Cabazitaxel — Drug Monograph

Brand names: Jevtana

Drug class: Taxane

Mechanism of Action

Cabazitaxel is a semi-synthetic taxane derivative that binds to tubulin and promotes its assembly into microtubules while simultaneously inhibiting their disassembly. This stabilizes the microtubule structure, leading to the inhibition of mitosis and interphase cellular functions. Unlike other taxanes, cabazitaxel is a poor substrate for the P-glycoprotein (P-gp) efflux pump, which may explain its activity in docetaxel-resistant tumors. The resulting mitotic arrest eventually triggers programmed cell death.

FDA Indications

• In combination with prednisone for the treatment of patients with metastatic castration-resistant prostate cancer previously treated with a docetaxel-containing treatment regimen

Common Side Effects

• Neutropenia
• Anemia
• Leukopenia
• Thrombocytopenia
• Diarrhea
• Nausea
• Vomiting
• Fatigue
• Asthenia
• Hematuria

Clinical Pearl

Cabazitaxel was specifically designed to overcome taxane resistance mediated by P-glycoprotein, making it a standard second-line option after docetaxel failure in prostate cancer. While the 25 mg/m² dose was originally approved, the 20 mg/m² dose is often preferred in clinical practice to reduce the incidence of severe neutropenia and febrile neutropenia while maintaining efficacy. Early and aggressive management of diarrhea is critical to prevent renal complications.

Related Therapies & Mechanisms

• Docetaxel (Taxotere) — Taxane · Prostate
• Nab-paclitaxel (Paclitaxel Protein-Bound) (Abraxane) — Taxane
• Paclitaxel (Taxol) — Taxane
• Abiraterone Acetate (Zytiga) — Prostate