Carboplatin, Cabazitaxel, and Abiraterone in High-Volume Metastatic Castration-Sensitive Prostate Cancer: The CASCARA Phase II Study.
Publication/Presentation Date
6-15-2026
Abstract
PURPOSE: This multicenter, single-arm, phase II trial evaluated the safety and efficacy of cabazitaxel and carboplatin followed by abiraterone, plus androgen deprivation therapy (ADT), in patients with high-volume metastatic castration-sensitive prostate cancer (mCSPC).
PATIENTS AND METHODS: Eligible patients had high-volume mCSPC and ≤3 months of prior ADT. Patients received six 21-day cycles of cabazitaxel (20 mg/m2) and carboplatin (AUC 4) with continuous ADT, followed by maintenance abiraterone (1,000 mg daily) and prednisone (5 mg daily). The primary endpoint was the proportion of patients free of prostate-specific antigen (PSA) or radiographic progression at 12 months. Secondary endpoints included complete PSA response (≤0.2 ng/mL), objective response, progression-free survival (PFS), and safety. Overall survival (OS) was also reported.
RESULTS: Sixty-one participants were enrolled at eight sites. The median age was 64 years, median baseline PSA was 6.6 ng/mL (0.07-745.7 ng/mL), 73.3% had Gleason grade group 5, 69.5% had 10 or more metastases, and 19.6% had a homologous recombination repair (HRR) mutation. PSA PFS at 12 months was 84.6% [95% confidence interval (CI), 72.5%-91.7%], and OS at 12 months was 94.8% (84.7%-98.3%). Complete PSA response was 66.7%, and complete objective response was 30.7%. Contrary to our hypothesis, relative to HRR wild-type patients, HRR-mutated patients (19.6%) had numerically fewer complete PSA responses (33.3% vs. 70.3%) and inferior PFS (HR, 2.43; 95% CI, 0.93-6.39). Common side effects of this quadruplet regimen included fatigue, nausea, and diarrhea.
CONCLUSIONS: Cabazitaxel and carboplatin followed by abiraterone, together with ADT, were feasible, safe, and efficacious in patients with high-volume mCSPC and warrant further study in larger randomized trials.
Volume
32
Issue
12
First Page
2403
Last Page
2412
ISSN
1557-3265
Published In/Presented At
Antonarakis, E. S., Cao, Q., Catharine, V., Carneiro, B. A., De Souza, A. L., VanderWeele, D. J., Singh, P., Bryce, A. H., Kelly, W. K., Jha, G. G., Lewis, B., Barata, P. C., Sartor, A. O., Stadler, W. M., Proudfoot, J. A., Davicioni, E., Dhawan, M., Morgans, A. K., & Ryan, C. J. (2026). Carboplatin, Cabazitaxel, and Abiraterone in High-Volume Metastatic Castration-Sensitive Prostate Cancer: The CASCARA Phase II Study. Clinical cancer research : an official journal of the American Association for Cancer Research, 32(12), 2403–2412. https://doi.org/10.1158/1078-0432.CCR-25-4823
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
41880596
Department(s)
Administration and Leadership
Document Type
Article