51
|
Gongora ABL, Canedo FSNA, de Melo ALA, Bezerra ROF, Asprino PF, Camargo AA, Bastos DA. Tumor Lysis Syndrome After Platinum-based Chemotherapy in Castration-resistant Prostate Cancer With a BRCA2 Mutation: A Case Report. Clin Genitourin Cancer 2019; 17:e61-e64. [DOI: 10.1016/j.clgc.2018.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/01/2018] [Indexed: 12/16/2022]
|
52
|
Maruzzo M, Basso U, Borsatti E, Evangelista L, Alongi F, Caffo O, Maines F, Galuppo S, De Vivo R, Zustovich F, Palleschi D, Zivi A, Sava T, Sorarù M, Iacovelli R, Nicodemo M, Baier S, Fratino L, Zagonel V. Results From a Large, Multicenter, Retrospective Analysis On Radium223 Use in Metastatic Castration-resistant Prostate Cancer (mCRPC) in the Triveneto Italian Region. Clin Genitourin Cancer 2019; 17:e187-e194. [DOI: 10.1016/j.clgc.2018.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/08/2018] [Accepted: 10/21/2018] [Indexed: 10/28/2022]
|
53
|
Dellis A, Zagouri F, Liontos M, Mitropoulos D, Bamias A, Papatsoris AG. Management of advanced prostate cancer: A systematic review of existing guidelines and recommendations. Cancer Treat Rev 2019; 73:54-61. [DOI: 10.1016/j.ctrv.2018.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
|
54
|
Update on Systemic Prostate Cancer Therapies: Management of Metastatic Castration-resistant Prostate Cancer in the Era of Precision Oncology. Eur Urol 2019; 75:88-99. [DOI: 10.1016/j.eururo.2018.03.028] [Citation(s) in RCA: 252] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 03/23/2018] [Indexed: 11/19/2022]
|
55
|
Nuclear Medicine Therapy With 223Radium-dichloride for Osseous Metastases in Prostate Carcinoma. Am J Clin Oncol 2019; 42:99-106. [DOI: 10.1097/coc.0000000000000479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
56
|
Nuhn P, De Bono JS, Fizazi K, Freedland SJ, Grilli M, Kantoff PW, Sonpavde G, Sternberg CN, Yegnasubramanian S, Antonarakis ES. Update on Systemic Prostate Cancer Therapies: Management of Metastatic Castration-resistant Prostate Cancer in the Era of Precision Oncology. Eur Urol 2019. [DOI: 10.1016/j.eururo.2018.03.028 [internet]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
57
|
Randomised phase II study of second-line olaratumab with mitoxantrone/prednisone versus mitoxantrone/prednisone alone in metastatic castration-resistant prostate cancer. Eur J Cancer 2019; 107:186-195. [DOI: 10.1016/j.ejca.2018.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/24/2018] [Accepted: 10/17/2018] [Indexed: 01/18/2023]
|
58
|
Fan L, Dong B, Chi C, Wang Y, Gong Y, Sha J, Pan J, Shangguan X, Huang Y, Zhou L, Xue W. Abiraterone acetate for chemotherapy-naive metastatic castration-resistant prostate cancer: a single-centre prospective study of efficacy, safety, and prognostic factors. BMC Urol 2018; 18:110. [PMID: 30509237 PMCID: PMC6276197 DOI: 10.1186/s12894-018-0416-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/26/2018] [Indexed: 12/26/2022] Open
Abstract
Background To evaluate the efficacy and safety of abiraterone acetate (AA) plus prednisone compared with prednisone alone in Asian patients with chemotherapy-naive metastatic castration-resistant prostate cancer (mCRPC), and to identify predictive factors. Methods We reviewed the medical records of 60 patients with chemotherapy-naive mCRPC at Renji Hospital who were treated with AA plus prednisone (n = 43) or prednisone alone (n = 17). All patients were assessed for prostate-specific antigen (PSA) response, PSA progression-free survival (PSA PFS), radiographic progression-free survival (rPFS), and overall survival (OS). The ability of several parameters to predict PSA PFS, rPFS, and OS was studied. Results The median follow-up time was 14.0 months (range 7.0–18.5 months), at which time 19 death events had been reported: 11 in the AA + prednisone group and 8 in the prednisone group. The AA + prednisone group had significantly longer median PSA PFS (10.3 vs 3.0 months, P < 0.001), rPFS (13.9 vs 3.9 months, P < 0.001), and OS (23.3 vs 17.5 months, P = 0.016) than the prednisone-alone group. The most frequently reported grade 3 or 4 adverse event in both the AA + prednisone and prednisone-alone groups was elevated alanine aminotransferase level in 5 of 43 patients (11.6%) and 2 of 17 patients (11.8%), respectively. No adverse events led to discontinuation of therapy. In multivariate analysis, time from androgen deprivation therapy (ADT) to castration resistance of ≤18 months was a determinant of shorter OS (P = 0.007). Conclusions These results support the favourable safety and efficacy profile of AA for the treatment of Asian patients with chemotherapy-naive mCRPC. Longer duration of ADT response was significantly associated with longer survival. Electronic supplementary material The online version of this article (10.1186/s12894-018-0416-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Liancheng Fan
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Baijun Dong
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Chenfei Chi
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yanqing Wang
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yiming Gong
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jianjun Sha
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jiahua Pan
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xun Shangguan
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yiran Huang
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Lixin Zhou
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Wei Xue
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China.
| |
Collapse
|
59
|
Laber DA, Chen MB, Jaglal M, Patel A, Visweshwar N. Phase 2 Study of Cyclophosphamide, Etoposide, and Estramustine in Patients With Castration-Resistant Prostate Cancer. Clin Genitourin Cancer 2018; 16:473-481. [DOI: 10.1016/j.clgc.2018.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 11/15/2022]
|
60
|
Dong L, Zieren RC, Xue W, de Reijke TM, Pienta KJ. Metastatic prostate cancer remains incurable, why? Asian J Urol 2018; 6:26-41. [PMID: 30775246 PMCID: PMC6363601 DOI: 10.1016/j.ajur.2018.11.005] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/18/2018] [Accepted: 09/12/2018] [Indexed: 12/21/2022] Open
Abstract
Metastatic prostate cancer patients present in two ways—with already disseminated disease at the time of presentation or with disease recurrence after definitive local therapy. Androgen deprivation therapy is given as the most effective initial treatment to patients. However, after the initial response, almost all patients will eventually progress despite the low levels of testosterone. Disease at this stage is termed castration resistant prostate cancer (CRPC). Before 2010, the taxane docetaxel was the first and only life prolonging agent for metastatic CRPC (mCRPC). The last decade has witnessed robust progress in CRPC therapeutics development. Abiraterone, enzalutamide, apalutamide and sipuleucel-T have been evaluated as first- and second-line agents in mCRPC patients, while cabazitaxel was approved as a second-line treatment. Radium-223 dichloride was approved in symptomatic patients with bone metastases and no known visceral metastases pre- and post-docetaxel. However, despite significant advances, mCRPC remains a lethal disease. Both primary and acquired resistance have been observed in CRPC patients treated by these new agents. It could be solely cell intrinsic or it is possible that the clonal heterogeneity in treated tumors may result from the adaptive responses to the selective pressures within the tumor microenvironment. The aim of this review is to list current treatment agents of CRPC and summarize recent findings in therapeutic resistance mechanisms.
Collapse
Affiliation(s)
- Liang Dong
- The Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Richard C Zieren
- The Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Wei Xue
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Theo M de Reijke
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Kenneth J Pienta
- The Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
61
|
Martin LJ, Alibhai SMH, Komisarenko M, Timilshina N, Finelli A. Identification of subgroups of metastatic castrate-resistant prostate cancer (mCRPC) patients treated with abiraterone plus prednisone at low- vs. high-risk of radiographic progression: An analysis of COU-AA-302. Can Urol Assoc J 2018; 13:192-200. [PMID: 30407155 DOI: 10.5489/cuaj.5586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Radiographic imaging is used to monitor disease progression for men with metastatic castrate-resistant prostate cancer (mCRPC). The optimal frequency of imaging, a costly and limited resource, is not known. Our objective was to identify predictors of radiographic progression to inform the frequency of imaging for men with mCRPC. METHODS We accessed data for men with chemotherapy-naive mCRPC in the abiraterone acetate plus prednisone (AA-P) group of a randomized trial (COU-AA-302) (n=546). We used Cox proportional hazards modelling to identify predictors of time to progression. We divided patients into groups based on the most important predictors and estimated the probability of radiographic progression-free survival (RPFS) at six and 12 months. RESULTS Baseline disease and change in prostate-specific antigen (PSA) at eight weeks were the strongest determinants of RPFS. The probability of RPFS for men with bone-only disease and a ≥50% fall in PSA was 93% (95% confidence interval [CI] 87-96) at six months and 80% (95% CI 72-86) at 12 months. In contrast, the probability of RPFS for men with bone and soft tissue metastasis and <50% fall in PSA was 55% (95% CI 41-67) at six months and 34% (95% CI 22-47) at 12 months. These findings should be externally validated. CONCLUSIONS Patients with chemotherapy-naive mCRPC treated with first-line AA-P can be divided into groups with significantly different risks of radiographic progression based on a few clinically available variables, suggesting that imaging schedules could be individualized.
Collapse
Affiliation(s)
- Lisa J Martin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shabbir M H Alibhai
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Maria Komisarenko
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Antonio Finelli
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| |
Collapse
|
62
|
Tan Y, Wang L, Du Y, Liu X, Chen Z, Weng X, Guo J, Chen H, Wang M, Wang X. Inhibition of BRD4 suppresses tumor growth in prostate cancer via the enhancement of FOXO1 expression. Int J Oncol 2018; 53:2503-2517. [PMID: 30272279 PMCID: PMC6203153 DOI: 10.3892/ijo.2018.4577] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/09/2018] [Indexed: 12/13/2022] Open
Abstract
Prostate cancer (PCa) is a malignant tumor with a high incidence in males. Localized tumors can be treated via surgery or radiation; however, it remains difficult to prevent disease progression. Bromodomain-containing protein 4 (BRD4) is an epigenetic reader protein that binds to acetylated lysine on histones and has been reported to serve critical roles in numerous types of cancers. In the present study, it was demonstrated that BRD4 expression levels were significantly increased in cancerous prostate tissue specimens and cells, which were associated with clinical stage and metastasis. In addition, the present study reported that inhibition of BRD4 via short hairpin RNA or JQ1 (a bromo-domain inhibitor) decreased PCa cell proliferation, induced G0/G1 cell cycle arrest and apoptosis, mitigated cell invasion and migration in vitro, and impaired tumor growth in vivo. Mechanistically, BRD4 inhibition-induced suppression of cell cycle progression was associated with the upregulation of p21 and cyclin D1. c-Myc and B-cell lymphoma-2 (Bcl-2), important genes responsible for cell cycle regulation and anti-apoptotic functions, were downregulated in response to BRD4 inhibition. Furthermore, the present study revealed that c-Myc expression was negatively regulated by p21, and that the induction of p21 via BRD4 inhibition was mediated by forkhead box protein O1 (FOXO1), rather than p53. In summary, the results of the present study suggested that the aberrant expression of BRD4 in PCa may induce carcinogenesis. In addition, a mechanism by which BRD4 inhibition suppresses cell proliferation via the regulation of FOXO1-p21-Myc signaling was proposed in the present study, which may contribute to the development of novel therapeutic approaches in the management of PCa.
Collapse
Affiliation(s)
- Yifan Tan
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Lei Wang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yang Du
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xiuheng Liu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Zhiyuan Chen
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xiaodong Weng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Jia Guo
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Hui Chen
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Min Wang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xiao Wang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| |
Collapse
|
63
|
Schultz NM, Shore ND, Chowdhury S, Klotz LH, Concepcion RS, Penson DF, Karsh LI, Yang H, Brown BA, Barlev A, Flanders SC. Number-needed-to-treat analysis of clinical progression in patients with metastatic castration-resistant prostate cancer in the STRIVE and TERRAIN trials. BMC Urol 2018; 18:77. [PMID: 30189902 PMCID: PMC6128000 DOI: 10.1186/s12894-018-0387-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/23/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This analysis estimated the number needed to treat with enzalutamide versus bicalutamide to achieve one additional patient with chemotherapy-naïve metastatic castration-resistant prostate cancer who would obtain clinical benefit regarding progression-free survival, radiographic progression-free survival, or no prostate-specific antigen progression at 1 and 2 years following treatment initiation. METHODS Clinical event rates were obtained from the STRIVE (NCT01664923) and TERRAIN (NCT01288911) trials, and the number needed to treat was the inverse of the absolute rate difference between the event rates of enzalutamide and bicalutamide. The 95% Confidence Interval of the number needed to treat was derived from the 95% Confidence Interval of the event rate difference. RESULTS Using STRIVE data (patients with metastatic disease: n = 128 enzalutamide; n = 129 bicalutamide) comparing enzalutamide with bicalutamide at 1 and 2 years, the numbers needed to treat to achieve one additional patient with chemotherapy-naïve metastatic castration-resistant prostate cancer with progression-free survival were 2.0 and 2.8, respectively; with radiographic progression-free survival, 2.6 and 3.0, respectively; and without prostate-specific antigen progression, 1.8 and 2.4, respectively. Using TERRAIN data (n = 184 enzalutamide; n = 191 bicalutamide) comparing enzalutamide with bicalutamide at 1 and 2 years, the numbers needed to treat to achieve one additional patient with progression-free survival were 4.3 and 3.7, respectively; with radiographic progression-free survival, 10.0 and 2.8, respectively; and without prostate-specific antigen progression, 2.1 and 3.2, respectively. CONCLUSIONS The combined data from TERRAIN and STRIVE demonstrated that treating chemotherapy-naïve metastatic castration-resistant prostate cancer with enzalutamide leads to more patients without clinical progression at 1 and 2 years than with bicalutamide. TRIAL REGISTRATION STRIVE (NCT01664923; registration date: August 10, 2012) and TERRAIN (NCT01288911; registration date: February 1, 2011).
Collapse
Affiliation(s)
- Neil M. Schultz
- Astellas Pharma, Inc., 1 Astellas Way, Northbrook, IL 60062 USA
| | - Neal D. Shore
- Carolina Urologic Research Center, Myrtle Beach, SC USA
| | | | - Laurence H. Klotz
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON Canada
| | | | | | | | | | - Bruce A. Brown
- Astellas Pharma, Inc., 1 Astellas Way, Northbrook, IL 60062 USA
| | - Arie Barlev
- Medivation, Inc., San Francisco, CA USA
- Pfizer, Inc., New York, NY USA
| | | |
Collapse
|
64
|
Kesavan M, Turner JH, Meyrick D, Yeo S, Cardaci G, Lenzo NP. Salvage Radiopeptide Therapy of Advanced Castrate-Resistant Prostate Cancer with Lutetium-177-Labeled Prostate-Specific Membrane Antigen: Efficacy and Safety in Routine Practice. Cancer Biother Radiopharm 2018; 33:274-281. [DOI: 10.1089/cbr.2017.2403] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Murali Kesavan
- Department of Haematology, The University of Western Australia, School of Medicine, Perth, Australia
- Department of Nuclear Medicine, The University of Western Australia, School of Medicine, Perth, Australia
| | - J. Harvey Turner
- Department of Haematology, The University of Western Australia, School of Medicine, Perth, Australia
- Department of Nuclear Medicine, The University of Western Australia, School of Medicine, Perth, Australia
| | - Danielle Meyrick
- Department of Haematology, The University of Western Australia, School of Medicine, Perth, Australia
- Department of Nuclear Medicine, The University of Western Australia, School of Medicine, Perth, Australia
| | - Sharon Yeo
- Department of Haematology, The University of Western Australia, School of Medicine, Perth, Australia
- Department of Nuclear Medicine, The University of Western Australia, School of Medicine, Perth, Australia
| | - Giuseppe Cardaci
- Department of Nuclear Medicine, School of Medicine, The University of Notre Dame, Fremantle, Australia
| | - Nat P. Lenzo
- Department of Haematology, The University of Western Australia, School of Medicine, Perth, Australia
- Department of Nuclear Medicine, The University of Western Australia, School of Medicine, Perth, Australia
- Theranostics Australia, East Fremantle, Australia
| |
Collapse
|
65
|
Patterns of Bicalutamide Use in Prostate Cancer Treatment: A U.S. Real-World Analysis Using the SEER-Medicare Database. Adv Ther 2018; 35:1438-1451. [PMID: 29946798 PMCID: PMC6133134 DOI: 10.1007/s12325-018-0738-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Indexed: 01/11/2023]
Abstract
Introduction Bicalutamide (BIC), a non-steroidal anti-androgen, is FDA-indicated for use in combination with a luteinizing hormone-releasing hormone (LHRH) analog for treatment of Stage D2 metastatic carcinoma of the prostate. Lack of consensus exists regarding the clinical benefit of BIC use, either alone or combined use of BIC with an LHRH analog or antagonist (combined androgen blockade or CAB), versus treatment with androgen deprivation therapy (ADT) alone. Methods The SEER-Medicare database was used to identify prostate cancer patients aged ≥ 66 years diagnosed between 2007 and 2011 and who filled at least one prescription for BIC. Duration of BIC treatment was assessed in relation to ADT use; either alone (monotherapy), as part of CAB only, and as part of CAB followed by monotherapy. Additionally, we assessed use of BIC during or outside a potential testosterone flare prevention period (initiation within 2 months of an LHRH agonist). Results A total of 7521 prostate cancer patients who filled a prescription for BIC were identified. Eighteen percent of the cohort used BIC alone, over half the patients (54%) used BIC as part of CAB and 27% used BIC as part of CAB followed by monotherapy. Among men treated with BIC as part of CAB, 58% received BIC only within the potential flare period. Conclusions Although there is no FDA indication for BIC use as monotherapy, > 44% of patients in this study used BIC alone or as part of CAB followed by monotherapy. Further research is necessary to understand the outcomes of BIC utilization in these settings, particularly compared with newer second-generation anti-androgens. Funding Medivation LLC, a Pfizer company, and Astellas, Pharma, Inc. Electronic supplementary material The online version of this article (10.1007/s12325-018-0738-5) contains supplementary material, which is available to authorized users.
Collapse
|
66
|
Tabakin AL, Sadimin ET, Tereshchenko I, Kareddula A, Stein MN, Mayer T, Hirshfield KM, Kim IY, Tischfield J, DiPaola RS, Singer EA. Correlation of Prostate Cancer CHD1 Status with Response to Androgen Deprivation Therapy: a Pilot Study. JOURNAL OF GENITOURINARY DISORDERS 2018; 2:1006. [PMID: 30714046 PMCID: PMC6358174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION CHD1 has been identified as a tumor suppressor gene in prostate cancer. Previous studies have shown strong associations between CHD1 deletion, prostate specific antigen [PSA] recurrence, and absence of ERG fusion. In this preliminary study we seek to find whether there is an independent correlation between CHD1 status and response to androgen deprivation therapy[ADT]. MATERIALS AND METHODS We identified 11 patients with prostate cancer who underwent prostatectomy and received at least 7 months of ADT at our institution. They were divided into undetectable [PSA < 0.2 ng/mL; n = 8] and detectable [PSA > 0.2 ng/mL; n = 3] according to their serum PSA nadir after 7 months of ADT. Tissue microarray was generated from their formalin-fixed paraffin-embedded prostatectomy and involved lymph node tissues. Fluorescence in situ hybridization [FISH] analysis for CHD1 and immunohistochemical stains for PSA, AR, PTEN, ERG and SPINK1 were performed. RESULTS Our results showed heterogeneity of FISH and immunostains expressions in different foci of tumor. Status of CHD1, ERG, PTEN, or SPINK1 did not correlate with one another or with response to ADT. CONCLUSIONS Additional larger studies may be needed to further elucidate trends between these biomarkers and clinical outcomes in prostate cancer patients.
Collapse
Affiliation(s)
- Alexandra L. Tabakin
- Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, USA
| | - Evita T. Sadimin
- Section of Pathologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, USA
| | - Irina Tereshchenko
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, USA
| | - Aparna Kareddula
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, USA
| | - Mark N. Stein
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, USA
| | - Tina Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, USA
| | - Kim M. Hirshfield
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, USA
| | - Isaac Y. Kim
- Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, USA
| | - Jay Tischfield
- Department of Genetics, Human Genetics Institute of New Jersey and Rutgers University, USA
| | - Robert S. DiPaola
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, USA
| | - Eric A. Singer
- Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, USA
| |
Collapse
|
67
|
García Vicente AM, González García B, Amo-Salas M, García Carbonero I, Cassinello Espinosa J, Gómez-Aldaraví Gutierrez JL, Suarez Hinojosa L, Soriano Castrejón Á. Baseline 18F-Fluorocholine PET/CT and bone scan in the outcome prediction of patients treated with radium 223 dichloride. Clin Transl Oncol 2018; 21:289-297. [DOI: 10.1007/s12094-018-1920-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/09/2018] [Indexed: 12/22/2022]
|
68
|
223Ra-Dichloride in castration-resistant metastatic prostate cancer: improving outcomes and identifying predictors of survival in clinical practice. Eur J Nucl Med Mol Imaging 2018; 45:2264-2273. [PMID: 29998419 PMCID: PMC6208810 DOI: 10.1007/s00259-018-4083-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/29/2018] [Indexed: 11/08/2022]
Abstract
Purpose We first assessed whether the pattern of referrals to a nuclear medicine clinic improved as experience with 223Ra-dichloride increased, and whether referral patterns affected patient outcomes, and second assessed the value of bone scintigraphy, total alkaline phosphatase (tALP) and lymphadenopathy as prognostic factors in patients receiving 223Ra-dichloride. Methods A total of 57 patients eligible to receive 223Ra-dichloride over a 2-year period (March 2014 to March 2016) were retrospectively assessed and prospectively followed (median follow up 298 days). 223Ra-Dichloride was administered at 4-week intervals for a maximum of six injections. The numbers of patients in years 1 and 2 referred in relation to extent of bone disease (EOBD) category and overall survival (OS) were determined. The prognostic factors EOBD category, baseline tALP (tALPBL), tALP response, greatest percentage reduction in tALP from baseline in any treatment cycle (ALPmax; among patients with elevated ALPBL), and the presence of lymphadenopathy were assessed as predictors of OS. Results The proportion of patients with EOBD1 was higher in year 2 than in year 1 (29% and 4%, respectively), and in year 2 there was a lower rate of symptomatic skeleton-related events, a higher proportion of patients completing six cycles, and longer (albeit nonsignificant) OS (p = 0.55). There were significant differences in OS between EOBD4 patients and those in all other groups and between EOBD1 and EOBD3 patients (p < 0.05). OS was longer in patients with normal tALPBL than in those with elevated tALPBL (p = 0.01), in ALP responders than in nonresponders (p < 0.05), and in patients without lymphadenopathy than in those with lymphadenopathy (p = 0.29). OS was correlated with ALPmax (r2 = 0.24). Conclusion A collaborative multidisciplinary referrals pathway, together with increased experience with 223Ra-dichloride, led to improved outcomes. In patients with elevated tALPBL, tALP dynamics may be useful for monitoring response and predicting OS. Imaging and prognostic markers may therefore be of value for individualizing 223Ra-dichloride treatment and planning retreatment; however, further studies are required.
Collapse
|
69
|
Unger JM, Griffin K, Donaldson GW, Baranowski KM, Good MJ, Reburiano E, Hussain M, Monk PJ, Van Veldhuizen PJ, Carducci MA, Higano CS, Lara PN, Tangen CM, Quinn DI, Wade JL, Vogelzang NJ, Thompson IM, Moinpour CM. Patient-reported outcomes for patients with metastatic castration-resistant prostate cancer receiving docetaxel and Atrasentan versus docetaxel and placebo in a randomized phase III clinical trial (SWOG S0421). J Patient Rep Outcomes 2018; 2:27. [PMID: 29951640 PMCID: PMC5997724 DOI: 10.1186/s41687-018-0054-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/21/2018] [Indexed: 01/22/2023] Open
Abstract
Background SWOG S0421 was a large randomized trial comparing docetaxel/prednisone plus placebo (DPP) to docetaxel/prednisone plus atrasentan over 12 cycles for patients with metastatic castration-resistant prostate cancer (mCRPC). The current report presents the PRO results for this trial, an important secondary endpoint. Methods The trial specified two primary PRO endpoints. Palliation of worst pain was based on the Brief Pain Inventory (BPI), where a 2 point difference is defined as clinically meaningful. Improvement of functional status was based on the Functional Assessment of Cancer Therapy – Prostate Cancer Trial Outcome Index (FACT-P TOI); a 5-point difference has been defined as clinically meaningful. We compared rates by arm using chi-square tests. Longitudinal analyses using linear mixed models addressed changes by arm over time. Results Four-hundred eighty-nine patients on each arm were evaluable for PRO endpoint data. There were no differences by arm in clinically meaningful pain palliation (41.7% for DPP vs. 44.0% for DPA, p = .70) or functional status (24.2% for DPP vs. 28.7% for DPA, p = .13). Longitudinal comparisons indicated no differences over time by arm for BPI Worst Pain scores (0.13 points, p = .23). Patients on the DPA arm had improved functional status of 1.78 points on average, a statistically significant (p = .02) but not clinically meaningful difference. Conclusions The SWOG S0421 PRO data showed little evidence of clinically meaningful differences by arm in either pain palliation or functional status. Electronic supplementary material The online version of this article (10.1186/s41687-018-0054-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Joseph M Unger
- 1SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,17Fred Hutchinson Cancer Research Center, M3-C102/P.O. Box 19024, 1100 Fairview Avenue North, Seattle, WA 98109-1024 USA
| | - Katherine Griffin
- 1SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | | | | | | | | | - Maha Hussain
- 6Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL USA
| | - Paul J Monk
- 7The Ohio State University James Cancer Hospital, Columbus, OH USA
| | | | | | - Celestia S Higano
- 10Pacific Cancer Research Consortium NCORP, Seattle Cancer Care Alliance, University of Washington, Seattle, WA USA
| | - Primo N Lara
- 11University of California at Davis, Sacramento, CA USA
| | - Catherine M Tangen
- 1SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - David I Quinn
- 12University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA USA
| | - James L Wade
- 1SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,2University of Utah, Salt Lake City, UT USA.,3Karmanos Cancer Center, Farmington Hills, MI USA.,4National Cancer Institute, Washington, DC USA.,ICON PLCC, Philadelphia, PA USA.,6Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL USA.,7The Ohio State University James Cancer Hospital, Columbus, OH USA.,Sarah Cannon Cancer Center, Kansas City, KS USA.,9Johns Hopkins University School of Medicine, Baltimore, MD USA.,10Pacific Cancer Research Consortium NCORP, Seattle Cancer Care Alliance, University of Washington, Seattle, WA USA.,11University of California at Davis, Sacramento, CA USA.,12University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA USA.,Heartland NCORP, Decatur, IL USA.,US Oncology Research Comprehensive Cancer Centers, Las Vegas, NV USA.,15CHRISTUS Santa Rosa Hospital Medical Center, San Antonio, TX USA.,16Fred Hutchinson Cancer Research Center, Seattle, WA USA.,17Fred Hutchinson Cancer Research Center, M3-C102/P.O. Box 19024, 1100 Fairview Avenue North, Seattle, WA 98109-1024 USA
| | | | - Ian M Thompson
- 1SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,2University of Utah, Salt Lake City, UT USA.,3Karmanos Cancer Center, Farmington Hills, MI USA.,4National Cancer Institute, Washington, DC USA.,ICON PLCC, Philadelphia, PA USA.,6Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL USA.,7The Ohio State University James Cancer Hospital, Columbus, OH USA.,Sarah Cannon Cancer Center, Kansas City, KS USA.,9Johns Hopkins University School of Medicine, Baltimore, MD USA.,10Pacific Cancer Research Consortium NCORP, Seattle Cancer Care Alliance, University of Washington, Seattle, WA USA.,11University of California at Davis, Sacramento, CA USA.,12University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA USA.,Heartland NCORP, Decatur, IL USA.,US Oncology Research Comprehensive Cancer Centers, Las Vegas, NV USA.,15CHRISTUS Santa Rosa Hospital Medical Center, San Antonio, TX USA.,16Fred Hutchinson Cancer Research Center, Seattle, WA USA.,17Fred Hutchinson Cancer Research Center, M3-C102/P.O. Box 19024, 1100 Fairview Avenue North, Seattle, WA 98109-1024 USA
| | | |
Collapse
|
70
|
Morris MJ, Rumble RB, Basch E, Hotte SJ, Loblaw A, Rathkopf D, Celano P, Bangs R, Milowsky MI. Optimizing Anticancer Therapy in Metastatic Non-Castrate Prostate Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2018; 36:1521-1539. [DOI: 10.1200/jco.2018.78.0619] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This clinical practice guideline addresses abiraterone or docetaxel with androgen-deprivation therapy (ADT) for metastatic prostate cancer that has not been treated (or has been minimally treated) with testosterone-lowering agents. Methods Standard therapy for newly diagnosed metastatic prostate cancer has been ADT alone. Three studies have compared ADT alone with ADT and docetaxel, and two studies have compared ADT alone with ADT and abiraterone. Results Three prospective randomized studies (GETUG-AFU 15, STAMPEDE, and CHAARTED) examined overall survival (OS) with adding docetaxel to ADT. STAMPEDE and CHAARTED favored docetaxel (hazard ratio [HR], 0.78; 95% CI, 0.66 to 0.93; n = 2,962 and HR, 0.73; 95% CI, 0.59 to 0.89; n = 790, respectively). GETUG-AFU 15 was negative. LATITUDE and STAMPEDE examined the impact on OS of adding abiraterone (with prednisone or prednisolone) to ADT. LATITUDE and STAMPEDE favored abiraterone (HR, 0.62; 95% CI, 0.51 to 0.76; n = 1,199 and HR, 0.63; 95% CI, 0.52 to 0.76; n = 1,917, respectively). Recommendations ADT plus docetaxel or abiraterone in newly diagnosed metastatic non-castrate prostate cancer offers a survival benefit as compared with ADT alone. The strongest evidence of benefit with docetaxel is in men with de novo high-volume (CHAARTED criteria) metastatic disease. Similar survival benefits are seen using abiraterone acetate in high-risk patients (LATITUDE criteria) and in the metastatic population in STAMPEDE. ADT plus abiraterone and ADT plus docetaxel have not been compared, and it is not known if some men benefit more from one regimen as opposed to the other. Fitness for chemotherapy, patient comorbidities, toxicity profiles, quality of life, drug availability, and cost should be considered in this decision. Additional information is available at www.asco.org/genitourinary-cancer-guidelines .
Collapse
Affiliation(s)
- Michael J. Morris
- Michael J. Morris and Dana Rathkopf, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ethan Basch and Matthew I. Milowsky, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Sebastien J. Hotte, Juravinski Cancer Centre, Hamilton; Andrew Loblaw, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Paul Celano, Greater Baltimore Medical Center, Towson, MD; and
| | - R. Bryan Rumble
- Michael J. Morris and Dana Rathkopf, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ethan Basch and Matthew I. Milowsky, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Sebastien J. Hotte, Juravinski Cancer Centre, Hamilton; Andrew Loblaw, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Paul Celano, Greater Baltimore Medical Center, Towson, MD; and
| | - Ethan Basch
- Michael J. Morris and Dana Rathkopf, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ethan Basch and Matthew I. Milowsky, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Sebastien J. Hotte, Juravinski Cancer Centre, Hamilton; Andrew Loblaw, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Paul Celano, Greater Baltimore Medical Center, Towson, MD; and
| | - Sebastien J. Hotte
- Michael J. Morris and Dana Rathkopf, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ethan Basch and Matthew I. Milowsky, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Sebastien J. Hotte, Juravinski Cancer Centre, Hamilton; Andrew Loblaw, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Paul Celano, Greater Baltimore Medical Center, Towson, MD; and
| | - Andrew Loblaw
- Michael J. Morris and Dana Rathkopf, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ethan Basch and Matthew I. Milowsky, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Sebastien J. Hotte, Juravinski Cancer Centre, Hamilton; Andrew Loblaw, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Paul Celano, Greater Baltimore Medical Center, Towson, MD; and
| | - Dana Rathkopf
- Michael J. Morris and Dana Rathkopf, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ethan Basch and Matthew I. Milowsky, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Sebastien J. Hotte, Juravinski Cancer Centre, Hamilton; Andrew Loblaw, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Paul Celano, Greater Baltimore Medical Center, Towson, MD; and
| | - Paul Celano
- Michael J. Morris and Dana Rathkopf, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ethan Basch and Matthew I. Milowsky, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Sebastien J. Hotte, Juravinski Cancer Centre, Hamilton; Andrew Loblaw, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Paul Celano, Greater Baltimore Medical Center, Towson, MD; and
| | - Rick Bangs
- Michael J. Morris and Dana Rathkopf, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ethan Basch and Matthew I. Milowsky, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Sebastien J. Hotte, Juravinski Cancer Centre, Hamilton; Andrew Loblaw, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Paul Celano, Greater Baltimore Medical Center, Towson, MD; and
| | - Matthew I. Milowsky
- Michael J. Morris and Dana Rathkopf, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ethan Basch and Matthew I. Milowsky, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Sebastien J. Hotte, Juravinski Cancer Centre, Hamilton; Andrew Loblaw, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Paul Celano, Greater Baltimore Medical Center, Towson, MD; and
| |
Collapse
|
71
|
Saad F, Pouliot F, Danielson B, Catton C, Kapoor A. Symptom assessment to guide treatment selection and determine progression in metastatic castration-resistant prostate cancer: Expert opinion and review of the evidence. Can Urol Assoc J 2018; 12:E415-E420. [PMID: 30227914 DOI: 10.5489/cuaj.5154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Multiple new agents to treat metastatic castration-resistant prostate cancer (mCRPC) have become available in recent years; however, the appropriate timing and sequencing of these agents have yet to be elucidated. Until accurate biomarkers become available to allow more focused therapeutic targeting for this population, treatment selection for men with mCRPC will continue to be driven largely by close assessment of patient-related factors and symptoms. Pain, as the predominant symptom of mCRPC, is often the focus when assessing progression and the need for a change in treatment. A myriad of other symptoms, including fatigue, impact on activities of daily living, sleep, and lower urinary tract symptoms, also affect men with mCRPC, and assessment of the composite of these symptoms provides an earlier signal for the need to adjust treatment. A number of tools are available for assessing symptoms in patients with advanced prostate cancer, but they are not routinely used, given their complexity and length. A new simplified questionnaire is proposed for the assessment of symptoms, beyond pain, to inform treatment decisions for men with mCRPC.
Collapse
Affiliation(s)
- Fred Saad
- Division of Urology, CHUM, l'Université de Montréal, Montreal, QC, Canada
| | - Frédéric Pouliot
- Department of Surgery, Division of Urology, Université Laval, Quebec City, QC, Canada
| | - Brita Danielson
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Charles Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anil Kapoor
- Department of Surgery (Urology), McMaster University, Hamilton, ON, Canada
| |
Collapse
|
72
|
Cash H, Steiner U, Heidenreich A, Klotz T, Albers P, Melchior S, Martus P, Fuller F, Magheli A, Hinz S, Kempkensteffen C, Miller K. Intermittent vs continuous docetaxel therapy in patients with metastatic castration-resistant prostate cancer - a phase III study (PRINCE). BJU Int 2018; 122:774-782. [PMID: 29633515 DOI: 10.1111/bju.14239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate non-inferiority of intermittent docetaxel compared to continuous docetaxel in patients with metastatic castration-resistant prostate cancer (mCRPC). PATIENT AND METHODS The investigator initiated randomised phase III study included 187 chemotherapy-naïve patients with mCRPC who were allocated to two treatment arms: intermittent docetaxel and continuous docetaxel. Docetaxel was applied in both arms as weekly (35 mg/m2 ) or 3-weekly (75 mg/m2 ). The primary endpoint was 1-year survival, which was tested for non-inferiority (margin δ = 0.125). The secondary endpoints were: overall survival (OS), progression-free survival (PFS), median time to treatment failure (TTF), and toxicity. RESULTS Of 156 eligible patients, 78 were allocated to each arm. The intermittent treatment met the non-inferiority criteria for 1-year survival (two-sided 95% confidence interval, -0.12, 18, P = 0.022), but not for OS, according to the result of a post hoc analysis. The differences between the study arms in PFS and TTF were not significant. The median (range) treatment holiday in the intermittent arm was 110 (13-486) days, or 38% of the overall treatment duration. Safety profiles of both study arms were comparable. The main limitation of this study was that the planned number of patients could not be recruited. CONCLUSION Intermittent docetaxel chemotherapy was non-inferior to continuous therapy for 1-year survival; non-inferiority in regard to OS was not reached.
Collapse
Affiliation(s)
- Hannes Cash
- Department of Urology, Charité, University Medicine Berlin, Berlin, Germany
| | - Ursula Steiner
- Department of Urology, Charité, University Medicine Berlin, Berlin, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Theodor Klotz
- Department of Urology, Weiden Hospital, Weiden, Germany
| | - Peter Albers
- Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometrics, Tübingen University Hospital, Tübingen, Germany
| | - Florian Fuller
- Department of Urology, Charité, University Medicine Berlin, Berlin, Germany
| | - Ahmed Magheli
- Department of Urology, Charité, University Medicine Berlin, Berlin, Germany
| | - Stefan Hinz
- Department of Urology, Charité, University Medicine Berlin, Berlin, Germany
| | | | - Kurt Miller
- Department of Urology, Charité, University Medicine Berlin, Berlin, Germany
| | | |
Collapse
|
73
|
Morris MJ, Rumble RB, Milowsky MI. Optimizing Anticancer Therapy in Metastatic Non-Castrate Prostate Cancer: ASCO Clinical Practice Guideline Summary. J Oncol Pract 2018; 14:319-322. [DOI: 10.1200/jop.18.00075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michael J. Morris
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY; ASCO, Alexandria, VA; and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - R. Bryan Rumble
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY; ASCO, Alexandria, VA; and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Matthew I. Milowsky
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY; ASCO, Alexandria, VA; and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
74
|
Caram MEV, Estes JP, Griggs JJ, Lin P, Mukherjee B. Temporal and geographic variation in the systemic treatment of advanced prostate cancer. BMC Cancer 2018; 18:258. [PMID: 29510667 PMCID: PMC5840834 DOI: 10.1186/s12885-018-4166-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several systemic treatments have been shown to increase survival for patients with metastatic castration-resistant prostate cancer. This study sought to characterize variation in use of the six "focus drugs" (docetaxel, abiraterone, enzalutamide, sipuleucel-T, radium-223, and cabazitaxel) that have been approved by the Food and Drug Administration for the treatment of metastatic castration-resistant prostate cancer during the years 2010-2015. We hypothesized that the use of these treatments would vary over time and by region of the country. METHODS We used Clinformatics DataMart™ Database (OptumInsight, Eden Prairie, MN), a de-identified claims database from a national insurance provider. Our sample included patients with prostate cancer who received any of the six drugs. We describe changes in usage patterns over time and geographic region of the United States via detailed descriptive statistics. We explore both patterns of first line therapy and sequence of treatments in our database. RESULTS Our final analysis included 4275 patients with a mean age of 74 years. Docetaxel was the most commonly used first-line therapy in 2010 (97%), 2011 (66%), and 2012 (49%). Abiraterone was the most commonly used first-line therapy in 2013 (56%), 2014 (46%), and 2015 (34%). Approximately 14% of our study cohort received ≥3 of the 6 drugs throughout their disease course. There was marked geographic variation in use of each of the drugs. CONCLUSION Variation in treatment patterns were found with respect to both time and geographic location. Prescription rates of abiraterone outpaced docetaxel as the most commonly prescribed drug after 2013 when it became widely available. However, some regions of the country still lagged behind and prescribed less than would be expected.
Collapse
Affiliation(s)
- Megan E. V. Caram
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI USA
- Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI USA
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI USA
| | - Jason P. Estes
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Jennifer J. Griggs
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI USA
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Paul Lin
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI USA
| | - Bhramar Mukherjee
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI USA
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI USA
| |
Collapse
|
75
|
Phase I Trial of the Combination of Docetaxel, Prednisone, and Pasireotide in Metastatic Castrate-Resistant Prostate Cancer. Clin Genitourin Cancer 2018. [PMID: 29534939 DOI: 10.1016/j.clgc.2018.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pasireotide (SOM230; Novartis Inc, Basel, Switzerland) is a multitargeted somatostatin receptor analogue likely to treat the neuroendocrine, and docetaxel resistant components within metastatic castrate-resistant prostate cancer (mCRPC). This phase I trial tested the combination of pasireotide, docetaxel, and prednisone in pretreated mCRPC. PATIENTS AND METHODS Chemotherapy naive mCRPC patients received docetaxel 75 mg/m2 intravenously every 21 days and pasireotide intramuscularly every 28 days at escalating dose levels of 40, 60, and 80 mg. Maximum tolerated dose and recommended phase II dose (RP2D) were assessed. RESULTS Eighteen patients were enrolled with a median age of 65 (range, 49-75) years, and pretherapy prostate-specific antigen of 259.9 ng/mL. The dose-limiting toxicities were Grade 4 hyperglycemia unresponsive to therapy and Grade 4 neutropenia lasting for > 7 days in 1 patient each occurring at the 80-mg dose level of pasireotide. The RP2D was determined at 60 mg every 28 days. Four patients at the 60 mg dose had Grade 3 or 4 hyperglycemia, which responded adequately to therapy. Median time to progression and survival were 7.2 and 18.3 months, respectively. Three of 6 patients with circulating tumor cells ≥5 converted to circulating tumor cells < 5 post therapy. The insulin like growth factor-1 levels revealed a median 51% decrease after therapy. The neuron-specific enolase and chromogranin did not show any marked change. CONCLUSION The addition of pasireotide to docetaxel and prednisone is clinically feasible at a dose level of 60 mg every 28 days. The combination showed potential for clinical efficacy but needs to be compared with the standard docetaxel and prednisone regimen.
Collapse
|
76
|
Butler AM, Cetin K, Hernandez RK, Diane Reams B, Overman RA, I Kim J, Hirsch BR, Abernethy AP, Liede A, Alan Brookhart M. Treatment dynamics of bone-targeting agents among men with bone metastases from prostate cancer in the United States. Pharmacoepidemiol Drug Saf 2018; 27:229-238. [PMID: 29316026 DOI: 10.1002/pds.4360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/06/2017] [Accepted: 10/26/2017] [Indexed: 11/07/2022]
Abstract
PURPOSE To examine the dynamics of treatment with 2 bone-targeting agents (BTAs)-denosumab and zoledronic acid-among men with bone metastases from prostate cancer. METHODS Using electronic health record data from oncology practices across the US, we identified prostate cancer patients diagnosed with bone metastasis in 2012/2013 without evidence of BTA use within 6 months prior to diagnosis. We examined the risk and predictors of BTA initiation, interruption, and re-initiation. RESULTS Among 897 men diagnosed with prostate cancer, the cumulative incidence of BTA initiation after bone metastasis diagnosis was 34% (95% confidence interval [CI], 31-37%) at 30 days, 64% (95% CI, 61-68%) at 180 days, and 88% (95% CI, 85-91%) at 2 years. Denosumab was initiated more frequently than zoledronic acid. Men with diabetes, more bone lesions, history of androgen deprivation therapy, or no hospice enrollment were more likely to initiate treatment. Following initiation, the cumulative incidence of treatment interruption was 17% (95% CI, 14-19%) at 60 days and 70% (95% CI, 66-74%) at 2 years, with interruption more likely among patients receiving emerging therapies for prostate cancer or enrolling in hospice. The cumulative incidence of re-initiation following interruption was 36.3% (95% CI, 32.7-40.2%) at 15 days, 49.8% (95% CI, 45.9-54.1%) at 30 days, and 81.0% (95% CI, 77.5-84.7%) at 1 year. CONCLUSIONS Bone-targeting agent therapy is initiated by the majority of men living with bone metastases following a prostate cancer diagnosis; however, the timing of initiation is highly variable. Once on treatment, gaps or interruptions in therapy are common.
Collapse
Affiliation(s)
- Anne M Butler
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Karynsa Cetin
- Amgen, Inc., Thousand Oaks and South San Francisco, CA, USA
| | | | - B Diane Reams
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert A Overman
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Jung I Kim
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | - M Alan Brookhart
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
77
|
Zhang Y, Mai H, Guo G, Bi G, Hao G, Li Y, Wang X, Cheng L, Wang J, Dong R, Liu Z, Chen L, Qu H. Association analysis of SNPs present in plasma with adverse events and population pharmacokinetics in Chinese sunitinib treated patients with renal cell carcinoma. Oncotarget 2018; 9:14109-14123. [PMID: 29581831 PMCID: PMC5865657 DOI: 10.18632/oncotarget.23881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 11/11/2017] [Indexed: 12/16/2022] Open
Abstract
Background Sunitinib is a tyrosine kinase inhibitor with effective therapeutic outcomes in patients with renal-cell carcinoma. The study were to analyze the association of single-nucleotide polymorphisms present in cell-free DNA and pharmacokinetics with sunitinib treatment-emergent adverse events in Chinese patients with renal-cell carcinoma. Materials and Methods We genotyped 8 keys SNPs in 6 candidate genes. The plasma concentrations of sunitinib and N-desethyl sunitinib were measured using a high performance liquid chromatography-tandam mass spectrometry method. Correlations between the single-nucleotide polymorphisms and adverse events were investigated by univariate and multivariate logistic regression and we quantitatively evaluated the effect of single-nucleotide polymorphisms on the pharmacokinetics of sunitinib by using a population PK model. Results Necessary dose reductions of sunitinib were significantly correlated with SNP rs1933437 in FLT3. A higher severity of AEs were collected with SNP rs2032582 in ABCB1 and rs1800812 in PDGFRα. Thrombocytopenia was collected with rs1800812 in PDGFRα. Our study provides a population PK model of sunitinib with the ABCB1 genotype as a predictive covariate for apparent oral clearance. Conclusions Our study preliminarily confirmed the hypothesis that the pharmacokinetics of sunitinib is affected by the SNPs of enzyme in Chinese renal-cell carcinoma patients, and this affects the different distribution and severity of adverse events of sunitinib.
Collapse
Affiliation(s)
- Yuanyuan Zhang
- Department of Clinical Pharmacology, Academy of Military Medical Sciences Affiliated Hospital, 307 Clinical College, Anhui Medical University, Beijing 100071, China
| | - Haixing Mai
- Department of Urology Department, Academy of Military Medical Sciences Affiliated Hospital, Beijing 100071, China
| | - Gang Guo
- Department of Urology Department, The General Hospital of the People's Liberation Army, Beijing 100853, China
| | - Guofang Bi
- Department of Clinical Pharmacology, Academy of Military Medical Sciences Affiliated Hospital, 307 Clinical College, Anhui Medical University, Beijing 100071, China
| | - Guangtao Hao
- Department of Clinical Pharmacology, Academy of Military Medical Sciences Affiliated Hospital, 307 Clinical College, Anhui Medical University, Beijing 100071, China
| | - Yuanyuan Li
- Department of Clinical Pharmacology, Academy of Military Medical Sciences Affiliated Hospital, 307 Clinical College, Anhui Medical University, Beijing 100071, China
| | - Xiaofang Wang
- Department of Clinical Pharmacology, Academy of Military Medical Sciences Affiliated Hospital, 307 Clinical College, Anhui Medical University, Beijing 100071, China
| | - Longmei Cheng
- Department of Clinical Pharmacology, Academy of Military Medical Sciences Affiliated Hospital, 307 Clinical College, Anhui Medical University, Beijing 100071, China
| | - Jing Wang
- Department of Clinical Pharmacology, Academy of Military Medical Sciences Affiliated Hospital, 307 Clinical College, Anhui Medical University, Beijing 100071, China
| | - Ruihua Dong
- Department of Clinical Pharmacology, Academy of Military Medical Sciences Affiliated Hospital, 307 Clinical College, Anhui Medical University, Beijing 100071, China
| | - Zeyuan Liu
- Department of Clinical Pharmacology, Academy of Military Medical Sciences Affiliated Hospital, 307 Clinical College, Anhui Medical University, Beijing 100071, China
| | - Lijun Chen
- Department of Urology Department, Academy of Military Medical Sciences Affiliated Hospital, Beijing 100071, China
| | - Hengyan Qu
- Department of Clinical Pharmacology, Academy of Military Medical Sciences Affiliated Hospital, 307 Clinical College, Anhui Medical University, Beijing 100071, China
| |
Collapse
|
78
|
Parker C, Heidenreich A, Nilsson S, Shore N. Current approaches to incorporation of radium-223 in clinical practice. Prostate Cancer Prostatic Dis 2018; 21:37-47. [PMID: 29298991 PMCID: PMC5895600 DOI: 10.1038/s41391-017-0020-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/16/2017] [Indexed: 12/03/2022]
Abstract
Background Treatment options for metastatic castration-resistant prostate cancer (mCRPC) have expanded in recent years and include cytotoxic agents (e.g., docetaxel and cabazitaxel), immunotherapy (e.g., sipuleucel-T), oral hormonal therapies targeting the androgen receptor axis (e.g., enzalutamide and abiraterone), and targeted alpha therapy (e.g., radium-223 dichloride (radium-223)). Although treatment guidelines have been updated to reflect the availability of new agents, it is not easy to apply them in daily clinical practice because recommendations vary depending on patient comorbidities and disease characteristics. Furthermore, therapeutic accessibility, clinical judgment, and experience affect the selection of treatment options. Methods In this review, we provide practical guidance for the integration of radium-223 into the management of patients with mCRPC based on our collective clinical experience, as well as the available clinical trial data. Results Radium-223 is a targeted alpha therapy; as a bone-seeking calcium mimetic, it accumulates in hydroxyapatite areas surrounding tumor lesions and selectively binds to the areas of increased bone turnover. Radium-223 prolongs overall survival and delays time to the first symptomatic skeletal events in men with mCRPC, and is indicated for the treatment of patients with CRPC, symptomatic bone metastases, and no known visceral metastases. We review its clinical efficacy and safety, practical guidance on identifying the appropriate patient, and recommendations for how best to educate and inform prospective patients regarding their treatment decision making. In addition, we review recent evidence for sequential and combination therapies with radium-223, provide our experiences with these treatment approaches, and discuss their implications for the future treatment of patients with mCRPC. Conclusions Based on our clinical experience, radium-223 should be considered relatively early in the treatment course in patients with mCRPC with bone metastases. Coordination of care among multidisciplinary team members, patients, and caregivers is essential for optimizing safe and effective treatment with all CRPC therapies.
Collapse
Affiliation(s)
- Chris Parker
- The Institute of Cancer Research, London, UK. .,The Royal Marsden NHS Foundation Trust, London, UK.
| | | | | | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| |
Collapse
|
79
|
Trabulsi EJ, Jassak P, Tang H, Hwang S, Salinas GD. Therapeutic Patterns and Barriers to the Treatment of Advanced Prostate Cancer: A Survey of Academic and Community Urologists in the United States. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Edouard J. Trabulsi
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Astellas Pharma Global Development, Medical Affairs Americas, Northbrook, Illinois
- CE Outcomes, Birmingham, Alabama
| | - Patricia Jassak
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Astellas Pharma Global Development, Medical Affairs Americas, Northbrook, Illinois
- CE Outcomes, Birmingham, Alabama
| | - Hong Tang
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Astellas Pharma Global Development, Medical Affairs Americas, Northbrook, Illinois
- CE Outcomes, Birmingham, Alabama
| | - Sharon Hwang
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Astellas Pharma Global Development, Medical Affairs Americas, Northbrook, Illinois
- CE Outcomes, Birmingham, Alabama
| | - Gregory D. Salinas
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Astellas Pharma Global Development, Medical Affairs Americas, Northbrook, Illinois
- CE Outcomes, Birmingham, Alabama
| |
Collapse
|
80
|
Moeller A, Cookson M, Patel SG. Metastatic Castrate-Resistant Prostate Cancer Practical Review. PHYSICIAN ASSISTANT CLINICS 2018. [DOI: 10.1016/j.cpha.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
81
|
Affiliation(s)
- John C. Henegan
- Division of Hematology and Oncology, Department of Medicine, University of Mississippi Cancer Center, Jackson, MS, USA
| | - Guru Sonpavde
- Department of Medical Oncology, GU section, Dana Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
82
|
Androgen receptor targeted therapies in metastatic castration-resistant prostate cancer – The urologists' perspective. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2017.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
83
|
Norum J, Nieder C. Treatments for Metastatic Prostate Cancer (mPC): A Review of Costing Evidence. PHARMACOECONOMICS 2017; 35:1223-1236. [PMID: 28756597 DOI: 10.1007/s40273-017-0555-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Prostate cancer (PC) is the most common cancer in Western countries. More than one third of PC patients develop metastatic disease, and the 5-year expected survival in distant disease is about 35%. During the last few years, new treatments have been launched for metastatic castrate-resistant prostate cancer (mCRPC). OBJECTIVES We aimed to review the current literature on health economic analysis on the treatment of metastatic prostate cancer (mPC), compare the studies, summarize the findings and make the results available to administrators and decision makers. METHODS A systematic literature search was done for economic evaluations (cost-minimization, cost-effectiveness, cost-utility, cost-of-illness, cost-of-drug, and cost-benefit analyses). We employed the PubMed® search engine and searched for publications published between 2012 and 2016. The terms used were "prostate cancer", "metastatic" and "cost". An initial screening of all headlines was performed, selected abstracts were analysed, and finally the full papers investigated. Study characteristics, treatment and comparator, country, type of evaluation, perspective, year of value, time horizon, efficacy data, discount rate, total costs and sensitivity analysis were analysed. The quality was assessed using the Quality of Health Economic Studies (QHES) instrument. RESULTS A total of 227 publications were detected and screened, 58 selected for full-text assessment and 31 included in the final analyses. Despite the significant international literature on the treatment of mCRPC, there were only 15 studies focusing on cost-effectiveness analysis (CEA). Medical treatment constituted two thirds of the selected studies. Significant costs in the treatment of mCRPC were disclosed. In the pre-docetaxel setting, both abiraterone acetate (AA) and enzalutamide were concluded beyond accepted cost/quality-adjusted life year limits. In the docetaxel refractory setting, most studies concluded that enzalutamide was cost-effective and superior to AA. In most studies, cabazitaxel was not recommended, because of high cost. Looking at bone-targeting drugs, generic zoledronic acid (ZA) was recommended. External beam radiotherapy (EBRT) was analysed in three studies, and single fraction radiotherapy was concluded to be cost saving. Radium-223 was documented as beneficial, but costly. The quality of the studies was generally good, but sensitivity analyses, discounting and the measurement of health outcomes were present in less than two thirds of the selected studies. CONCLUSIONS The treatment of mCRPC was associated with significant cost. In the post-docetaxel setting, single fraction radiotherapy and enzalutamide were considered cost-effective in most studies. Generic ZA was the recommended bone-targeting therapy.
Collapse
Affiliation(s)
- Jan Norum
- Department of Surgery, Finnmark Hospital Trust, 9600, Hammerfest, Norway.
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, 9037, Tromsø, Norway.
| | - Carsten Nieder
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, 9037, Tromsø, Norway
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway
| |
Collapse
|
84
|
Optimal usage of radium-223 in metastatic castration-resistant prostate cancer. J Formos Med Assoc 2017; 116:825-836. [PMID: 29046247 DOI: 10.1016/j.jfma.2017.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/10/2017] [Accepted: 04/11/2017] [Indexed: 11/21/2022] Open
Abstract
Radium-223 is a first-in-class α-emitting radiopharmaceutical that targets bone metastases associated with metastatic castration-resistant prostate cancer (mCRPC). In the pivotal phase III trial ALSYMPCA, radium-223 significantly increased overall survival (OS), compared with placebo (median 14.9 vs 11.3 months; hazard ratio 0.70; 95% CI 0.58-0.83; p < 0.001), in patients with mCRPC and symptomatic bone metastases-with a comparable safety profile. To optimize treatment outcomes, selection of appropriate patients is important. As well as osteoblastic bone metastases, mCRPC patients should be well enough to receive six doses of radium-223 as this treatment duration has been shown to greatly improve OS outcomes compared with administration of four or fewer doses. Additionally, alkaline phosphatase and lactate dehydrogenase are emerging as important biomarkers during radium-223 treatment. Optimal concomitant standard-of-care therapies (such as abiraterone or enzalutamide) to be administered with radium-223 have yet to be defined as does the most efficacious dose and duration of radium-223 treatment. In conclusion, radium-223 is an important addition to the mCRPC treatment landscape and marks a paradigm shift in the treatment of bone metastases.
Collapse
|
85
|
Phase 2 Study of Weekly Paclitaxel Plus Estramustine in Metastatic Hormone-Refractory Prostate Carcinoma: ECOG-ACRIN Cancer Research Group (E1898) Trial. Clin Genitourin Cancer 2017; 16:e315-e322. [PMID: 29173976 DOI: 10.1016/j.clgc.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/30/2017] [Accepted: 10/09/2017] [Indexed: 01/14/2023]
Abstract
INTRODUCTION This multicenter phase 2 study assessed the combination of estramustine and weekly paclitaxel with metastatic castration-resistant prostate cancer (CRPC). PATIENTS AND METHODS We enrolled 77 patients who had received no prior chemotherapy for CRPC between 1998 and 2000; a total of 74 subjects were eligible for the study. Each 8-week cycle included paclitaxel 90 mg/m2 provided intravenously weekly for 6 weeks, followed by 2 weeks off therapy and oral estramustine 280 mg twice daily for 3 days beginning 24 hours before the first dose of paclitaxel. The primary end point was rate of objective or prostate-specific antigen (PSA) response at 16 weeks. A 50% response rate was considered of further interest. RESULTS Eligible patients received a median of 3 cycles (range, 1-10 cycles). The response rate among patients with measurable disease was 34% (95% confidence interval [CI], 19-52). The PSA response rate was 58% (95% CI, 47-70). Clinical benefit rate was 45% (95% CI, 33-57). The median progression-free survival was 5.9 months (95% CI, 4.4-6.7). The median overall survival was 17.6 months (95% CI, 14.6-20.8). The most common clinical grade 3/4 toxicities were fatigue (14%) and sensory neuropathy (7%). Grade 3/4 hematologic toxicities included lymphopenia (21%) and anemia (9%). There was one toxicity-related death. Quality-of-life scores improved by week 8, but the change was not statistically significant. CONCLUSION The combination has activity defined by PSA declines in CRPC but did not meet the protocol-specified end point for efficacy as defined by objective response rate. Since this study was conducted, more effective, better-tolerated regimens have been developed.
Collapse
|
86
|
Falchook AD, Dusetzina SB, Tian F, Basak R, Selvam N, Chen RC. Aggressive End-of-Life Care for Metastatic Cancer Patients Younger Than Age 65 Years. J Natl Cancer Inst 2017; 109:3852625. [PMID: 28954284 DOI: 10.1093/jnci/djx028] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background Aggressive medical care at the end of life can be harmful to patients and families, but its prevalence in use among younger cancer patients is unknown. The goal of the study was to report on the use of aggressive care and hospice services for patients younger than age 65 years. Methods Using the HealthCore Integrated Research Database, we analyzed patients who died between 2007 and 2014 with metastatic lung (n = 12 764), colorectal (n = 5207), breast (n = 5855), pancreatic (n = 3397), or prostate (n = 1508) cancer. Based on published quality measures, we assessed uses of chemotherapy, intensive care, emergency room visits, and hospice care at the end of life. We examined additional items including radiotherapy, invasive procedures, hospitalization, and in-hospital deaths. Multivariable modified Poisson regression models were used to adjust for age, sex, geographic region, rural/urban location, year of death, and regional education and income measures. Results Across the five cancers, 10.1% to 14.1% of patients received chemotherapy within the last 14 days of life, 15.9% to 20.6% received intensive care in last 30 days, and 1.5% to 2.5% went to the emergency room two or more times in last 30 days. Hospice enrollment at least three days before death was 54.4% to 59.6%. However, 55.3% to 59.3% of patients had a hospital admission in the last 30 days, and one-third died (30.3%-35.4%) in the hospital. Conclusions There was low use of cancer-directed treatment at the end of life for younger cancer patients, and hospice use was higher than 50%. However, there was a relatively high utilization of hospital-based care. These results demonstrate an opportunity for continued improvements in the provision of high-value, patient-centered care at the end of life.
Collapse
Affiliation(s)
- Aaron D Falchook
- Department of Radiation Oncology, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Lineberger Comprehensive Cancer Center, Department of Health Policy and Management, Gillings School of Global Public Health, and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; HealthCore, Inc., Alexandria, VA
| | - Stacie B Dusetzina
- Department of Radiation Oncology, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Lineberger Comprehensive Cancer Center, Department of Health Policy and Management, Gillings School of Global Public Health, and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; HealthCore, Inc., Alexandria, VA
| | - Fang Tian
- Department of Radiation Oncology, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Lineberger Comprehensive Cancer Center, Department of Health Policy and Management, Gillings School of Global Public Health, and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; HealthCore, Inc., Alexandria, VA
| | - Ramsankar Basak
- Department of Radiation Oncology, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Lineberger Comprehensive Cancer Center, Department of Health Policy and Management, Gillings School of Global Public Health, and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; HealthCore, Inc., Alexandria, VA
| | - Nandini Selvam
- Department of Radiation Oncology, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Lineberger Comprehensive Cancer Center, Department of Health Policy and Management, Gillings School of Global Public Health, and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; HealthCore, Inc., Alexandria, VA
| | - Ronald C Chen
- Department of Radiation Oncology, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Lineberger Comprehensive Cancer Center, Department of Health Policy and Management, Gillings School of Global Public Health, and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; HealthCore, Inc., Alexandria, VA
| |
Collapse
|
87
|
Simpson A, Petnga W, Macaulay VM, Weyer-Czernilofsky U, Bogenrieder T. Insulin-Like Growth Factor (IGF) Pathway Targeting in Cancer: Role of the IGF Axis and Opportunities for Future Combination Studies. Target Oncol 2017; 12:571-597. [PMID: 28815409 PMCID: PMC5610669 DOI: 10.1007/s11523-017-0514-5] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite a strong preclinical rationale for targeting the insulin-like growth factor (IGF) axis in cancer, clinical studies of IGF-1 receptor (IGF-1R)-targeted monotherapies have been largely disappointing, and any potential success has been limited by the lack of validated predictive biomarkers for patient enrichment. A large body of preclinical evidence suggests that the key role of the IGF axis in cancer is in driving treatment resistance, via general proliferative/survival mechanisms, interactions with other mitogenic signaling networks, and class-specific mechanisms such as DNA damage repair. Consequently, combining IGF-targeted agents with standard cytotoxic agents, other targeted agents, endocrine therapies, or immunotherapies represents an attractive therapeutic approach. Anti-IGF-1R monoclonal antibodies (mAbs) do not inhibit IGF ligand 2 (IGF-2) activation of the insulin receptor isoform-A (INSR-A), which may limit their anti-proliferative activity. In addition, due to their lack of specificity, IGF-1R tyrosine kinase inhibitors are associated with hyperglycemia as a result of interference with signaling through the classical metabolic INSR-B isoform; this may preclude their use at clinically effective doses. Conversely, IGF-1/IGF-2 ligand-neutralizing mAbs inhibit proliferative/anti-apoptotic signaling via IGF-1R and INSR-A, without compromising the metabolic function of INSR-B. Therefore, combination regimens that include these agents may be more efficacious and tolerable versus IGF-1R-targeted combinations. Herein, we review the preclinical and clinical experience with IGF-targeted therapies to-date, and discuss the rationale for future combination approaches as a means to overcome treatment resistance.
Collapse
Affiliation(s)
- Aaron Simpson
- Department of Oncology, University of Oxford, Oxford, UK
| | | | | | | | - Thomas Bogenrieder
- Boehringer Ingelheim RCV, Dr. Boehringer Gasse 5-11, 1121, Vienna, Austria.
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
| |
Collapse
|
88
|
Du Y, Carrio I, De Vincentis G, Fanti S, Ilhan H, Mommsen C, Nitzsche E, Sundram F, Vogel W, Oyen W, Lewington V. Practical recommendations for radium-223 treatment of metastatic castration-resistant prostate cancer. Eur J Nucl Med Mol Imaging 2017; 44:1671-1678. [PMID: 28631036 PMCID: PMC5537325 DOI: 10.1007/s00259-017-3756-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Radium Ra 223 dichloride (radium-223, Xofigo®) is the first targeted alpha therapy for patients with castration-resistant prostate cancer and symptomatic bone metastases. Radium-223 provides a new treatment option for this setting, but also necessitates a new treatment management approach. We provide straightforward and practical recommendations for European nuclear medicine centres to optimize radium-223 service provision. METHODS An independent research consultancy agency observed radium-223 procedures and conducted interviews with all key staff members involved in radium-223 treatment delivery in 11 nuclear medicine centres across six countries (Germany, Italy, the Netherlands, Spain, Switzerland and the UK) experienced in administering radium-223. The findings were collated and discussed at a meeting of experts from these centres, during which key consensus recommendations were defined. RESULTS The recommendations cover centre organization and preparation; patient referral; radium-223 ordering, preparation and disposal; radium-223 treatment delivery/administration; and patient experience. Guidance includes structured coordination and communication within centres and multidisciplinary teams, focusing on sharing best practice to provide high-quality, patient-centred care throughout the treatment pathway. CONCLUSIONS These expert recommendations are intended to complement existing management guidelines. Sharing best practice and experience will help nuclear medicine centres to optimize radium-223 service provision and improve patient care.
Collapse
Affiliation(s)
- Yong Du
- Department of Nuclear Medicine & PET/CT, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
| | | | | | | | - Harun Ilhan
- Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Caroline Mommsen
- Praxis für diagnostische und therapeutische Nuklearmedizin Berlin, Berlin, Germany
| | | | - Francis Sundram
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Wouter Vogel
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Wim Oyen
- Department of Nuclear Medicine & PET/CT, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
- The Institute of Cancer Research, London, UK
| | - Val Lewington
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
89
|
Salem S, Komisarenko M, Timilshina N, Martin L, Grewal R, Alibhai S, Finelli A. Impact of Abiraterone Acetate and Enzalutamide on Symptom Burden of Patients with Chemotherapy-naive Metastatic Castration-resistant Prostate Cancer. Clin Oncol (R Coll Radiol) 2017; 29:601-608. [DOI: 10.1016/j.clon.2017.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/06/2017] [Accepted: 03/15/2017] [Indexed: 11/25/2022]
|
90
|
Siemens DR, Klotz L, Heidenreich A, Chowdhury S, Villers A, Baron B, van Os S, Hasabou N, Wang F, Lin P, Shore ND. Efficacy and Safety of Enzalutamide vs Bicalutamide in Younger and Older Patients with Metastatic Castration Resistant Prostate Cancer in the TERRAIN Trial. J Urol 2017; 199:147-154. [PMID: 28827103 DOI: 10.1016/j.juro.2017.08.080] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Enzalutamide significantly prolonged median progression-free survival vs bicalutamide in chemotherapy naïve men with metastatic castration resistant prostate cancer in the TERRAIN (Enzalutamide versus Bicalutamide in Castrate Men with Metastatic Prostate Cancer) trial. In this post hoc analysis we investigated the influence of age on the efficacy and safety of enzalutamide vs bicalutamide in this population. MATERIALS AND METHODS Patients were randomized 1:1 to enzalutamide 160 mg per day or bicalutamide 50 mg per day. Progression-free survival, time to prostate specific antigen progression and safety were analyzed post hoc in younger (age less than 75 years) and older (age 75 years or greater) subgroups. RESULTS Enzalutamide significantly reduced the risk of disease progression or death vs bicalutamide in patients younger than 75 years (HR 0.38, 95% CI 0.27-0.52, p <0.0001) and 75 years old or older (HR 0.59, 95% CI 0.37-0.92, p = 0.018). Time to prostate specific antigen progression was also significantly prolonged with enzalutamide vs bicalutamide in each subgroup. The adverse event distribution between treatments was similar in each subgroup except for more (5% or greater difference between subgroups) atrial fibrillation, urinary tract infections, falls and decreased appetite as well as less extremity pain and hot flushing in enzalutamide treated patients 75 years old or older, and less back pain and hot flushing in bicalutamide treated patients 75 years old or older. Grade 3 or greater cardiac events were more frequent in enzalutamide treated and bicalutamide treated patients who were 75 years old or older vs younger than 75 years. Fatigue was more frequent in enzalutamide treated patients with a similar distribution in each age subgroup. CONCLUSIONS Enzalutamide improved clinical outcomes vs bicalutamide irrespective of age. Increased falls and cardiac events suggest caution when prescribing to older patients (age 75 years or greater) with significant comorbidity.
Collapse
Affiliation(s)
- D Robert Siemens
- Centre for Applied Urological Research, Queen's University, Kingston, Ontario, Canada.
| | - Laurence Klotz
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Simon Chowdhury
- Guy's, King's and St Thomas' Hospitals, London, United Kingdom
| | | | | | | | | | - Fong Wang
- Medivation, Inc., which was acquired by Pfizer, Inc. in September 2016, San Francisco, California, USA
| | - Ping Lin
- Medivation, Inc., which was acquired by Pfizer, Inc. in September 2016, San Francisco, California, USA
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, South Carolina, USA
| |
Collapse
|
91
|
Hematologic Toxicity of Concurrent Administration of Radium-223 and Next-generation Antiandrogen Therapies. Am J Clin Oncol 2017; 40:342-347. [PMID: 25723740 DOI: 10.1097/coc.0000000000000181] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE/OBJECTIVES Radium-223 is a first-in-class radiopharmaceutical recently approved for the treatment of castration-resistant prostate cancer in patients with symptomatic bone metastases. Initial studies investigating Radium-223 primarily used nonsteroidal first-generation antiandrogens. Since that time, newer antiandrogen therapies have demonstrated improved survival in patients with castration-resistant prostate cancer. It has been suggested that the rational combination of these newly approved agents with Radium-223 may lead to improved response rates and clinical outcomes. Currently, there is lack of information regarding the safety of concurrent administration of these agents with radiopharmaceuticals. Here, we report on hematologic toxicity findings from our institution in patients receiving concurrent Radium-223 and next-generation antiandrogen therapies with either enzalutamide or abiraterone. MATERIALS/METHODS In a retrospective study, we analyzed patients who received Radium-223 as part of an early-access trial, and following FDA approval in May 2013, patients receiving Radium-223 as part of standard care. Radium-223 was given at standard dosing of 50 kBq/kg each month for 6 total cycles. Complete blood counts were performed before treatment monthly and following each injection. Blood counts from patients receiving Radium alone and concurrently with next-generation antiandrogens were compared. To date, 25 total patients were analyzed, with a median of 5 monthly doses received per patient. Fourteen patients received concurrent therapy during monthly Radium-223 with either enzalutamide (n=8) or abiraterone (n=6). RESULTS Six patients expired due to disease progression. Two patients discontinued treatment due to grade 3 myelosuppression. For patients receiving either Radium alone and with concurrent next-generation antiandrogen therapy, there did not appear to be any statistically significant differences between initial and nadir blood counts. Mean change from initial neutrophil count to nadir was 1.9×10/L in patients receiving Radium alone, versus 2.3×10/L in patients receiving concurrent therapy (P=0.77). Mean change from initial hemoglobin value to nadir was 1.5 g/L in patients receiving Radium alone, versus 1.8 g/L in patients receiving concurrent therapy (P=0.31). Mean change from initial platelet count to nadir was 52.3×10 cells/L in patients receiving Radium alone versus 70.6×10 cells/L in patients receiving concurrent therapy (P=0.39). Individual blood counts for each measured laboratory are included in the supplemental data. PSA was stable or decreased in 22% of patients receiving Radium alone versus 35% of patients receiving combination treatment (P=0.24). CONCLUSIONS Concurrent administration of Radium-223 and next-generation antiandrogen therapies appears to be well tolerated with similar toxicities to standard administration of Radium-223 alone. This particular cohort of patients represents a high-risk, heavily pretreated group of patients with advanced metastatic disease and significant marrow burden. Despite these risk factors, hematologic toxicity was modest and was in the range expected for this risk group based on previous trials. To date, this is the first study investigating the toxicity of combination treatment. Further studies investigating the safety and efficacy of combination treatments are warranted.
Collapse
|
92
|
Shore N, Heidenreich A, Saad F. Predicting Response and Recognizing Resistance: Improving Outcomes in Patients With Castration-resistant Prostate Cancer. Urology 2017; 109:6-18. [PMID: 28797685 DOI: 10.1016/j.urology.2017.04.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 11/19/2022]
Abstract
Optimal sequencing strategies for approved agents in metastatic castration-resistant prostate cancer (mCRPC) are unclear. Retrospective clinical studies suggest cross-resistance between specific therapies. This review assesses treatment decisions for mCRPC. Increased use of chemohormonal therapy in castration-sensitive disease may affect subsequent treatment decisions in mCRPC. Initial abiraterone or enzalutamide treatment may result in cross-resistance for subsequent androgen receptor-targeted therapy. Clinical responses may be seen in both docetaxel- and cabazitaxel-treated patients progressing after treatment with abiraterone or enzalutamide. These observations are supported by proposed resistance mechanisms. In conclusion, small, retrospective studies suggest cross-resistance between specific therapies in mCRPC. Larger prospective studies are required.
Collapse
Affiliation(s)
- Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC.
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Reconstructive Urological Surgery, University Hospital of Cologne, Cologne, Germany
| | - Fred Saad
- Department of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
93
|
Caram ME, Borza T, Min HS, Griggs JJ, Miller DC, Hollenbeck BK, Mukherjee B, Skolarus TA. Early National Dissemination of Abiraterone and Enzalutamide for Advanced Prostate Cancer in Medicare Part D. J Oncol Pract 2017; 13:e694-e702. [PMID: 28628393 PMCID: PMC5555032 DOI: 10.1200/jop.2016.020206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Abiraterone and enzalutamide were approved by the Food and Drug Administration in 2011 and 2012 to treat men with metastatic castration-resistant prostate cancer (mCRPC). Most men with mCRPC are > 65 years of age and thus eligible for Medicare Part D. We conducted a study to better understand the early dissemination of these drugs across the United States using national Medicare Part D data. METHODS We evaluated the number of prescriptions for abiraterone and enzalutamide by provider specialty and hospital referral region (HRR) using Medicare Part D and Dartmouth Atlas data. We categorized HRRs by abiraterone and enzalutamide prescriptions, adjusted for prostate cancer incidence, and examined factors associated with regional variation using multilevel regression models. RESULTS Among providers who wrote the majority of prescriptions for abiraterone or enzalutamide in 2013 (n = 2,121), 87.5% were medical oncologists, 3.3% were urologists, and 9.2% were other provider specialties. Among prescribers, approximately 30% were responsible for three quarters of the claims for abiraterone and 20% were responsible for more than half the claims for enzalutamide. Some HRRs demonstrated low-prescribing rates despite average medical oncology and urology physician workforce density. Our multilevel model demonstrated that regional factors potentially influenced variation in care. CONCLUSION The majority of prescriptions written for abiraterone and enzalutamide through Medicare Part D in 2013 were written by a minority of providers, with marked regional variation across the United States. Better understanding of the early national dissemination of these effective but expensive drugs can help inform strategies to optimize introduction of new, evidence-based mCRPC treatments.
Collapse
Affiliation(s)
- Megan E.V. Caram
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Tudor Borza
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Hye-Sung Min
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jennifer J. Griggs
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - David C. Miller
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | | | - Bhramar Mukherjee
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Ted A. Skolarus
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI
| |
Collapse
|
94
|
Gross ME, Dorff TB, Quinn DI, Diaz PM, Castellanos OO, Agus DB. Safety and Efficacy of Docetaxel, Bevacizumab, and Everolimus for Castration-resistant Prostate Cancer (CRPC). Clin Genitourin Cancer 2017; 16:S1558-7673(17)30200-8. [PMID: 28826933 PMCID: PMC7444943 DOI: 10.1016/j.clgc.2017.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/16/2017] [Accepted: 07/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous data suggests that co-targeting mammalian target of rapamycin and angiogenic pathways may potentiate effects of cytotoxic chemotherapy. We studied combining mammalian target of rapamycin and vascular endothelial growth factor inhibition with docetaxel in castrate-resistant prostate cancer (CRPC). METHODS Eligible patients had progressive, metastatic, chemotherapy-naive CRPC. Docetaxel and bevacizumab were given intravenously day 1 with everolimus orally daily on a 21-day cycle across 3 dose levels (75:15:2.5, 75:15:5, and 65:15:5; docetaxel mg/m2, mg/kg bevacizumab, and mg everolimus, respectively). Maintenance therapy with bevacizumab/everolimus without docetaxel was allowed after ≥ 6 cycles. RESULTS Forty-three subjects were treated across all dose levels. Maximal tolerated doses for the combined therapies observed in the phase 1B portion of the trial were: docetaxel 75 mg/m2, bevacizumab 15 mg/kg, and everolimus 2.5 mg. Maximal prostate-specific antigen decline ≥ 30% and ≥ 50% was achieved in 33 (79%) and 31 (74%) of patients, respectively. Best response by modified Response Evaluation Criteria In Solid Tumors criteria in 25 subjects with measurable disease at baseline included complete or partial response in 20 (80%) patients. The median progression-free and overall survival were 8.9 months (95% confidence interval, 7.4-10.6 months) and 21.9 months (95% confidence interval, 18.4-30.3 months), respectively. Hematologic toxicities were the most common treatment-related grade ≥ 3 adverse events including: febrile neutropenia (12; 28%), lymphopenia (12; 28%), leukocytes (10; 23%), neutrophils (9; 21%), and hemoglobin (2; 5%). Nonhematologic grade ≥ 3 adverse events included: hypertension (8; 19%), fatigue (3; 7%), pneumonia (3; 7%), and mucositis (4; 5%). There was 1 treatment-related death owing to neutropenic fever and pneumonia in a patient treated at dose level 3 despite dose modifications and prophylactic growth factor support. CONCLUSIONS Docetaxel, bevacizumab, and everolimus can be safely administered in CRPC and demonstrate a significant level of anticancer activity, meeting the predetermined response criteria. However, any potential benefit of combined therapy must be balanced against increased risk for toxicities. Our results do not support the hypothesis that this combination of agents improves upon the results obtained with docetaxel monotherapy in an unselected population of chemotherapy-naive patients with CRPC.
Collapse
Affiliation(s)
- Mitchell E Gross
- Lawrence J. Ellison Institute for Transformative Medicine, University of Southern California, Los Angeles, CA; Department of Medicine/Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Tanya B Dorff
- Department of Medicine/Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA; USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David I Quinn
- Department of Medicine/Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA; USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Patricia M Diaz
- Department of Medicine/Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Olga O Castellanos
- Department of Medicine/Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David B Agus
- Lawrence J. Ellison Institute for Transformative Medicine, University of Southern California, Los Angeles, CA; Department of Medicine/Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
95
|
Vogelzang NJ. Radium-223 dichloride for the treatment of castration-resistant prostate cancer with symptomatic bone metastases. Expert Rev Clin Pharmacol 2017. [PMID: 28649893 DOI: 10.1080/17512433.2017.1345624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Castration-resistant prostate cancer (CRPC) is associated with the development of bone metastases, increased mortality, and a reduction in the patient's quality of life (QOL). The management of metastatic CRPC (mCRPC) has rapidly evolved over the past decade, with a number of available therapeutic agents improving overall survival. Radium-223 dichloride (radium-223), the first targeted alpha therapy, improves survival accompanied by QOL benefits with a favorable safety profile. It is approved in over 40 countries for the treatment of patients with CRPC with symptomatic bone metastases and no known visceral metastatic disease. Areas covered: The current management of CRPC in men with bone metastases, and in particular the role of radium-223 in this setting, is reviewed and discussed. A search of bibliographic databases for peer-reviewed literature and major meetings was conducted. Expert commentary: In treating patients with mCRPC, the best sequencing and/or combination of radium-223 with other agents has yet to be fully elucidated. The role of radium-223 in treating patients with hormone-sensitive metastatic prostate cancer who are candidates for chemotherapy should also be investigated in well-designed trials. The ability to tailor radium-223 therapy to both the clinical and genetic profiles of CRPC patients would be a promising development.
Collapse
Affiliation(s)
- Nicholas J Vogelzang
- a Division of Hematology/Oncology , Comprehensive Cancer Centers of Nevada , Las Vegas , NV , USA
| |
Collapse
|
96
|
Petrylak DP, Crawford ED. Biomarkers for the Management of Castration-Resistant Prostate Cancer: We Are Not There Yet. Target Oncol 2017; 12:401-412. [DOI: 10.1007/s11523-017-0500-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
97
|
Humeniuk MS, Zhang T, Armstrong AJ. Exploiting DNA damage without repair: The activity of platinum chemotherapy in BRCA-mutated prostate cancers. Cancer 2017; 123:3441-3444. [DOI: 10.1002/cncr.30806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Michael S. Humeniuk
- Department of Medicine; Duke University Medical Center; Durham North Carolina
| | - Tian Zhang
- Department of Medicine; Duke University Medical Center; Durham North Carolina
- Duke Cancer Institute; Durham North Carolina
| | - Andrew J. Armstrong
- Duke Cancer Institute; Durham North Carolina
- Department of Medicine, Division of Medical Oncology and Department of Surgery; Division of Urology, Duke University Medical Center; Durham North Carolina
- Department of Pharmacology and Cancer Biology; Duke University; Durham North Carolina
| |
Collapse
|
98
|
Kulkarni HR, Singh A, Schuchardt C, Niepsch K, Sayeg M, Leshch Y, Wester HJ, Baum RP. PSMA-Based Radioligand Therapy for Metastatic Castration-Resistant Prostate Cancer: The Bad Berka Experience Since 2013. J Nucl Med 2017; 57:97S-104S. [PMID: 27694180 DOI: 10.2967/jnumed.115.170167] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 08/22/2016] [Indexed: 11/16/2022] Open
Abstract
A potential milestone in personalized nuclear medicine is theranostics of metastatic castration-resistant prostate cancer (mCRPC) based on molecular imaging using PET/CT with 68Ga-labeled prostate-specific membrane antigen (PSMA) ligands and molecular radiotherapy using PSMA-targeted radioligand therapy (PRLT) with 177Lu-PSMA ligands. 68Ga-PSMA PET/CT enables accurate detection of mCRPC lesions with high diagnostic sensitivity and specificity and provides quantitative and reproducible data that can be used to select patients for PRLT and therapeutic monitoring. Our comprehensive experience over the last 3 years using different radioligands indicates that PRLT is highly effective for the treatment of mCRPC, even in advanced cases, and potentially lends a significant benefit to overall and progression-free survival. Additionally, significant improvement in clinical symptoms and excellent palliation of pain can be achieved.
Collapse
Affiliation(s)
- Harshad R Kulkarni
- Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Aviral Singh
- Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Christiane Schuchardt
- Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Karin Niepsch
- Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Manal Sayeg
- Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Yevgeniy Leshch
- Division of Radiopharmacy, Zentralklinik Bad Berka, Bad Berka, Germany; and
| | - Hans-Juergen Wester
- Pharmaceutical Radiochemistry, Faculties of Chemistry and Medicine, Technical University Munich, Munich, Germany
| | - Richard P Baum
- Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, Bad Berka, Germany
| |
Collapse
|
99
|
Prior JO, Gillessen S, Wirth M, Dale W, Aapro M, Oyen WJ. Radiopharmaceuticals in the elderly cancer patient: Practical considerations, with a focus on prostate cancer therapy. Eur J Cancer 2017; 77:127-139. [DOI: 10.1016/j.ejca.2017.01.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/12/2017] [Accepted: 01/29/2017] [Indexed: 11/24/2022]
|
100
|
Lutetium-177-labelled anti-prostate-specific membrane antigen antibody and ligands for the treatment of metastatic castrate-resistant prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2017; 20:352-360. [DOI: 10.1038/pcan.2017.23] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/04/2017] [Accepted: 03/16/2017] [Indexed: 11/08/2022]
|