Chemotherapy has a bad reputation, but is it as bad as many of us expect? Are all chemotherapies the same? Do they all come with the same level of side effects? The answer to these questions is probably not and no.

When we hear the word chemotherapy, the most natural response is that it will be terrible, it will lead to all types of nasty side effects and the total disintegration of a person’s quality of life. There is no denying that chemotherapy has side effects, but like all other advanced prostate cancer treatments, the side effects can differ from one man to the next.

At Cancer ABCs, we see men who do stop chemotherapy or have a dose reduction because the side effects become intolerable. Still, we also see this in many men who use primary ADT and the new, more advanced second-generation hormone manipulation drugs like Zytiga, Xtandi, Apalutamide, and Darolutamide.

Quality of life (QoL) is important; for many of us, QoL is more important than its length.

Prostate cancer treatment currently has two (2) different chemotherapy drugs approved by the FDA; docetaxel (Taxotere) and cabazitaxel (Jevtana). Taxotere was approved before Jevtana so it is often given before Jevtana. However, over time there has been some thinking out of the box; what has been asked is, what if we gave Jevtana before Taxotere?

Examining this question was an abstract (abstract 5017) at the most recent ASCO virtual meeting. The abstract reported the final results from the randomized CABADOC trial. Patient preference was evaluated between Jevtna and Taxotere for first-line chemotherapy in men with metastatic castrate-resistant prostate cancer (mCRPC). The abstract was authored by: G Baciarello, R Delva, G Gravis, et al

The CABADOC Trial was a randomized study of 195 men who had not had any chemotherapy. It asked whether patients prefer Taxotere or Jevtana since both treatments have very similar clinical outcomes. The study was conducted in 17 different centers.

The study concluded that significantly more men preferred Jevtana compared with Taxotere (43% vs 27%), whereas 30% of the men had no preference. The most common factors influencing preferences were fatigue, pain, hair loss, and patient-defined life quality. There was a slightly reduced incidence of diarrhea in the first 3-month period in men receiving G-CSF and Jevtana (32.1% vs 24.3%) but not in men receiving docetaxel (23.8% vs 25%). Median progression-free and overall survival were similar in both groups.