Daniel P. Petrylak, MD, professor of medicine and urology and co-leader, Cancer Signaling Networks, Yale Cancer Center, discusses the efficacy results from the CARD trial, which evaluated the radiographic progression-free survival (rPFS) of cabazitaxel (Jevtana) combined with either abiraterone acetate (Zytiga) or enzalutamide (Xtandi) in patients with metastatic castration-resistant prostate cancer (mCRPC).

The results showed that the use of cabazitaxel achieved better rPFS than either second-generation antiandrogen. This suggests that patients still have resistance to second-generation hormonal agents but, currently, there is no algorithm for understanding which agent should be administered and when.

A widely held theory is that sensitivity to abiraterone acetate and enzalutamide can be re-established if patients are treated with docetaxel because it can get rid of AR-V7-positive clones, says Petrylak. The CARD study opposes this hypothesis and shows that there’s more benefit with giving chemotherapy after antiandrogens and docetaxel.

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