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Cassinello J, Domínguez-Lubillo T, Gómez-Barrera M, Hernando T, Parra R, Asensio I, Casado MA, Moreno P. Optimal treatment sequencing of abiraterone acetate plus prednisone and enzalutamide in patients with castration-resistant metastatic prostate cancer: A systematic review and meta-analysis. Cancer Treat Rev 2021; 93:102152. [PMID: 33486302 DOI: 10.1016/j.ctrv.2020.102152] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the impact of the hormonal treatment sequencing including abiraterone acetate plus prednisone (AAP) and enzalutamide (ENZ) in mCRPC, and determine which sequence provides more benefits for patients. METHODS Studies published in English between 1 January 2013 and 30 September 2017 were identified in PubMed and EMBASE electronic databases. Studies assessing the efficacy of treatment sequences, based on AAP and ENZ, in mCRPC patients, were eligible for analysis. RESULTS Seventeen studies met the inclusion criteria. Two assessed both treatment sequences AAP → ENZ and ENZ → AAP; it was found that sequence of AAP → ENZ showed a statistically significantly longer PSA-PFS than the observed in ENZ → AAP (pooled HR: 0,54; 95% CI; 0,36-0,82; p < 0,05). The nine studies analysing Doc → AAP → ENZ sequence, revealed favourable results in terms of PFS. The 5 studies which analysed AAP → ENZ sequence, show a decrease in PSA levels ≥ 50% in 11-41% of patients treated with enzalutamide after previous treatment with AAP. In the two studies that analysed the Doc → ENZ → AAP sequence, PSA response rates were much lower than those reported with Doc → AAP → ENZ, with decreases in PSA ≥ 30 of 3-18% and PSA ≥ 50 of 8-11%. CONCLUSION Significant clinical efficacy of AAP administered as the first-line treatment in mCRPC patients followed by enzalutamide, delaying disease progression, compared with the ENZ → AAP sequence. However, more studies and randomized trials are needed, to validate the best treatment sequencing.
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Affiliation(s)
- J Cassinello
- Department of Oncology, University General Hospital of Guadalajara, Calle Donante de Sangre, S/N, 19002, Guadalajara, Spain
| | - T Domínguez-Lubillo
- Department of health economics and market access, Janssen-Cilag, Paseo Doce Estrellas 5-7, 28042 Madrid, Spain
| | - M Gómez-Barrera
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo, 4 i, 28224, Pozuelo de Alarcón, Madrid, Spain
| | - T Hernando
- Department of health economics and market access, Janssen-Cilag, Paseo Doce Estrellas 5-7, 28042 Madrid, Spain
| | - R Parra
- Department of health economics and market access, Janssen-Cilag, Paseo Doce Estrellas 5-7, 28042 Madrid, Spain
| | - I Asensio
- Department of health economics and market access, Janssen-Cilag, Paseo Doce Estrellas 5-7, 28042 Madrid, Spain
| | - M A Casado
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo, 4 i, 28224, Pozuelo de Alarcón, Madrid, Spain
| | - P Moreno
- Department of health economics and market access, Janssen-Cilag, Paseo Doce Estrellas 5-7, 28042 Madrid, Spain.
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Kuppen MCP, Westgeest HM, van den Eertwegh AJM, van Moorselaar RJA, van Oort IM, Coenen JLLM, van den Bergh ACMF, Mehra N, Somford DM, Bergman AM, Ten Bokkel Huinink D, Fossion L, Geenen MM, Hendriks MP, van de Luijtgaarden ACM, Polee MB, Weijl NI, van de Wouw AJ, de Wit R, Uyl-de Groot CA, Gerritsen WR. Real-world Outcomes of Sequential Androgen-receptor Targeting Therapies with or Without Interposed Life-prolonging Drugs in Metastatic Castration-resistant Prostate Cancer: Results from the Dutch Castration-resistant Prostate Cancer Registry. Eur Urol Oncol 2019; 4:618-627. [PMID: 31601523 DOI: 10.1016/j.euo.2019.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/20/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cross resistance between androgen-receptor targeting therapies (ARTs) (abiraterone acetate plus prednisone [ABI+P] or enzalutamide [ENZ]) for treatment of metastatic castration-resistant prostate cancer (mCRPC) may affect responses to second ART (ART2). OBJECTIVE To establish treatment duration and prostate-specific antigen (PSA) response of ART2 in real-world mCRPC patients treated with or without other life-prolonging drugs (LPDs; ie, docetaxel, cabazitaxel, or radium-223) between ART1 and ART2. DESIGN, SETTING, AND PARTICIPANTS Castration-resistant prostate cancer patients, diagnosed between 2010 and 2016 were retrospectively registered in Castration-resistant Prostate Cancer Registry (CAPRI). Patients treated with both ARTs were clustered into two subgroups: ART1>ART2 or ART1>LPD>ART2. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcomes were ≥50% PSA response and treatment duration of ART2. Descriptive statistics and binary logistic regression after multiple imputations were performed. RESULTS AND LIMITATIONS A total of 273 patients were included with a median follow-up of 8.4 mo from ART2. Patients with ART1>ART2 were older and had favourable prognostic characteristics at ART2 baseline compared with patients with ART1>LPD>ART2. No differences between ART1>ART2 and ART1>LPD>ART2 were found in PSA response and treatment duration. Multivariate analysis suggested that PSA response of ART2 was less likely in patients with visceral metastases (odds ratio [OR] 0.143, p=0.04) and more likely in patients with a relatively longer duration of androgen-deprivation treatment (OR 1.028, p=0.01) and with ABI + P before ENZ (OR 3.192, p=0.02). A major limitation of this study was missing data, a common problem in retrospective observational research. CONCLUSIONS The effect of ART2 seems to be low, with a low PSA response rate and a short treatment duration irrespective of interposed chemotherapy or radium-223, especially in patients with short time on castration, visceral disease, and ENZ before ABI+P. PATIENT SUMMARY We observed no differences in outcomes of patients treated with sequential abiraterone acetate plus prednisone (ABI+P) and enzalutamide (ENZ) with or without interposed chemotherapy or radium-223. In general, outcomes were lower than those in randomised trials, questioning the additional effect of second treatment with ABI+P or ENZ in daily practice.
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Affiliation(s)
- Malou C P Kuppen
- Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands.
| | - Hans M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | | | | | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - A C M Fons van den Bergh
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Diederik M Somford
- Department of Urology, Canisius Wilhemina Hospital, Nijmegen, The Netherlands
| | - Andre M Bergman
- Division of Internal Medicine (MOD) and Oncogenomics, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Laurent Fossion
- Department of Urology, Maxima Medical Center, Eindhoven, The Netherlands
| | - Maud M Geenen
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | - Mathijs P Hendriks
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Marco B Polee
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Nir I Weijl
- Department of Internal Medicine, MCH-Bronovo Hospital, 's-Gravenhage, The Netherlands
| | - Agnes J van de Wouw
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus MC Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
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3
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Linder S, van der Poel HG, Bergman AM, Zwart W, Prekovic S. Enzalutamide therapy for advanced prostate cancer: efficacy, resistance and beyond. Endocr Relat Cancer 2018; 26:R31-R52. [PMID: 30382692 PMCID: PMC6215909 DOI: 10.1530/erc-18-0289] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 12/20/2022]
Abstract
The androgen receptor drives the growth of metastatic castration-resistant prostate cancer. This has led to the development of multiple novel drugs targeting this hormone-regulated transcription factor, such as enzalutamide – a potent androgen receptor antagonist. Despite the plethora of possible treatment options, the absolute survival benefit of each treatment separately is limited to a few months. Therefore, current research efforts are directed to determine the optimal sequence of therapies, discover novel drugs effective in metastatic castration-resistant prostate cancer and define patient subpopulations that ultimately benefit from these treatments. Molecular studies provide evidence on which pathways mediate treatment resistance and may lead to improved treatment for metastatic castration-resistant prostate cancer. This review provides, firstly a concise overview of the clinical development, use and effectiveness of enzalutamide in the treatment of advanced prostate cancer, secondly it describes translational research addressing enzalutamide response vs resistance and lastly highlights novel potential treatment strategies in the enzalutamide-resistant setting.
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Affiliation(s)
- Simon Linder
- Division of OncogenomicsOncode Institute, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Division of UrologyThe Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Andries M Bergman
- Division of Medical OncologyThe Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of OncogenomicsThe Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wilbert Zwart
- Division of OncogenomicsOncode Institute, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Laboratory of Chemical Biology and Institute for Complex Molecular SystemsDepartment of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Stefan Prekovic
- Division of OncogenomicsOncode Institute, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Correspondence should be addressed to S Prekovic:
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Maines F, De Giorgi U, Procopio G, Facchini G, Fratino L, Sabbatini R, Gasparro D, Basso U, Mosillo C, Campadelli E, Massari F, Sava T, Sirotova S, Messina C, Scagliarini S, Conteduca V, Verzoni E, Rossetti S, Veccia A, Kinspergher S, Caffo O. Enzalutamide after chemotherapy in advanced castration-resistant prostate cancer: the Italian Named Patient Program. Future Oncol 2018; 14:2691-2699. [PMID: 30207488 DOI: 10.2217/fon-2018-0113] [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: 11/21/2022] Open
Abstract
AIM To collect efficacy and safety data of enzalutamide after docetaxel, we retrospectively evaluated the Italian Named Patient Program results. PATIENTS & METHODS Two hundred and nine metastatic castration-resistant prostate cancer patients were enrolled. Median age was 73 years. Total 42.1% patients had pain, 14.4% had a performance status of two and 59.8% had a Gleason score ≥8. Total 31.1% had previously received ≥2 chemotherapies, 15.3 and 12% had been previously treated with abiraterone and cabazitaxel, respectively and 14.8% had received both. RESULTS Median progression-free survival and overall survival were 4.8 and 13.1 months, respectively. A prostate-specific antigen reduction ≥50% was observed in 49.1%. Total 32.7% abiraterone-pretreated patients achieved a biochemical response compared with 56% of abiraterone-naive patients. CONCLUSION Enzalutamide was safe and well tolerated. Its antitumor activity in abiraterone-pretreated patients was limited.
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Affiliation(s)
- Francesca Maines
- Medical Oncology, S Chiara Hospital, Largo Medaglie d'Oro 1, Trento, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Giuseppe Procopio
- Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, via Venezian 1, Milano, Italy
| | - Gaetano Facchini
- Medical Oncology, Istituto Nazionale dei Tumori - IRCCS, Fondazione 'G Pascale', via Semmola 49, Napoli, Italy
| | - Lucia Fratino
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, via F. Gallini 2, Aviano - Pordenone, Italy
| | - Roberto Sabbatini
- Department of Oncology & Hematology, Azienda Ospedaliero - Universitaria di Modena, via del pozzo 71, Italy
| | - Donatello Gasparro
- Medical Oncology, Ospedale Maggiore di Parma, via Gramsci 14, Parma, Italy
| | - Umberto Basso
- UOC Oncologia Medica 1, Istituto Oncologico Veneto IRCCS, via Gattamelata 64, Padova
| | - Claudia Mosillo
- Department of Radiology, Oncology & Human Pathology, Sapienza, Università di Roma, Roma, Italy
| | | | - Francesco Massari
- Division of Oncology, S Orsola-Malpighi Hospital, via Albertoni 15, Bologna, Italy
| | - Teodoro Sava
- Medical Oncology, Ospedale di Camposampiero, ULSS Alta Padovana, Cittadella, Italy
| | - Suzana Sirotova
- Medical Oncology, Parini Hospital, Viale Ginevra 3, Aosta, Italy
| | - Caterina Messina
- Medical Oncology, ASST Papa Giovanni XXIII Bergamo Hospital, Piazza OMS 1, Bergamo, Italy
| | - Sarah Scagliarini
- Medical Oncology, Azienda Ospedaliera di Rilievo Nazionale Cardarelli, via Cardarelli 9, Napoli, Italy
| | - Vincenza Conteduca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Elena Verzoni
- Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, via Venezian 1, Milano, Italy
| | - Sabrina Rossetti
- Medical Oncology, Istituto Nazionale dei Tumori - IRCCS, Fondazione 'G Pascale', via Semmola 49, Napoli, Italy
| | - Antonello Veccia
- Medical Oncology, S Chiara Hospital, Largo Medaglie d'Oro 1, Trento, Italy
| | | | - Orazio Caffo
- Medical Oncology, S Chiara Hospital, Largo Medaglie d'Oro 1, Trento, Italy
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5
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de Bono JS, Chowdhury S, Feyerabend S, Elliott T, Grande E, Melhem-Bertrandt A, Baron B, Hirmand M, Werbrouck P, Fizazi K. Antitumour Activity and Safety of Enzalutamide in Patients with Metastatic Castration-resistant Prostate Cancer Previously Treated with Abiraterone Acetate Plus Prednisone for ≥24 weeks in Europe. Eur Urol 2018; 74:37-45. [DOI: 10.1016/j.eururo.2017.07.035] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
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6
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von Eyben FE, Roviello G, Kiljunen T, Uprimny C, Virgolini I, Kairemo K, Joensuu T. Third-line treatment and 177Lu-PSMA radioligand therapy of metastatic castration-resistant prostate cancer: a systematic review. Eur J Nucl Med Mol Imaging 2017; 45:496-508. [PMID: 29247284 PMCID: PMC5787223 DOI: 10.1007/s00259-017-3895-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/20/2017] [Indexed: 12/19/2022]
Abstract
Aims There is a controversy as to the relative efficacy of 177Lu prostate specific membrane antigen (PSMA) radioligand therapy (RLT) and third-line treatment for patients with metastatic castration-resistant prostate cancer (mCRPC). The aim of our systematic review was to elucidate whether 177Lu-PSMA RLT and third-line treatment have similar effects and adverse effects (PROSPERO ID CRD42017067743). Methods The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches in Pubmed and Embase selected articles up to September 2017. A search in ClinicalTrials.gov indicated ongoing studies. The meta-analysis used the random-effects model. Results Twelve studies including 669 patients reported 177Lu-PSMA RLT. Overall, 43% of the patients had a maximum decline of PSA of ≥50% following treatment with 177Lu-PSMA RLT. The treatment with 177Lu-PSMA-617 and 177Lu-PSMA for imaging and therapy (I&T) had mainly transient adverse effects. Sixteen studies including 1338 patients reported third-line treatment. Overall, 21% of the patients had a best decline of PSA of ≥50% following third-line treatment. After third-line treatment with enzalutamide and cabazitaxel, adverse effects caused discontinuation of treatment for 10% to 23% of the patients. 177Lu-PSMA RLT gave a best PSA decline ≥50% more often than third-line treatment (mean 44% versus 22%, p = 0.0002, t test). 177Lu-PSMA RLT gave objective remission more often than third-line treatment (overall 31 of 109 patients versus 43 of 275 patients, p = 0.004, χ2 test). Median survival was longer after 177Lu-PSMA RLT than after third-line treatment, but the difference was not statistically significant (mean 14 months versus 12 months, p = 0.32, t test). Adverse effects caused discontinuation of treatment more often for third-line treatment than for 177Lu-PSMA RLT (22 of 66 patients versus 0 of 469 patients, p < 0.001, χ2 test). Conclusions As for patients with mCRPC, treatment with 177Lu-PSMA-617 RTL and 177Lu-PSMA I&T gave better effects and caused fewer adverse effects than third-line treatment.
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Affiliation(s)
| | - Giandomenico Roviello
- Department of Oncology, Medical Oncology Unit, San Donato Hospital, Arezzo, Italy
- Department Medical, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Christian Uprimny
- Department of Nuclear Medicine, University Hospital Innsbruck, Innsbruck, Austria
| | - Irene Virgolini
- Department of Nuclear Medicine, University Hospital Innsbruck, Innsbruck, Austria
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Abstract
Androgen deprivation is still standard therapy for prostate cancer, either as primary androgen deprivation therapy or with the use of secondary hormonal drugs including abiraterone and enzalutamide. However, especially the clinically occult side effects like metabolic changes or cardiovascular complications and effects on the psyche of the patient are often not recognized in daily practice. Active monitoring of such side effects is essential for prevention and early intervention. In addition, the efficacy of androgen deprivation therapies is limited by primary and secondary resistance. The underlying molecular mechanism including splice variants of the androgen receptor in contrast to mutations are usually reversible and should be regarded as a sign of efficacy of the current treatment. Therefore, the clever, timely use of androgen deprivation or even the use of a bipolar androgen therapy should enable reversal of resistance to again render tumor cells sensitive to androgen-deprivation therapy.
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Affiliation(s)
- C H Ohlmann
- Klinik für Urologie und Kinderurologie, Universität des Saarlandes, 66421, Homburg/Saar, Deutschland.
| | - P Thelen
- Klinik für Urologie, Universitätsmedizin Göttingen, 37099 Göttingen, Deutschland
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8
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Hoshi S, Numahata K, Ono K, Yasuno N, Bilim V, Hoshi K, Amemiya H, Sasagawa I, Ohta S. Treatment sequence in castration-resistant prostate cancer: A retrospective study in the new anti-androgen era. Mol Clin Oncol 2017; 7:601-603. [PMID: 28855993 DOI: 10.3892/mco.2017.1361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/16/2017] [Indexed: 01/07/2023] Open
Abstract
In recent years, abiraterone acetate (AA) and enzalutamide (EZL) have become available for the treatment of cancer. Prior clinical trials have demonstrated the benefits of these agents in males with castration-resistant prostate cancer (CRPC). The optimal sequencing of available therapies in the context of efficacy and known cross-resistance remains uncertain. Based on the mechanisms of action and accessible clinical data, AA and EZL may be indicated for the early stages of prostate cancer. Until clinical trials are conducted to determine the best treatment sequence, individualized therapy is required for each patient based on the clinicopathological characteristics. In the present study, 46 sequential patients (median age: 77, range 59-89; median serum PSA level: 56 ng/ml, range 1.5-3,211) with CRPC treated with EZL (160 mg/day) were retrospectively analyzed between June 2014 and July 2015 at the following institutions: Yamagata Prefectural Central Hospital (Yamagata, Japan); Yamagata Tokushukai Hospital (Yamagata, Japan); Ishinomaki Red Cross Hospital (Ishinomaki, Japan); Kan-etsu Hospital (Tsurugashima, Japan); Niigata Cancer Center Hospital (Niigata, Japan); Sakado Central Hospital (Sakado, Japan). A total of 18 patients were pre-treated with Docetaxel (DOC) and 28 patients were DOC-naïve. Once EZL therapy was initiated, increases in prostate specific antigen (PSA) levels were observed in 3/18 patients (17%) pre-treated with DOC and in 6/20 (30%) who were DOC-naïve. In total, 8/28 DOC-naïve patients were treated with AA without EZL. An increase in the PSA level was observed in only 1/8 (12%) cases following AA treatment in the DOC-naïve group. It was demonstrated that AA had a better efficacy in DOC-naïve patients. The efficacy of EZL was limited in AA-pre-treated patients following DOC administration.
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Affiliation(s)
- Senji Hoshi
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata 990-2214, Japan.,Department of Urology, Yamagata Tokushukai Hospital, Yamagata 990-0834, Japan
| | - Kenji Numahata
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata 990-2214, Japan
| | - Kunio Ono
- Department of Urology, Ishinomaki Red Cross Hospital, Ishinomaki, Miyagi 986-0861, Japan
| | - Nobuhiro Yasuno
- Department of Pharmacy, Kan-etsu Hospital, Tsurugashima, Saitama 350-2213, Japan
| | - Vladimir Bilim
- Department of Urology, Niigata Cancer Center Hospital, Niigata 951-8133, Japan
| | - Kiyotsugu Hoshi
- Department of Urology, Yamagata Tokushukai Hospital, Yamagata 990-0834, Japan
| | - Hiroshi Amemiya
- Department of Urology, Sakado Central Hospital, Sakado, Saitama 350-0233, Japan
| | - Isoji Sasagawa
- Department of Urology, Yamagata Tokushukai Hospital, Yamagata 990-0834, Japan
| | - Shoichiro Ohta
- Department of Clinical Pathology, Faculty of Pharmaceutical Science, Josai University, Sakado, Saitama 350-0295, Japan
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9
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Tsaur I, Becker C, Thelen P, Roos FC. [Splice variant AR-V7 : Is it time for its routine use as a predictive marker in prostate cancer?]. Urologe A 2017; 56:1164-1167. [PMID: 28702748 DOI: 10.1007/s00120-017-0461-x] [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] [Indexed: 11/30/2022]
Abstract
Androgen receptor splice variants (AR-Vs), if overexpressed, lack the ligand-binding domain conveying metastasized castration-resistant prostate cancer with a therapeutic resistance to androgen receptor signaling inhibitors. Particularly AR-V7 has recently been proposed as a potential predictive biomarker to identify patients who would probably benefit most from taxane-based cytotoxic treatment. Several assays to substantiate or quantify AR-V7 expression have recently been proposed. However, their broad clinical value is still debatable. This contemporary update aims to shed light on the current evidence in the field and draw distinct practical conclusions.
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Affiliation(s)
- I Tsaur
- Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Mainz, Deutschland.,Fachgruppe Molekulare Urologie der Arbeitsgruppe urologische Forschung der Deutschen Gesellschaft für Urologie, Düsseldorf, Deutschland
| | - C Becker
- Forschungskoordination, Deutsche Gesellschaft für Urologie e. V., Uerdinger Straße 64, 40474, Düsseldorf, Deutschland.
| | - P Thelen
- Klinik für Urologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - F C Roos
- Klinik für Urologie und Kinderurologie des Universitätsklinikums der Johann Wolfgang Goethe Universität Frankfurt, Frankfurt, Deutschland
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10
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Miyoshi Y, Uemura K, Kawahara T, Yoneyama S, Hattori Y, Teranishi JI, Ohta JI, Takebayashi S, Yokomizo Y, Hayashi N, Yao M, Uemura H. Prognostic Value of Automated Bone Scan Index in Men With Metastatic Castration-resistant Prostate Cancer Treated With Enzalutamide or Abiraterone Acetate. Clin Genitourin Cancer 2016; 15:472-478. [PMID: 28110835 DOI: 10.1016/j.clgc.2016.12.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/09/2016] [Accepted: 12/21/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Bone scan index (BSI) is an objective tool for quantifying bone metastasis load. We assessed its prognostic usefulness in patients with metastatic castration-resistant prostate cancer (CRPC) treated with enzalutamide (ENZ) or abiraterone acetate (AA). MATERIALS AND METHODS We analyzed 40 patients who received ENZ or AA treatment (ENZ/AA) for metastatic CRPC. The Cox proportional hazards model and a C-index were used to investigate associations between overall survival (OS) and BSI, and patient age, prostate-specific antigen, time to CRPC, previous docetaxel use, and pain. RESULTS Median OS after ENZ/AA was 17.8 months. All patient deaths (n = 19; 47.5%) were from prostate cancer. In multivariate analysis, decreased BSI was an independent predictor for longer OS (hazard ratio, 8.97; P = .011). Inclusion of BSI improved the C-index from 0.721 to 0.792 in predicting OS after ENZ/AA. CONCLUSIONS Decreased BSI after ENZ/AA independently predicts longer OS.
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Affiliation(s)
- Yasuhide Miyoshi
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan.
| | - Koichi Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kawahara
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Shuko Yoneyama
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Hattori
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun-Ichi Teranishi
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun-Ichi Ohta
- Department of Urology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Shigeo Takebayashi
- Department of Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yumiko Yokomizo
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Narihiko Hayashi
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
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Badrising SK, van der Noort V, Hamberg P, Coenen JL, Aarts MJ, van Oort IM, van den Eertwegh AJ, Los M, van den Berg HP, Gelderblom H, Vrijaldenhoven S, Kerver ED, van Voorthuizen T, de Jong IJ, Haanen JB, Bergman AM. Enzalutamide as a Fourth- or Fifth-Line Treatment Option for Metastatic Castration-Resistant Prostate Cancer. Oncology 2016; 91:267-273. [DOI: 10.1159/000448219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW A number of molecular and genomic biomarkers that possess the ability to guide treatment or 'actionable targets' are being reported in metastatic prostate cancer. In addition, pathways of resistance to existing therapies and novel agents to overcome them are currently under active investigation. The next wave of investigations is focused on personalized therapy of prostate cancer. The focus of this review article is to provide an update on clinical development in advanced prostate cancer and to highlight the ongoing investigations of biomarker discovery, and ways of overcoming therapeutic resistance. The next generation of clinical trials developing novel targets and compounds promises to be in populations enriched with specific marker expression. RECENT FINDINGS The breakthrough report, of the ability of the androgen receptor variant 7 mutation, detected in circulating tumor cells, to predict the lack of response to abiraterone or enzalutamide, and the remarkable responses of poly adenosine diphosphate ribose polymerase inhibitors in prostate cancer with DNA repair mutations have elevated hopes of a bright future in the biomarker-driven therapeutic arena. Novel targets such as bromodomain extra terminal-1 and phosphatidylinositol 3-kinase hold promise for the possibility of overcoming resistance. Novel hormone agents are also under active study. SUMMARY As the clinical application of the multifaceted therapies narrows down to enriched patient populations selected by genomic testing, the therapeutic efficiency will escalate considerably. Novel targets, resistance mechanisms and relevant agents are being avidly tested, and the dream of personalized medicine is emerging into reality.
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Affiliation(s)
- Manish K Thakur
- Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, Michigan, USA
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Di Lorenzo G, Pagliuca M, Perillo T, Benincasa A, Bosso D, De Placido S, Buonerba C. Docetaxel Rechallenge in a Heavily Pretreated Patient With Castration-Resistant Prostate Cancer: A Case Report and Review of Literature. Medicine (Baltimore) 2016; 95:e2754. [PMID: 27057826 PMCID: PMC4998742 DOI: 10.1097/md.0000000000002754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chemotherapy agents for patients with metastatic castration-resistant prostate cancer (mCRPC) include docetaxel and cabazitaxel. Although docetaxel is approved in the first-line treatment setting, a few studies have shown that selected patients can benefit from docetaxel rechallenge.We, here, report the case of a heavily pretreated mCRPC patient who reported clinical benefit from receiving docetaxel after previous exposure to docetaxel, cabazitaxel, abiraterone, and enzalutamide.After 4 cycles of treatment, patient's performance status had improved to 1, the hemoglobin level was 12.9 g/dL and his serum prostate specific antigen levels were reduced by >70%, with no treatment-related adverse events.Although docetaxel rechallenge is a therapeutic option for selected patients, the risk of cumulative toxicity described in literature must be carefully considered.As the risk of cabazitaxel-related cumulative toxicity is probably lower, retreatment with cabazitaxel rather than docetaxel may also be an option in the setting of heavily pretreated mCRPC patients.
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Affiliation(s)
- Giuseppe Di Lorenzo
- From the Medical Oncology Unit, Department of Clinical Medicine, Federico II University, Naples, Italy
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