Cabazitaxel provides a new treatment option for patients who have progressed despite docetaxel therapy. Its clinical use in mCRPC is based on the results of the TROPIC study.¹ Within Australia clinical experience with cabazitaxel in the post-docetaxel setting is accumulating; the authors’ combined experience to date is 74 patients. They draw on their experience, offering practical advice to maximize clinical outcomes with cabazitaxel treatment.

• Patient selection: In the absence of predictive biomarkers, continuing to apply performance status when selecting patients for cabazitaxel appears appropriate. A review of information predictive of increased toxicity (chemotherapy history, amount of bone marrow irradiation and prior strontium or samarium use) may be of benefit.
• Timing: Progression (weight loss, increased pain or rising PSA) after three cycles of docetaxel provides a reasonable basis upon which to consider switching to an alternative therapy.
• Sequencing: No trial data are available to inform on the relative sequencing of cabazitaxel and abiraterone. Treatment should be individualised after having considered current symptoms, performance status, responses and toxicities to prior treatments, clinical and radiological progression, and PSA kinetics.
• Duration: Patients can remain on treatment as long as they are continuing to show a clinical benefit or until toxicity becomes unacceptable. Currently several patients have received over 20 cycles.
• Monitoring: Close monitoring is essential so that the opportunity to expose the patient to all available lines of therapy is not missed.
• Adverse event management: Previously presented results from the Australian EAP program have reported a very low rate of Grade ≥ 3 neutropenia, supporting the value of primary prophylaxis with G-CSF in high-risk patients.² Use of G-CSF outside the trial setting is less well established in Australia. Risk of serious adverse events can be minimised through the use of protocols which include a combination of education plus proactive and active management.