Patients Diagnosed With Metastatic Castration-sensitive Prostate Cancer and High Serum Lactate Dehydrogenase Levels Did Not Receive an Adequate Dose of Cabazitaxel.

Background/aim: Timely administration of cabazitaxel is critical for patients with metastatic castration-resistant prostate cancer (mCRPC), and missing this opportunity can significantly impact outcomes. However, the specific reasons for this remain unclear. We aimed to evaluate factors, at the time of metastatic castration-sensitive prostate cancer (mCSPC) diagnosis, that are associated with the inability to receive cabazitaxel in patients who are managed with docetaxel for mCRPC.

Patients and methods: A total of 146 patients from 17 hospitals who received docetaxel for metastatic castration-resistant prostate cancer (mCRPC) between September 2014 and December 2022 were retrospectively evaluated. The cutoff values for continuous variables indicating the inability to receive ≥4 cycles of cabazitaxel were defined using the Youden index in the receiver operating characteristic analysis. Evaluating the factors at diagnosis related to not receiving ≥4 cycles of cabazitaxel was the study endpoint, using Binary logistic analysis.

Results: The median follow-up time from diagnosis was 40.5 [interquartile range (IQR)=23.0-70.7] months. Sixty-four patients could not receive ≥4 cycles of cabazitaxel for mCRPC. In the multivariate analysis, LDH level ≥326 U/l (n=22) (reference: <326 U/l (n=124), odds ratio=6.22, 95% confidence interval=1.90-20.4) was significantly related to failure to receive ≥4 cycles of cabazitaxel for mCRPC. Patients with LDH levels ≥326 U/l had a significantly shorter overall survival time than those with LDH levels <326 U/l (median: 22 vs. 72 months; p<0.001).

Conclusion: Patients with high LDH levels upon mCSPC diagnosis were not able to receive ≥4 cycles of cabazitaxel due to rapid progression.