For metastatic prostate cancer, when would you add carboplatin to docetaxel or cabazitaxel?

There is no clear consensus on this topic. However, I consider carboplatin plus docetaxel or cabazitaxel in men with the following features who are fit for chemotherapy and wish to be aggressive in their care, based on Paul Corn's MD Anderson trial (PMID 31515154):

1. Aggressive variant phenotypic features like liver metastases, high LDH, NEPC/small cell histology, high CEA, low PSA<10, and bulky disease (soft tissue or >20 bone mets), lytic bone mets.
2. Aggressive variant genotypic features by tumor or ctDNA testing in the mCRPC setting post-AR therapy, with 2 of the following tumor suppressor losses or mutations: RB1, TP53, and PTEN.

In these patients, cabazi/carbo improved PFS AND OS vs cabazitaxel in this RCT. NCCN v2.2022 now recommends thi...