title: Prostate-specific antigen flare induced by cabazitaxel-based chemotherapy in patients with metastatic castration-resistant prostate cancer.
abstract: BACKGROUND
  A prostate-specific antigen (PSA) flare occurs in about 15% of metastatic castration-resistant prostate cancer (mCRPC) patients receiving docetaxel. This flare has no standard definition. Its impact on treatment efficacy is unclear. We sought to evaluate the incidence and characteristics of PSA flare on cabazitaxel, and its impact on survival.
  
  
  METHODS
  Multicentre retrospective review of consecutive patients treated with cabazitaxel second-line chemotherapy for mCRPC. Collection of baseline characteristics, disease history and PSA levels before and during cabazitaxel therapy. Overall survival (OS) and radiological/clinical progression-free survival (PFS) for patient groups corresponding to different definitions of PSA flare estimated by the Kaplan-Meier method and compared using the log-rank test.
  
  
  RESULTS
  Overall, 125 patients were included. Median PFS and OS were 6.5 and 13.3 months, respectively. Depending upon the definition used, flare incidence ranged from 8.3% to 30.6%. The flare lasted <2.6 months. A PSA flare followed by a ⩾ 50% decrease was associated with a median PFS and OS of 11.2 and 25.2 months, respectively. Median PFS and OS for a ⩾ 30% rather than ⩾ 5 0% decrease were 10.4 and 16.5 months. These outcomes were not significantly different from those in patients with immediate PSA decreases of ⩾ 50% or ⩾ 30% from baseline, but were significantly better than in patients experiencing no PSA decrease (p = 0.006 and 0.015, respectively, for OS).
  
  
  CONCLUSIONS
  The PSA response to cabazitaxel, with or without initial flare, was associated with a strong survival benefit. The taxane-induced flare during the first 12 weeks of therapy can be ignored when evaluating PSA response.
authors.affiliation: Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Angelergues
authors.affiliation: Department of Medicine, Centre Léon Bérard, Lyon, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Maillet
authors.affiliation: Department of Medicine, Centre Léon Bérard, Lyon, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Fléchon
authors.affiliation: Department of Internal Medicine, Istanbul University Hospitals, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozgüroglu
authors.affiliation: Stat Process, Port-Mort, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Mercier
authors.affiliation: Department of Medicine, Institut de Cancérologie de la Loire, Saint-Etienne, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Guillot
authors.affiliation: Department of Medical Oncology, Val de Grace Hospital, Paris, France.
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Le Moulec
authors.affiliation: Department of Medicine, Institut Paoli Calmettes, Marseille, France.
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Gravis
authors.affiliation: Department of Medicine, Institut Curie, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Beuzeboc
authors.affiliation: Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Massard
authors.affiliation: Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
authors.affiliation: Department of Medical Oncology, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: de La Motte Rouge
authors.affiliation: Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Delanoy
authors.affiliation: Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France.
authors.forename: Reza-Thierry
authors.initials: RT
authors.lastname: Elaidi
authors.affiliation: Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France. Electronic address: stephane.oudard@egp.aphp.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Oudard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D064129:Prostatic Neoplasms, Castration-Resistant / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D043823:Taxoids / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids; C552428:cabazitaxel; D017430:Prostate-Specific Antigen
keywords: Cabazitaxel; Castration resistant prostate cancer; Chemotherapy; Cytotoxic agents; Prostate-specific antigen; Survival rate