    • 5 months later he reported increasing back pain and difficulty walking
    • PSA 21.4 ng/mL
    • PSADT 5.1 months
    • No new bone lesions on imaging
  • Abiraterone 1000 mg PO qDay + prednisone 5 mg PO q12hr was initiated
  • 1 year later PSA 30.2 ng/mL
    • Abdominal/pelvic CT showed multiple new small liver lesions, 1 new vertebral lesion and 1 new appendicular lesion
  • Treatment with cabazitaxel 20 mg/m2 IV q3W + prednisone 10 mg PO qDay was initiated