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Anido-Herranz U, Fernandez-Calvo O, Ruiz-Bañobre J, Martinez-Breijo S, Fernandez-Nuñez N, Nogareda-Seoane Z, Garrido-Pumar M, Casas-Nebra J, Muñiz-Garcia G, Portela-Pereira P, Gomez-Caamaño A, Perez-Fentes DA, Santome-Couto L, Lázaro M, Molina-Diaz A, Medina-Colmenero A, Vazquez-Estevez S. Outcomes and patterns of use of Radium-223 in metastatic castration-resistant prostate cancer. Front Oncol 2024; 14:1385466. [PMID: 38774416 PMCID: PMC11106362 DOI: 10.3389/fonc.2024.1385466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/09/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Radium-223 dichloride (Ra-223) is recommended as a treatment option for metastatic castration-resistant prostate cancer (mCRPC) patients with symptomatic bone metastases and no visceral disease, after docetaxel failure, or in patients who are not candidates to receive it. In this study, we aimed to ambispectively analyze overall survival (OS) and prognostic features in mCRPC in patients receiving Ra-223 as per clinical routine practice and identify the most suitable treatment sequence. Patients and methods This study is observational, multicentric, and ambispective. Eligibility criteria included mCRPC patients treated with Ra-223, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, without visceral metastases, and no more than three cm involved lymph nodes. Results A total of 145 patients were included; the median age was 73.97 years, and a Gleason score of more than or equal to 7 in 61 (48%) patients; 73 (81%) had previously received docetaxel. The most important benefit was reached by those patients who received Ra-223 in the second-line setting, with a median OS of 17 months (95% CI, 12-21), and by patients who received six cycles of treatment, with a median OS of 19 months (95% CI, 14-21). An alkaline phosphatase (ALP) decrease was also identified as a prognosis marker. When performing the multivariate analysis, the time to develop castration-resistant disease longer than 24 months was the most important prognostic factor to predict the evolution of the patients receiving Ra-223. Ra-223 was well tolerated, with thrombocytopenia, anemia, and diarrhea being the main adverse events. Conclusion There is a benefit for those patients who received Ra-223 in the second-line setting, regardless of prior use of docetaxel. In addition, a survival benefit for patients presenting with a decline in ALP was observed.
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Affiliation(s)
- Urbano Anido-Herranz
- Translational Medical Oncology Group (ONCOMET), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Department of Medical Oncology, University Clinical Hospital of Santiago de Compostela (SERGAS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | | | - Juan Ruiz-Bañobre
- Translational Medical Oncology Group (ONCOMET), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Department of Medical Oncology, University Clinical Hospital of Santiago de Compostela (SERGAS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Sara Martinez-Breijo
- Department of Urology, University Clinical Hospital of A Coruña, A Coruña, Spain
| | | | - Zulema Nogareda-Seoane
- Department of Nuclear Medicine, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Miguel Garrido-Pumar
- Department of Nuclear Medicine, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Gloria Muñiz-Garcia
- Department of Nuclear Medicine – GALARIA, Complexo Hospitalario Universitario Ourense A. S. de Ourense, Ourense, Spain
| | | | - Antonio Gomez-Caamaño
- Department of Radiation Oncology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Daniel Adolfo Perez-Fentes
- Department of Urology, EOXI University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Martín Lázaro
- Department of Medical Oncology, Álvaro Cunqueiro Hospital, Vigo, Spain
| | - Aurea Molina-Diaz
- Department of Medical Oncology, University Clinical Hospital of A Coruña, A Coruña, Spain
| | - Ana Medina-Colmenero
- Department of Medical Oncology, Fundación Centro Oncológico de Galicia, A Coruña, Spain
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Tilki D, van den Bergh RCN, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J, Eberli D, De Meerleer G, De Santis M, Farolfi A, Gandaglia G, Gillessen S, Grivas N, Henry AM, Lardas M, J L H van Leenders G, Liew M, Linares Espinos E, Oldenburg J, van Oort IM, Oprea-Lager DE, Ploussard G, Roberts MJ, Rouvière O, Schoots IG, Schouten N, Smith EJ, Stranne J, Wiegel T, Willemse PPM, Cornford P. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer. Part II-2024 Update: Treatment of Relapsing and Metastatic Prostate Cancer. Eur Urol 2024:S0302-2838(24)02306-6. [PMID: 38688773 DOI: 10.1016/j.eururo.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/14/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND AND OBJECTIVE The European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines on the treatment of relapsing, metastatic, and castration-resistant prostate cancer (PCa) have been updated. Here we provide a summary of the 2024 guidelines. METHODS The panel performed a literature review of new data, covering the time frame between 2020 and 2023. The guidelines were updated and a strength rating for each recommendation was added on the basis of a systematic review of the evidence. KEY FINDINGS AND LIMITATIONS Risk stratification for relapsing PCa after primary therapy may guide salvage therapy decisions. New treatment options, such as androgen receptor-targeted agents (ARTAs), ARTA + chemotherapy combinations, PARP inhibitors and their combinations, and prostate-specific membrane antigen-based therapy have become available for men with metastatic PCa. CONCLUSIONS AND CLINICAL IMPLICATIONS Evidence for relapsing, metastatic, and castration-resistant PCa is evolving rapidly. These guidelines reflect the multidisciplinary nature of PCa management. The full version is available online (http://uroweb.org/guideline/ prostate-cancer/). PATIENT SUMMARY This article summarises the 2024 guidelines for the treatment of relapsing, metastatic, and castration-resistant prostate cancer. These guidelines are based on evidence and guide doctors in discussing treatment decisions with their patients. The guidelines are updated every year.
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Affiliation(s)
- Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey.
| | | | | | | | | | - Julie Darraugh
- European Association of Urology, Arnhem, The Netherlands
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Maria De Santis
- Department of Urology, Universitätsmedizin Berlin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Andrea Farolfi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Laboratory, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Nikolaos Grivas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | - Michael Lardas
- Department of Urology, Metropolitan General Hospital, Athens, Greece
| | | | - Matthew Liew
- Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | | | - Jan Oldenburg
- Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU Medical Center, Amsterdam, The Netherlands
| | | | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
| | - Olivier Rouvière
- Department of Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, UFR Lyon-Est, Lyon, France
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Emma J Smith
- European Association of Urology, Arnhem, The Netherlands
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital-Västra Götaland, Gothenburg, Sweden
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul M Willemse
- Department of Urology, Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Philip Cornford
- Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK
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Conteduca V, Di Tullio P, Allamprese R, Bruno G, Lolli C, Schepisi G, Rosano A, Giordano G, Garofoli M, Chiuri VE, Fratino L, Zanardi E, Galli L, Massari F, Falagario U, Rescigno P, Fornarini G, Sanguedolce F, Santini D, Procopio G, Caffo O, Carrieri G, Landriscina M, De Giorgi U. Initial management approach for localized/locally advanced disease is critical to guide metastatic castration-resistant prostate cancer care. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00800-8. [PMID: 38347113 DOI: 10.1038/s41391-024-00800-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Currently, several therapies are available for metastatic castration-resistant prostate cancer (mCRPC) but no specific clinical factors to personalize treatment. We first sought the prognostic value of duration on androgen-deprivation therapy (ADT) for hormone-sensitive prostate cancer (HSPC) in patients receiving androgen-receptor-signaling inhibitors (ARSI) for mCRPC. METHODS A multicenter cohort of mCRPC patients who started ARSI between July 2011 and October 2021 was identified. Based on their initial disease burden and duration on ADT for HSPC, primary progressive (PP) men were classified into four groups: low/intermediate-risk localized disease (LOC) and high-risk localized/locally advanced disease (LAD) and short-term (ST) < 24 vs. long-term (LT) ADT ≥ 24 months, whereas de novo (DN) mHSPC were subdivided into short-time vs. long-time to CRPC. RESULTS We included 919 mCRPC patients with a median age of 77 years [interquartile range (IQR) = 71-82)]. Median ADT duration in HSPC was 24 months (IQR = 14-40). Median follow-up was 91 months (IQR = 62-138), median OS and PFS from ARSI start were 20 (IQR 10-32) and 10 months (IQR = 5-19), respectively. In PP developing metastatic disease (n = 655, 71.3%), LOC and LAD with ST ADT had a greater than almost double-risk of death compared to LT ADT (LOC/ST: hazard ratio [HR] = 2.01; 95% CI 1.54-2.64; LAD/ST: HR = 1.73; 95% CI 1.34-2.24; p < 0.001). In the multivariate analysis including age, prognostic cohort, Gleason, ECOG, radical radiotherapy and prostatectomy, groups with ST ADT were associated with worse OS compared to LT ADT (LOC/ST: HR = 1.84; 95% CI 1.38-2.45; p < 0.001; LAD/ST: HR = 1.59; 95% CI 1.21-2.10; p < 0.001), along with ECOG > 2 (HR = 1.55; 95% CI 1.06-2.26; p = 0.03). There were also similar results of PFS. Moreover, long-time to CRPC in patients with history of DN mHSPC (n = 264, 28.7%) resulted in a better OS/PFS (HR = 0.76, 95% CI 0.56-1.02, p = 0.064 and HR = 0.74, 95% CI 0.55-0.99, p = 0.042, respectively). CONCLUSIONS Our study showed that duration on ADT for mHSPC was significantly associated with survival in mCRPC undergoing ARSI. These findings suggest a possible connection between initial management of prostate tumour and a better prognostication in mCRPC. Prospective trials are warranted.
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Affiliation(s)
- Vincenza Conteduca
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy.
| | - Piergiorgio Di Tullio
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy
| | - Rossana Allamprese
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy
- Laboratory of Preclinical and Translational Research, Centro di Riferimento Oncologico della Basilicata (IRCCSCROB), Rionero in Vulture, Italy
| | - Giuseppina Bruno
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy
| | - Cristian Lolli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giuseppe Schepisi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Aldo Rosano
- National Institute for the Analysis of Public Policy-INAPP, 00198, Rome, Italy
| | - Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy
| | - Marianna Garofoli
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy
| | | | - Lucia Fratino
- Medical Oncology Department, National Cancer Institute, Aviano, Italy
| | - Elisa Zanardi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Galli
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ugo Falagario
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy
- Department of Urology, University of Foggia, Foggia, Italy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Pasquale Rescigno
- Department of Oncology, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | - Francesca Sanguedolce
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy
| | - Daniele Santini
- UOC Oncologia A, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Procopio
- Dipartimento di Oncologia Medica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Orazio Caffo
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Giuseppe Carrieri
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy
| | - Matteo Landriscina
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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Scailteux LM, Vincendeau S, Gravis G, Mathieu R, Balusson F, Kerbrat S, Oger E. Real-World Treatment Patterns Among French Patients With Metastatic Castration-Resistant Prostate Cancer Under Abiraterone or Enzalutamide. Clin Genitourin Cancer 2023; 21:e362-e369. [PMID: 37188606 DOI: 10.1016/j.clgc.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Using large French retrospective study cohort of chemotherapy-naïve metastatic castration-resistant prostate cancer patients (mCRPC; n = 10,308) comparing survival between patients who initiated abiraterone (ABI; 64%) and those initiating enzalutamide (ENZ; 36%), the present objective was to describe treatment patterns in the 2 years following initiation. METHOD Using the national health data system (SNDS) from 2014 to 2018, we first explored the number of treatment lines, and secondly, patterns of patient management using state sequence analysis; cluster analyses were performed on the 0 to 12 month and 13 to 24 month periods. Age, Charlson score, and duration of androgen deprivation therapy (ADT) were obtained for each cluster in the first year of follow-up. RESULTS Patients with only 1 treatment line accounted for 52%. In the 0 to 12 month sequence analysis, the main clusters among ABI/ENZ new users involved patients who continued the initial treatment (54% of 65% respectively) and discontinued active treatment (14.5% for both). Less than 2 years exposure to ADT prior to ABI/ENZ initiation was frequently observed for noncontrolled mCRPC, as shown in the death and switch from ABI/ENZ to docetaxel clusters. The clusters for a switch ABI/ENZ to ENZ/ABI involved 6% to 11% of the patients. CONCLUSION Our study suggested fairly similar patterns between ABI and ENZ initiation. The cluster of patients with active treatment discontinuation needs to be further investigated, as well as factors influencing therapeutic choice. Better understanding for the use of second-generation hormone therapy in mCRPC in real life, could improve its implementation by clinicians in the early stages of prostate cancer.
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Affiliation(s)
- Lucie-Marie Scailteux
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) , Rennes, France; PEPS research consortium, Rennes, France.
| | - Sébastien Vincendeau
- Departement of Urology, Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
| | - Gwenaëlle Gravis
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Romain Mathieu
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) , Rennes, France; Departement of Urology, Rennes University Hospital, Rennes, France
| | - Frédéric Balusson
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) , Rennes, France; PEPS research consortium, Rennes, France
| | - Sandrine Kerbrat
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) , Rennes, France; PEPS research consortium, Rennes, France
| | - Emmanuel Oger
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) , Rennes, France; PEPS research consortium, Rennes, France
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Obinata D, Hashimoto S, Uchida H, Nakahara K, Yoshizawa T, Mochida J, Yamaguchi K, Takahashi S. Clinical characteristics of patients with metastatic castration-resistant prostate cancer after treatment with combined androgen blockade. BMC Urol 2023; 23:74. [PMID: 37118708 PMCID: PMC10148407 DOI: 10.1186/s12894-023-01233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/02/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Although the second-generation androgen receptor inhibitors and taxanes have recently been recommended for the initial treatment of metastatic prostate cancer, bicalutamide and flutamide are still used in a large number of cases. Therefore, it is important to elucidate the clinical characteristics of these treated CRPC cases and their sensitivity to the currently used therapeutic agents. We aimed to examine the outcomes of metastatic castration-resistant prostate cancer following combined androgen blockade as initial therapy at our institution. METHODS Ninety-four patients who developed metastatic castration-resistant prostate cancer after hormonal treatment with combined nonsteroidal androgen receptor antagonists and continuous androgen deprivation therapy between January 2015 and December 2020 were included. The presence of visceral metastases, duration of efficacy of each treatment, and overall survival after castration-resistant prostate cancer were evaluated. RESULTS Patients with a longer duration of castration-resistant prostate cancer tended to have a longer response duration to subsequent enzalutamide administration (p = 0.003). Patients who achieved a 90% reduction in prostate-specific antigen levels with enzalutamide had a significantly better castration-resistant prostate cancer prognosis (p = 0.002). Meanwhile, those with visceral metastases at the time of castration-resistant prostate cancer diagnosis had a significantly poorer prognosis (p < 0.001). A positive correlation was observed between the treatment efficacy of abiraterone and taxanes for castration-resistant prostate cancer. CONCLUSION The study provides scientific evidence to support that patients with longer time to castration-resistant prostate cancer are more sensitive to enzalutamide, and the use of abiraterone between docetaxel and cabazitaxel has favorable prognostic impact. These findings provide instrumental evidence that can enable better treatment selection for prostate cancer patients.
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Affiliation(s)
- Daisuke Obinata
- Department of Urology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Sho Hashimoto
- Department of Urology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Hideaki Uchida
- Department of Urology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Ken Nakahara
- Department of Urology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Tsuyoshi Yoshizawa
- Department of Urology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Junichi Mochida
- Department of Urology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Kenya Yamaguchi
- Department of Urology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-Ku, Tokyo, 173-8610, Japan.
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-Ku, Tokyo, 173-8610, Japan
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The presence of lymph node metastases and time to castration resistance predict the therapeutic effect of enzalutamide for castration-resistant prostate cancer. Int J Clin Oncol 2023; 28:427-435. [PMID: 36580184 DOI: 10.1007/s10147-022-02288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Enzalutamide is effective against castration-resistant prostate cancer (CRPC). However, it is unclear which patients would benefit more from enzalutamide treatment. Here, we analyzed patients who received enzalutamide as first-line therapy for CRPC and evaluated the factors that predict treatment response and prognosis. METHODS We retrospectively analyzed 101 patients treated with enzalutamide for CRPC at our institution. As primary endpoints we regarded the prostate-specific antigen (PSA) response rate and PSA-progression-free survival (PSA-PFS) from the start of enzalutamide treatment. Laboratory and imaging data were analyzed to predict treatment efficacy. RESULTS PSA reductions of ≥ 50% and ≥ 90% were observed in 78 (77%) and 47 (47%) patients, respectively, compared with the baseline. During the follow-up period, 67 (66%) patients showed PSA progression, with a median PSA-PFS of 11 months. Moreover, 31 patients (31%) died, with a median overall survival of 64 months. On multivariate analysis, lymph node metastases at the start of enzalutamide treatment [odds ratio (OR) 0.0575, 95% confidence interval (CI) 0.0105-0.316, p = 0.0010] and time to CRPC (OR 0.177, 95% CI 0.0428-0.731, p = 0.0167] were associated with ≥ 90% PSA response. Lymph node metastases (hazard ratio [HR] 3.00, 95% CI 1.48-6.09, p = 0.0023) and time to CRPC (HR 1.84, 95% CI 1.02-3.30, p = 0.0419) were also predictors of PSA-PFS on a multivariate model. CONCLUSIONS Time to CRPC and lymph node metastasis were predictors of the PSA response rate and PSA-PFS.
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Low TLR and PSMA-TV predict biochemical response to abiraterone acetate in metastatic prostate cancer patients developing castration resistance after chemohormonal therapy at hormone-sensitive stage. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04438-8. [DOI: 10.1007/s00432-022-04438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
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8
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French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Management of metastatic disease and castration resistance. Prog Urol 2022; 32:1373-1419. [DOI: 10.1016/j.purol.2022.07.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
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9
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Time to castration resistance is a novel prognostic factor of cancer-specific survival in patients with nonmetastatic castration-resistant prostate cancer. Sci Rep 2022; 12:16202. [PMID: 36171391 PMCID: PMC9519913 DOI: 10.1038/s41598-022-20319-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 09/12/2022] [Indexed: 11/08/2022] Open
Abstract
We aimed to identify prognostic factors of cancer-specific survival (CSS) in non-metastatic castration-resistant prostate cancer (M0CRPC) patients. The final analysis of this retrospective cohort included 82 patients who were diagnosed as M0CRPC between 1998 and 2018 at the University of Tokyo Hospital. CRPC was defined as prostate-specific antigen (PSA) progression (increased PSA ≥ 25% and ≥ 2 ng/mL above the nadir or detection of a metastatic lesion). The median value of age and PSA at the time of CRPC were 76 (range 55-94) years and 2.84 (range 2.04-22.5) ng/mL, respectively. The median follow-up time from CRPC diagnosis was 38 (range 3-188) months. The prognostic factors of CSS were 'PSA doubling time (PSADT) ≤ 3 months', 'time to CRPC diagnosis from the start of androgen deprivation therapy (TTCRPC) ≤ 12 months', of which TTCRPC was a novel risk factor of CSS. In the multivariate analysis, 'PSADT ≤ 3 months' and TTCRPC ≤ 12 months' remained as statistically significant predictors of CSS. Novel risk stratification was developed based on the number of these risk factors. The high-risk group showed a hazard ratio of 4.416 (95% confidence interval 1.701-11.47, C-index = 0.727).
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10
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Evaluation and Effectiveness of Clinical Trials with Hormone Therapy in the Treatment of Prostate Cancer. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Prostate cancer is currently the most common malignant tumour in men. Research on hormone therapy advances is necessary because, unfortunately, some tumours are not organ-confined. Objective: To review and analyse the current state of evidence regarding clinical trials with neoadjuvant or adjuvant hormone therapy for prostate cancer and determine the contribution of these trials to the clinical practice. Methods: A critical systematic analysis of hormone therapy clinical trials for prostate cancer in the American Society of Clinical Oncology (ASCO) 2022 official database was carried out and following the Cochrane Handbook for Systematic Reviews ofInterventions, a meta-analysis of random effects and standard mean descriptive statistics were performed. Groups: Group A = Neoadjuvant (n = 53) clinical trials and Group B = Adjuvant (n = 73) clinical hormone therapy. Variables: Phase of the trial, modality of primary treatment, investigated intervention or drug, molecular targets, trial length, sponsors and collaborators, country/countries of trial development, estimated enrolment, assignment of patients, intervention and masking model, trial purpose, related articles, the average number of studied patients, and conclusive results in clinical practice. Results: A total of 7.15% of the studies were in phase I, 14.28% between phase I-phase II, 52.38% in phase II, 0.23% between phase II-phase III and 23.80% in phase III. In the neoadjuvant group, enzalutamide and abiraterone were more frequently used, the androgen receptor was more frequently investigated as a molecular target. In the adjuvant group, abiraterone and prednisone were more frequently used and the androgen receptor and cytochrome P450 were more frequently investigated. The mean number of articles related to each trial was 5.26 (SD 3.15, 1–10). In 47.27% of the published articles directly related to the trials, the investigated treatment was superior to the standard treatment. Adjuvant investigated drugs showed more superiority (52.22%) than neoadjuvant drugs (41.33%). Conclusions: Only 41.33% of neoadjuvant studies and 52.22% of adjuvant studies show conclusive results of superiority for the proposed therapeutic strategies. About a third of related scientific publications that transfer the results to clinical practice did not report conclusive results for either neoadjuvant (32%) or adjuvant (37.78%) therapy.
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11
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Fallara G, Alverbratt C, Garmo H, Vikman H, Hjelm Eriksson M, Lissbrant IF, Stattin P. Time on treatment with abiraterone and enzalutamide in the Patient-overview Prostate Cancer in The National Prostate Cancer Register of Sweden. Acta Oncol 2021; 60:1589-1596. [PMID: 34533422 DOI: 10.1080/0284186x.2021.1978539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are little and inconsistent data from clinical practice on time on treatment with the androgen receptor-targeted drugs (ART) abiraterone and enzalutamide in men with metastatic castration-resistant prostate cancer (mCRPC). We assessed time on treatment with ART and investigated predictors of time on treatment. MATERIAL AND METHODS Time on treatment with ART in men with mCRPC in the patient-overview prostate cancer (PPC), a subregister of the National Prostate Cancer Register (NPCR) of Sweden, was assessed by use of Kaplan-Meier plots and Cox regression. To assess the representativity of PPC for time on treatment, a comparison was made with all men in NPCR who had a filling for ART in the Prescribed Drug Registry. RESULTS 2038 men in PPC received ART between 2015 and 2019. Median time on treatment in chemo-naïve men was 10.8 (95% confidence interval 9.1-13.1) months for abiraterone and 14.1 (13.5-15.5) for enzalutamide. After the use of docetaxel, time on treatment was 8.2 (6.5-12.4) months for abiraterone and 11.1 (9.8-12.6) for enzalutamide. Predictors of a long time on treatment with ART were long duration of ADT prior to ART, low serum levels of PSA at start of ART, absence of visceral metastasis, good performance status, and no prior use of docetaxel. PPC captured 2522/6337 (40%) of all men in NPCR who had filled a prescription for ART. Based on fillings in the Prescribed Drug Registry, men in PPC had a slightly longer median time on treatment with ART compared to all men in NPCR, 9.6 (9.1-10.3) vs. 8.6 (6.3-9.1) months. CONCLUSIONS Time on treatment in clinical practice was similar or shorter than that in published RCTs, due to older age, poorer performance status and more comorbidities.
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Affiliation(s)
- Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita‐Salute San Raffaele University, Milan, Italy
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Charlotte Alverbratt
- Department of Oncology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Göteborg, Göteborg, Sweden
| | - Hans Garmo
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Regional Cancer Centre, Uppsala University Hospital, Uppsala/Örebro, Sweden
| | - Hanna Vikman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Ingela Franck Lissbrant
- Department of Oncology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Göteborg, Göteborg, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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12
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Shiota M, Blas L, Kobayashi S, Matsumoto T, Kashiwagi E, Takeuchi A, Inokuchi J, Shiga KI, Yokomizo A, Eto M. Predictive factors of survival outcomes in first-line therapy for metastatic castration-resistant prostate cancer. Int J Urol 2021; 29:26-32. [PMID: 34549837 DOI: 10.1111/iju.14702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/01/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate predictive factors of survival of metastatic castration-resistant prostate cancer patients undergoing first-line treatment with androgen receptor pathway inhibitors or docetaxel. METHODS Japanese patients with metastatic castration-resistant prostate cancer treated with androgen receptor pathway inhibitor or docetaxel between 2008 and 2018 were included. The differential impact of various clinicopathological factors on the outcome, including progression-free survival and overall survival, was compared between treatment with androgen receptor pathway inhibitor and docetaxel. RESULTS Of 254 patients with metastatic castration-resistant prostate cancer, 119 (46.9%) and 135 (53.2%) were treated with androgen receptor pathway inhibitor and docetaxel, respectively. The multivariate analysis showed that androgen receptor pathway inhibitor was an independent prognostic factor for better progression-free survival (hazard ratio 0.62, 95% confidence interval 0.42-0.92, P = 0.016) and overall survival (hazard ratio 0.61, 95% confidence interval 0.41-0.93, P = 0.021), compared with docetaxel. Pretreatment prostate-specific antigen levels and time to castration-resistant prostate cancer were differentially associated with progression-free survival and overall survival between androgen receptor pathway inhibitor or docetaxel. In patients who presented <6 months to castration-resistant prostate cancer, progression-free survival was shorter in those treated with androgen receptor pathway inhibitor (median 1.1 months, 95% confidence interval 0.2-2.8 months) compared with those who received docetaxel (median 5.0 months, 95% confidence interval 1.8-6.7 months; P = 0.014). CONCLUSIONS First-line therapy with androgen receptor pathway inhibitor is associated with a better prognosis when compared with docetaxel, even after adjustment for prognostic factors. However, a shorter time to castration-resistant prostate cancer is associated with better progression-free survival for patients receiving docetaxel, suggesting that docetaxel is the preferred option for patients with a shorter time to castration-resistant prostate cancer.
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Affiliation(s)
- Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Leandro Blas
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Satoshi Kobayashi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Takashi Matsumoto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Eiji Kashiwagi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Ario Takeuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | | | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
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13
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Cattrini C, España R, Mennitto A, Bersanelli M, Castro E, Olmos D, Lorente D, Gennari A. Optimal Sequencing and Predictive Biomarkers in Patients with Advanced Prostate Cancer. Cancers (Basel) 2021; 13:4522. [PMID: 34572748 PMCID: PMC8467385 DOI: 10.3390/cancers13184522] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 12/12/2022] Open
Abstract
The treatment landscape of advanced prostate cancer has completely changed during the last decades. Chemotherapy (docetaxel, cabazitaxel), androgen-receptor signaling inhibitors (ARSi) (abiraterone acetate, enzalutamide), and radium-223 have revolutionized the management of metastatic castration-resistant prostate cancer (mCRPC). Lutetium-177-PSMA-617 is also going to become another treatment option for these patients. In addition, docetaxel, abiraterone acetate, apalutamide, enzalutamide, and radiotherapy to primary tumor have demonstrated the ability to significantly prolong the survival of patients with metastatic hormone-sensitive prostate cancer (mHSPC). Finally, apalutamide, enzalutamide, and darolutamide have recently provided impactful data in patients with nonmetastatic castration-resistant disease (nmCRPC). However, which is the best treatment sequence for patients with advanced prostate cancer? This comprehensive review aims at discussing the available literature data to identify the optimal sequencing approaches in patients with prostate cancer at different disease stages. Our work also highlights the potential impact of predictive biomarkers in treatment sequencing and exploring the role of specific agents (i.e., olaparib, rucaparib, talazoparib, niraparib, and ipatasertib) in biomarker-selected populations of patients with prostate cancer (i.e., those harboring alterations in DNA damage and response genes or PTEN).
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Affiliation(s)
- Carlo Cattrini
- Medical Oncology, “Maggiore della Carità” University Hospital, 28100 Novara, Italy; (C.C.); (A.M.); (A.G.)
- Department of Translational Medicine (DIMET), University of Eastern Piedmont (UPO), 28100 Novara, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Rodrigo España
- Urology Unit, Hospital Regional de Málaga, University of Malaga, 29910 Málaga, Spain;
| | - Alessia Mennitto
- Medical Oncology, “Maggiore della Carità” University Hospital, 28100 Novara, Italy; (C.C.); (A.M.); (A.G.)
- Department of Translational Medicine (DIMET), University of Eastern Piedmont (UPO), 28100 Novara, Italy
| | - Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy;
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Elena Castro
- Genitourinary Cancer Translational Research Group, Instituto de Investigación Biomédica de Málaga, 29010 Málaga, Spain;
- Medical Oncology, UGCI, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, 29010 Málaga, Spain
| | - David Olmos
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre, 28029 Madrid, Spain;
- Genitourinary Cancer Translational Research Group, The Institute of Biomedical Research in Málaga, 29010 Málaga, Spain
| | - David Lorente
- Medical Oncology, Hospital Provincial de Castellón, 12002 Castellón de la Plana, Spain
| | - Alessandra Gennari
- Medical Oncology, “Maggiore della Carità” University Hospital, 28100 Novara, Italy; (C.C.); (A.M.); (A.G.)
- Department of Translational Medicine (DIMET), University of Eastern Piedmont (UPO), 28100 Novara, Italy
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14
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Di Stefano RF, Tucci M, Turco F, Samuelly A, Bungaro M, Pisano C, Vignani F, Gallicchio M, Scagliotti GV, Di Maio M, Buttigliero C. Prognostic role of the duration of response to androgen deprivation therapy in patients with metastatic castration resistant prostate cancer treated with enzalutamide or abiraterone acetate. Prostate Cancer Prostatic Dis 2021; 24:812-825. [PMID: 33603237 DOI: 10.1038/s41391-021-00336-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/14/2020] [Accepted: 01/27/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Our retrospective study aims to evaluate the prognostic role of duration of response to androgen deprivation therapy (ADT) in metastatic castration resistant prostate cancer (mCRPC) patients treated with enzalutamide (E) or abiraterone acetate (AA). MATERIALS AND METHODS Data about ADT start and duration were available in 255 (82%) of 311 patients treated with AA or E. Patients were divided in three groups according to ADT response (group 1 [G1]: <12 months; group 2 [G2]: 12-36 months; group 3 [G3]: >36 months). Outcome measures were progression-free survival (PFS) and overall survival (OS). RESULTS Patients with longer ADT response had better OS (median 17.3 months G1, 19.9 months G2, 31.6 months G3; HR G3 vs G1 0.41, 95% CI 0.25-0.64; p = 0.001) and better PFS (median 5.9 months G1, 8.8 months G2, 11.7 months G3; HR G3 vs G1 0.41, 95% CI 0.41-0.27; p < 0001). In docetaxel-naive patients, median OS was 18.8 in G1, 35.2 in G2, and not reached in G3 (HR G3 vs G1 0.33, 95% CI 0.14-0.78; p = 0.038), median PFS was 7 months G1, 9.3 months G2, and 20 months G3 (HR G3 vs G1 0.31, 95% CI 0.15-0.62; p = 0.003). In postdocetaxel patients, median OS was 13.1 months in G1, 17.2 months in G2, and 21.4 months in G3 (HR G3 vs G1 0.52, 95% CI 0.29-0.94; p = 0.082), while median PFS was 5.2 months in G1, 6.8 months in G2, and 8.3 months in G3 (HR G3 vs G1 0.54, 95% CI 0.32-0.91; p = 0.067). CONCLUSIONS Duration of ADT response is an independent prognostic factor of outcome with AA or E.
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Affiliation(s)
- Rosario F Di Stefano
- Department of Oncology, Division of Medical Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Marcello Tucci
- Medical Oncology Department, Cardinal Massaia Hospital, Asti, Italy.
| | - Fabio Turco
- Department of Oncology, Division of Medical Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Alessandro Samuelly
- Department of Oncology, Division of Medical Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Maristella Bungaro
- Department of Oncology, Division of Medical Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Chiara Pisano
- Department of Oncology, Division of Medical Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Francesca Vignani
- Department of Oncology, Division of Medical Oncology, Ordine Mauriziano Hospital, University of Turin, Turin, Italy
| | - Mara Gallicchio
- Department of Oncology, Division of Medical Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giorgio V Scagliotti
- Department of Oncology, Division of Medical Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Massimo Di Maio
- Department of Oncology, Division of Medical Oncology, Ordine Mauriziano Hospital, University of Turin, Turin, Italy
| | - Consuelo Buttigliero
- Department of Oncology, Division of Medical Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
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15
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Kobayashi K, Okuno N, Arai G, Nakatsu H, Maniwa A, Kamiya N, Satoh T, Kikukawa H, Nasu Y, Uemura H, Nakashima T, Mikami K, Iinuma M, Tanabe K, Furukawa J, Kobayashi H. Efficacy and safety of abiraterone acetate plus prednisolone in patients with early metastatic castration-resistant prostate cancer who failed first-line androgen-deprivation therapy: a single-arm, phase 4 study. Jpn J Clin Oncol 2021; 51:544-551. [PMID: 33324967 PMCID: PMC8012350 DOI: 10.1093/jjco/hyaa225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022] Open
Abstract
Aim The aim was to evaluate the efficacy and safety of abiraterone acetate plus prednisolone in patients with chemotherapy-naïve early metastatic castration-resistant prostate cancer who failed first-line androgen deprivation therapy. Methods Patients with early metastatic castration-resistant prostate cancer with confirmed prostate-specific antigen progression within 1-year or prostate-specific antigen progression without having normal prostate-specific antigen level (<4.0 ng/mL) during first-line androgen deprivation therapy were enrolled and administered abiraterone acetate (1000 mg) plus prednisolone (10 mg). A minimum of 48 patients were required according to Simon’s minimax design. The primary endpoint was prostate-specific antigen response rate (≥50% prostate-specific antigen decline by 12 weeks), secondary endpoints included prostate-specific antigen progression-free survival and overall survival. Safety parameters were also assessed. Results For efficacy, 49/50 patients were evaluable. Median age was 73 (range: 55–86) years. The median duration of initial androgen deprivation therapy was 32.4 (range: 13.4–84.1) weeks and 48 patients experienced prostate-specific antigen progression within 1-year after initiation of androgen deprivation therapy. prostate-specific antigen response rate was 55.1% (95% confidence interval: 40.2%–69.3%), median prostate-specific antigen–progression-free survival was 24.1 weeks, and median overall survival was 102.9 weeks (95% confidence interval: 64.86 not estimable [NE]). Most common adverse event was nasopharyngitis (15/50 patients, 30.0%). The most common ≥grade 3 adverse event was alanine aminotransferase increased (6/50 patients, 12.0%). Conclusions Abiraterone acetate plus prednisolone demonstrated a high prostate-specific antigen response rate of 55.1%, suggesting tumor growth still depends on androgen synthesis in patients with early metastatic castration-resistant prostate cancer. However, prostate-specific antigen–progression-free survival was shorter than that reported in previous studies. Considering the benefit–risk profile, abiraterone acetate plus prednisolone would be a beneficial treatment option for patients with chemotherapy-naive metastatic prostate cancer who show early castration resistance.
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Affiliation(s)
- K Kobayashi
- Department of Urology, Federation of National Public Service Personnel Mutual Aid Associations Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - N Okuno
- Department of Urology, Independent Administrative Institution National Hospital Organization Sagamihara Hospital, Kanagawa, Japan
| | - G Arai
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - H Nakatsu
- Department of Urology, Asahi General Hospital, Chiba, Japan
| | - A Maniwa
- Department of Urology, Independent Administrative Institution National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan
| | - N Kamiya
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | - T Satoh
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - H Kikukawa
- Department of Urology, Independent Administrative Institution National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Y Nasu
- Department of Urology, Japan Organization of Occupational Health and Safety Okayama Rosai Hospital, Okayama, Japan
| | - H Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Kanagawa, Japan
| | - T Nakashima
- Department of Urology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - K Mikami
- Department of Urology, Chibaken Saiseikai Narashino Hospital, Chiba, Japan
| | - M Iinuma
- Department of Urology, Independent Administrative Institution National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - K Tanabe
- Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - J Furukawa
- Department of Urology, National University Corporation Kobe University Hospital, Hyogo, Japan
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16
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Oruç Z, Kaplan MA, Karaağaç M, Özyurt N, Tatlı AM, Kaya AO, Menekşe S, Kut E, Koca S, Sever ÖN, Yasin İ, Ebinç S, Zeynelgil E, Sakin A, Turhal NS, Isikdogan A. Efficacy and tolerability of current treatments for hormone-refractory prostate cancer patients with visceral metastases. Future Oncol 2021; 17:1611-1624. [PMID: 33631986 DOI: 10.2217/fon-2020-1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess the efficacy and tolerability of the first-line treatment options for hormone-refractory prostate cancer patients with visceral metastases. Materials & methods: The records of 191 patients diagnosed with hormone-refractory prostate cancer with visceral metastases were analyzed retrospectively. Results: Docetaxel was administered to 61.2% (n = 117), abiraterone to 14.2% (n = 27) and enzalutamide to 9.4% (n = 18) as the first-line treatment. The median survival of the patients receiving docetaxel, abiraterone and enzalutamide as the first-line treatment during the hormone-refractory period was 15 (95% Cl: 12.9-17) months, 6 (95% Cl: 1.8-10.1) months and 11 (95% Cl: 0.9-23.1) months (p = 0.038), respectively. Conclusion: The present study established a statistically significant difference in favor of docetaxel in terms of overall survival and progression-free survival.
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Affiliation(s)
- Zeynep Oruç
- Department of Medical Oncology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - M Ali Kaplan
- Department of Medical Oncology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Mustafa Karaağaç
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Neslihan Özyurt
- Department of Medical Oncology, Giresun University, Prof. Dr. A. İlhan Özdemir Training & Research Hospital, Giresun, Turkey
| | - Ali Murat Tatlı
- Department of Medical Oncology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Ali Osman Kaya
- Department of Medical Oncology, Faculty of Medicine, Biruni University, Medıcana Internatıonal Hospital, Istanbul, Turkey
| | - Serkan Menekşe
- Department of Medical Oncology, Manisa City Hospital, Manisa, Turkey
| | - Engin Kut
- Department of Medical Oncology, Manisa City Hospital, Manisa, Turkey
| | - Sinan Koca
- Department of Medical Oncology, Medeniyet University, Göztepe Training & Research Hospital, Istanbul, Turkey
| | - Özlem Nuray Sever
- Department of Medical Oncology, Gazi University School of Medicine, Ankara, Turkey
| | - İrem Yasin
- Department of Medical Oncology, Bezmialem University, Medical Faculty, Istanbul, Turkey
| | - Senar Ebinç
- Department of Medical Oncology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Esra Zeynelgil
- Department of Medical Oncology, Dışkapı Training & Research Hospital, Ankara, Turkey
| | - Abdullah Sakin
- Department of Medical Oncology, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
| | | | - Abdurrahman Isikdogan
- Department of Medical Oncology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
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17
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Devlies W, Handle F, Devos G, Joniau S, Claessens F. Preclinical Models in Prostate Cancer: Resistance to AR Targeting Therapies in Prostate Cancer. Cancers (Basel) 2021; 13:915. [PMID: 33671614 PMCID: PMC7926818 DOI: 10.3390/cancers13040915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022] Open
Abstract
Prostate cancer is an androgen-driven tumor. Different prostate cancer therapies consequently focus on blocking the androgen receptor pathway. Clinical studies reported tumor resistance mechanisms by reactivating and bypassing the androgen pathway. Preclinical models allowed the identification, confirmation, and thorough study of these pathways. This review looks into the current and future role of preclinical models to understand resistance to androgen receptor-targeted therapies. Increasing knowledge on this resistance will greatly improve insights into tumor pathophysiology and future treatment strategies in prostate cancer.
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Affiliation(s)
- Wout Devlies
- Laboratory of Molecular Endocrinology, KU Leuven, 3000 Leuven, Belgium;
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium; (G.D.); (S.J.)
| | - Florian Handle
- Division of Experimental Urology, Department of Urology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Gaëtan Devos
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium; (G.D.); (S.J.)
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium; (G.D.); (S.J.)
| | - Frank Claessens
- Laboratory of Molecular Endocrinology, KU Leuven, 3000 Leuven, Belgium;
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18
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Mai L, Zhang Z, Li Y, Liu R, Li J, Huang S, Lin M, Liu B, Cao W, Wu J, Liu M, Zhou F, Liu Y, He L. Impact of Time to Castration Resistance on Cytoreductive Radiotherapy in Metastatic Castration-Resistant Prostate Cancer. Front Oncol 2020; 10:606133. [PMID: 33344256 PMCID: PMC7746838 DOI: 10.3389/fonc.2020.606133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/09/2020] [Indexed: 01/07/2023] Open
Abstract
Background The role of local radiotherapy in metastatic castration-resistant prostate cancer (mCRPC) remains undefined. This study aimed to identify the value of local radiotherapy and potential candidates for mCRPC. Methods A total of 215 patients with mCRPC treated with or without cytoreductive radiotherapy (CRT) between June 2011 and February 2019 were analyzed. Overall survival (OS) was calculated from the onset of mCRPC. The receiver-operating characteristic (ROC) curve was used to find the cutoff point for time to castration resistance (TCR). Results One-hundred and fifty-five (72.1%) patients received abiraterone after mCRPC, and 54 (25.1%) patients received CRT. The median TCR was 14.9 months. After a median follow-up of 31.7 months, the median OS was 33.3 months. The Eastern Cooperative Oncology Group (ECOG) performance scores 0-1, oligometastases, abiraterone after mCRPC, CRT, and TCR ≥9 months were independent prognostic factors for better OS. Stratified analyses showed improved survival when CRT was applied to patients treated with abiraterone (HR 0.44; 95% CI 0.23-0.83; P = 0.012) and TCR ≥9 months (HR 0.39; 95% CI 0.21-0.74; P = 0.004). The percentage of PSA response after radiotherapy was higher in patients with TCR ≥9 months compared to those with TCR <9 months. No grade 3 or worse adverse events after radiotherapy were reported. Conclusions ECOG performance score, oligometastases, abiraterone application, TCR and CRT were independent prognostic factors for OS in patients with mCRPC. Patients with a short duration of response to primary androgen deprivation therapy were less likely to benefit from CRT.
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Affiliation(s)
- Lixin Mai
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zitong Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yonghong Li
- Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ruiqi Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jibin Li
- Department of Clinical Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Sijuan Huang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Maosheng Lin
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Boji Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wufei Cao
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jianhua Wu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Mengzhong Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Fangjian Zhou
- Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yang Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Liru He
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Merseburger AS, Rüssel C, Belz H, Spiegelhalder P, Feyerabend S, Tran N, Kruetzfeldt K, Baurecht W, Bögemann M. [Early- vs. late-onset treatment using abiraterone acetate plus prednisone in chemo-naïve, asymptomatic or mildly symptomatic patients with metastatic CRPC after androgen deprivation therapy]. Aktuelle Urol 2020; 51:562-571. [PMID: 32268436 DOI: 10.1055/a-1121-7593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Abiraterone acetate (AA) is a prodrug of abiraterone, which is an irreversible inhibitor of 17α-hydroxylase/C17, 20-lyase. Since 2011, abiraterone acetate has been available in combination with prednisone/prednisolone (AA + P) for the treatment of metastatic castration-resistant prostate cancer (mCRPC) after pre-treatment with docetaxel, and since 2012 for the treatment of chemotherapy-naïve asymptomatic or mildly symptomatic mCRPC patients. A revision of the guidelines of the European Association of Urology in 2014 redefining castration resistance gave rise to the question of when the treatment of mCRPC with abiraterone acetate plus prednisone should be initiated after prior hormone treatment and how successful it would be. This led us to observe an early-onset AA + P therapy cohort (EC) and a late-onset therapy cohort (LC) of patients. PATIENTS AND METHODS We designed a combined retrospective and prospective, multicentre, non-interventional two-cohort study to obtain data on the effectiveness and safety of an early-onset AA + P therapy in mCRPC patients in the clinical routine compared to a late therapy onset. The EC comprised patients who received AA + P immediately after castration resistance without a prior first-generation antiandrogen such as bicalutamide or flutamide. The LC included patients who, after castration resistance had occurred, started treatment with AA + P only after unsuccessful treatment with a first-generation antiandrogen. Patients with mCRPC who received AA + P therapy according to the physician's routine clinical practice decision were considered. The patients were consecutively included in the study on the basis of their medical records, with the treatment decision having been made independently of and before patient enrolment. Patients were documented or followed from the beginning of AA + P therapy until the start of a carcinoma-specific systemic follow-up therapy (retrospectively if before and prospectively if after start of data collection). Effectiveness analyses were done for all patients with at least two AA + P administrations and safety analyses for all treated patients. RESULTS Of the 159 patients included, 44 received early therapy and 105 received later therapy with AA + P. 10 patients could not be clearly assigned and were summarised in a third cohort (missed early-onset therapy assignment; MEC). 56/159 patients (35.2 %) were still alive at study start and 103/159 patients (64.8 %) had already deceased (31/44 [70.5 %] in EC, 64/105 [61.0 %] in LC, and 8/10 [80.0 %] in MEC). 24/159 patients (15.1 %) were documented both retrospectively and prospectively. The median duration of AA + P treatment was 11.3 months for EC, 12.0 months for LC, and 8.3 months for MEC patients. The median time to next systemic cancer therapy or death was 12.3 months for EC and 12.8 months for LC patients (p = 0.2820). The median time to the next systemic cancer therapy alone (i. e. without the event 'death') was 22.7 months for EC and 23.3 months for LC patients (p = 0.5995). Median overall survival (OS) was 22.3 months for EC and 39.2 months for LC patients (p = 0.0232). The incidence of serious adverse events (SAEs) was low. SAEs occurred in 3/44 EC (6.8 %), 4/105 LC (3.8 %), and 1/10 MEC patients (10.0 %). One SAE in EC and one in LC resulted in death. CONCLUSIONS In contrast to the new definition of castration resistance, AA + P was still more frequently used in daily clinical practice during the study observation period in patients treated with antiandrogens of the first generation after occurrence of castration resistance. Nevertheless, AA + P therapy appears to be effective and well tolerated during clinical routine in mCRPC patients. A comparison of the study results with earlier 'real-world' studies, however, has to take limiting factors into account. The observed difference in median overall survival might be explained by the imbalance of baseline characteristics between both cohorts with regard to number of patients, patients already deceased at start of documentation, patients with visceral metastases and patients with opioids at start of AA + P. For these reasons, patients in the EC initially might have had a poorer prognosis. A prospective randomised and controlled clinical trial would therefore be necessary to assess a possible difference in overall survival and response of the AA + P treatment with respect to therapy onset.
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Affiliation(s)
| | | | - Hanjo Belz
- Zeisigwaldkliniken Bethanien Chemnitz, Klinik für Urologie, Chemnitz
| | | | | | - Nguyen Tran
- Janssen-Cilag GmbH, Medical and Scientific Affairs, Neuss
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20
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Dülgar Ö, Özyükseler DT, Başak M, Ay S, Tural D, Yıldırım ME, Gümüş M. Is the duration of castration resistance predictive for sequential treatment responses in the metastatic castration-resistant prostate cancer setting? J Oncol Pharm Pract 2020; 27:1388-1394. [PMID: 32847482 DOI: 10.1177/1078155220951612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Prostate cancer is the second leading cause of cancer death in men. Androgen deprivation therapy (ADT) has been the primary therapeutic approach for treatment of prostate cancer. However,nearly all patients develop the castration-resistant disease . We evaluated real-world data with abiraterone and enzalutamide treatment. By this data, we aimed to analyze whether that prior short response to ADT could predict response to subsequent therapy with androgen receptor axis targeted agent (ARATA). MATERIAL AND METHOD We collected data from two cancer centers, 151 consecutive patients with treated abiraterone or enzalutamide in the first line of metastatic castration resistant prostat cancer (mCRPC) setting were included. The patients who received docetaxel in castration naive setting is also included. Time to castration resistance (TTCR) was defined as the duration from the initial to failure of primary ADT. RESULTS Patients with treated ARATA were divided into two groups according to the time to castration resistance (TTCR). Patients who became resistant to ADT up to one year had a median PFS of 6.6 months, compared to median PFS of 13.3 months for patients who responded ADT for more than 1 year. (p = 0.002). In the post-docetaxel setting, median PFS is 12.6 months of patients with treated ARATA who had TTCR for more than one year, and median PFS is 6.6 months in those who had TTCR less than one year (p = 0.007).Univariate and multivariate analyses were performed to determine the clinical factors on ARATA outcomes. Eastern Cooperative Oncology Group (ECOG) performance status(PS), median prostate-specific antigen(PSA) and time to CRPC were significantly predicted outcomes of ARATA on multivariate analysis. CONCLUSION TTCR is also a predictor for PFS of the patients who were treated ARATA both whole cohort and post-docetaxel.
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Affiliation(s)
- Özgecan Dülgar
- Istanbul Medeniyet University, Goztepe Education and Research Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Deniz Tataroğlu Özyükseler
- Istanbul Kartal Lutfi Kırdar Education and Research Hospital Department of Medical Oncology, Istanbul, Turkey
| | - Mustafa Başak
- Tokat Gaziosmanpaşa University Hospital, Department of Medical Oncology, Tokat, Turkey
| | - Seval Ay
- Istanbul Medeniyet University, Goztepe Education and Research Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Deniz Tural
- Bakırköy Sadi Konuk Education and Research Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Mahmut Emre Yıldırım
- Istanbul Kartal Lutfi Kırdar Education and Research Hospital Department of Medical Oncology, Istanbul, Turkey
| | - Mahmut Gümüş
- Istanbul Medeniyet University, Goztepe Education and Research Hospital, Department of Medical Oncology, Istanbul, Turkey
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21
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Kafka M, Eder IE, Klocker H, Heidegger I. Emerging promising biomarkers for treatment decision in metastatic castration-resistant prostate cancer. Urol Oncol 2020; 38:801-815. [PMID: 32591248 DOI: 10.1016/j.urolonc.2020.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022]
Abstract
Prostate cancer is one of the most common causes of death in males. Even if treatment is often of curative intent in early stages of the disease, up to 50% of patients relapse after primary therapy. Moreover, 10% to 15% of patients present in a primary metastatic stage of disease. In the past years the treatment landscape of metastatic castration-resistant prostate cancer expanded due to the development of second-generation antiandrogens (abiraterone acetate, enzalutamide), chemotherapeutic agents and radium-223. With the availability of several therapeutic lines, we are now confronted with the problem of choosing the most suitable therapy in each state of disease. As often observed in clinical routine, prostate specific antigen is not sufficient for early prediction of a therapy response. Furthermore, biomarkers for prediction of the optimal first-line therapy are badly needed in order to avoid primary resistance. Therefore, the present short review article gives an overview of currently available clinical and preclinical biomarkers for treatment response to metastatic castration-resistant prostate cancer therapeutic agents with the aim of providing support for a personalized decision-making process in everyday use.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Iris E Eder
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut Klocker
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Isabel Heidegger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria.
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22
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Predictors of resistance to abiraterone acetate or enzalutamide in patients with metastatic castration-resistant prostate cancer in post-docetaxel setting: a single-center cohort study. Anticancer Drugs 2020; 31:742-746. [PMID: 32516165 DOI: 10.1097/cad.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Treatment with abiraterone acetate or enzalutamide is one of the approved approaches in men with metastatic castration-resistant prostate cancer (mCRPC) in the post-docetaxel setting. However, a significant fraction of patients do not respond to treatment, and we aimed to determine their characteristics. From April 2015 to May 2019, 71 patients with mCRPC were treated with abiraterone acetate (N = 34) or enzalutamide (N = 37) at our institution. Resistance to treatment was defined as radiological or scintigraphic progression within 3 months, as documented at the first control. After a median follow-up of 14.9 months, resistance was detected in 22 patients (31%). Many of the baseline characteristics differed between responders and nonresponders but did not serve as predictors with clinically acceptable certainty. To overcome this, the resistance score was defined as the number of positive out of the following six predictors: Most patients with resistance and a few responders had >3 positive predictors. Therefore, by using a cutoff of four positive predictors, the resistance score showed both a high sensitivity of 82% [57-96%; 95% confidence interval (CI)] and a specificity of 88% (74-96%; 95% CI). The proposed resistance score integrates the diagnostic performances of multiple predictors and may serve to decide which patients with mCRPC should be offered treatments other than hormonal therapy.
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23
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Mai L, Li Y, Yang P, Zhang Z, Wu J, Zhou F, Liu Y, He L. Successful management of prostate cancer with bulky pelvic lymph node metastases after rapid development of castration-resistant prostate cancer: a case report with review of the literature. Transl Androl Urol 2020; 9:1428-1436. [PMID: 32676427 PMCID: PMC7354291 DOI: 10.21037/tau-20-725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The rapid development of castration-resistant prostate cancer (CRPC) is a poor prognostic sign for loco-regionally advanced prostate cancer. Non-metastatic CRPC (nmCRPC) with bulky regional lymph node metastases is extremely rare and difficult to treat clinically without reported case. We present a case of a 72-year-old man with locally advanced prostate cancer with bulky lymph node metastases (53 mm × 77 mm × 67 mm), developing nmCRPC after 9-month ADT treatment. Immunohistochemistry (IHC) tests found partially positive MUC1 and negative BRCA1 expression in the initial biopsy specimens. Next-generation sequence analysis on the blood specimen after CRPC predicted a good tolerance to docetaxel. According to the multidisciplinary team recommendations, he was administrated docetaxel 75 mg/m2 on day 1 every 21 days for 6 cycles, and subsequently radiotherapy, with the delivery of a total dose of 67.5, 60-65 and 47.5 Gy in 25 fractions to the prostate, the enlarged lymph nodes and the whole pelvis respectively. Over a follow-up of 50 months, his disease has achieved good local control and he is alive without evidence of distant metastases or late adverse events. This case highlights individualized and multimodal therapy of intensification of systemic therapy and timely application of radiotherapy in such rare condition.
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Affiliation(s)
- Lixin Mai
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yonghong Li
- Department of Urology Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ping Yang
- Department of Pathology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zitong Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jianhua Wu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Fangjian Zhou
- Department of Urology Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yang Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Liru He
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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24
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Nagaya N, Nagata M, Lu Y, Kanayama M, Hou Q, Hotta ZU, China T, Kitamura K, Matsushita K, Isotani S, Muto S, Sakamoto Y, Horie S. Prostate-specific membrane antigen in circulating tumor cells is a new poor prognostic marker for castration-resistant prostate cancer. PLoS One 2020; 15:e0226219. [PMID: 31986176 PMCID: PMC6984691 DOI: 10.1371/journal.pone.0226219] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/21/2019] [Indexed: 01/29/2023] Open
Abstract
The aim of this study is to elucidate the clinical significance of prostate-specific membrane antigen (PSMA) expression in circulating tumor cells (CTCs) from castration-resistant prostate cancer (CRPC) patients. We analyzed a total of 203 CTC samples from 79 CRPC patients to investigate the proportion of positive mRNA expressions at different treatment phases. Among them, we elected to focus on specimens from 56 CRPC patients who progressed on therapy and were subsequently provided a new treatment (treatment-switch cohort). In this cohort, we investigated the association between PSMA expression in CTCs and treatment response. CTCs were detected in 55/79 patients and median serum PSA in CTC-positive patients was 67.0 ng/ml. In the treatment-switch cohort of 56 patients, 20 patients were positive for PSMA in CTCs. PSMA expression was inversely associated with percentage of change in prostate-specific antigen (PSA). The median PSA progression-free survival and overall survival were significantly shorter in the PSMA-positive cohort. Furthermore, PSMA expression was predictive of poorer treatment response, shorter PSA progression-free survival and overall survival. PSMA expression in circulating tumor cells may be a novel poor prognostic marker for CRPC.
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MESH Headings
- Aged
- Aged, 80 and over
- Antigens, Surface/blood
- Antigens, Surface/genetics
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Cohort Studies
- Follow-Up Studies
- Glutamate Carboxypeptidase II/blood
- Glutamate Carboxypeptidase II/genetics
- Humans
- Male
- Middle Aged
- Neoplastic Cells, Circulating/metabolism
- Neoplastic Cells, Circulating/pathology
- Prognosis
- Prostatic Neoplasms, Castration-Resistant/blood
- Prostatic Neoplasms, Castration-Resistant/drug therapy
- Prostatic Neoplasms, Castration-Resistant/pathology
- Survival Rate
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Affiliation(s)
- Naoya Nagaya
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masayoshi Nagata
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yan Lu
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mayuko Kanayama
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Qi Hou
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Zen-u Hotta
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Strategic Investigation on Comprehensive Cancer Network, Interfaculty Initiative in Information Studies/Graduate School of Interdisciplinary Information Studies, the University of Tokyo, Tokyo, Japan
| | - Toshiyuki China
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kosuke Kitamura
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhito Matsushita
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shuji Isotani
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Advanced Informatics of Genetic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshiro Sakamoto
- Department of Urology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- * E-mail:
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25
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Pagliuca M, Buonerba C, Fizazi K, Di Lorenzo G. The Evolving Systemic Treatment Landscape for Patients with Advanced Prostate Cancer. Drugs 2019; 79:381-400. [PMID: 30742279 DOI: 10.1007/s40265-019-1060-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Prostate cancer (PC) is a major health issue in developed countries, with, on the one hand, men suffering from sequelae related to unnecessary treatment of non-lethal PC, and, on the other hand, still dying because of advanced PC that progresses to castration-resistant disease. Systemic treatment is the mainstay of therapy of castration-resistant PC (CRPC). To date, a multitude of systemic agents have been tested and many of these have failed to provide a clinically meaningful benefit in CRPC, while others have been approved by the US Food and Drug Administration and/or the European Medicines Agency, including antiandrogen hormonal drugs (abiraterone, enzalutamide, apalutamide), chemotherapy (docetaxel and cabazitaxel), immunotherapy (Sipuleucel-T), and radiopharmaceutical (Radium-223) agents. In this review, systemic treatments regarded as most likely to have an impact in clinical practice are presented and discussed. In addition to the pivotal clinical studies, selected retrospective and non-randomized clinical trials are also discussed if deemed to have an impact on clinical practice or future research. A comprehensive appraisal of the expanding landscape of systemic therapies for advanced PC is provided from an expert perspective, with a focus on novel classification and diagnostic tools that have been paving the way for the development of precision medicine in PC.
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Affiliation(s)
- Martina Pagliuca
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Carlo Buonerba
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
- Experimental Zoo-prophylactic Institute of Southern Italy, Portici, Italy
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Giuseppe Di Lorenzo
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy.
- Department of Medicine, Università degli Studi del Molise, Campobasso, Italy.
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26
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Jayaram A, Wingate A, Wetterskog D, Conteduca V, Khalaf D, Sharabiani MTA, Calabrò F, Barwell L, Feyerabend S, Grande E, Martinez-Carrasco A, Font A, Berruti A, Sternberg CN, Jones R, Lefresne F, Lahaye M, Thomas S, Joshi S, Shen D, Ricci D, Gormley M, Merseburger AS, Tombal B, Annala M, Chi KN, De Giorgi U, Gonzalez-Billalabeitia E, Wyatt AW, Attard G. Plasma Androgen Receptor Copy Number Status at Emergence of Metastatic Castration-Resistant Prostate Cancer: A Pooled Multicohort Analysis. JCO Precis Oncol 2019; 3:1900123. [PMID: 32923850 DOI: 10.1200/po.19.00123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Increases in androgen receptor (AR) copy number (CN) can be detected in plasma DNA when patients develop metastatic castration-resistant prostate cancer. We aim to evaluate the association between AR CN as a continuous variable and clinical outcome. PATIENTS AND METHODS PCR2023 was an international, multi-institution, open-label, phase II study of abiraterone acetate plus prednisolone (AAP) or abiraterone acetate plus dexamethasone that included plasma AR assessment as a predefined exploratory secondary end point. Plasma AR CN data (ClinicalTrials.gov identifier: NCT01867710) from this study (n = 133) were pooled with data from the following three other cohorts: cohort A, which was treated with either AAP or enzalutamide (n = 73); the PREMIERE trial (ClinicalTrials.gov identifier: NCT02288936) of biomarkers for enzalutamide (n = 94); and a phase II trial from British Columbia (ClinicalTrials.gov identifier: NCT02125357) that randomly assigned men to either AAP or enzalutamide (n = 201). The primary outcome measures for the biomarker analysis were overall survival and progression-free survival. RESULTS Using multivariable fractional polynomials analysis using Cox regression models, a nonlinear relationship between plasma AR CN and outcome was identified for overall survival, where initially for small incremental gains in CN there was a large added hazard ratio that plateaued at higher CN. The CN cut point associated with the highest local hazard ratio was 1.92. A similar nonlinear association was observed with progression-free survival. In an exploratory analysis of PCR2023, the time from start of long-term androgen-deprivation therapy to start of AAP or abiraterone acetate plus dexamethasone was significantly shorter in patients with plasma AR CN of 1.92 or greater than patients with plasma AR CN of less than 1.92 (43 v 130 weeks, respectively; P = .005). This was confirmed in cohort A (P = .003), the PREMIERE cohort (P = .03), and the British Colombia cohort (P = .003). CONCLUSION Patients with metastatic castration-resistant prostate cancer can be dichotomized by a plasma AR CN cut point of 1.92. Plasma AR CN value of 1.92 or greater identifies aggressive disease that is poorly responsive to AR targeting and is associated with a prior short response to primary androgen-deprivation therapy.
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Affiliation(s)
- Anuradha Jayaram
- University College London Cancer Institute, London, United Kingdom
| | - Anna Wingate
- University College London Cancer Institute, London, United Kingdom
| | | | - Vincenza Conteduca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy
| | - Daniel Khalaf
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Lorraine Barwell
- University of Glasgow, The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | - Alberto Martinez-Carrasco
- Hospital Universitario Morales Meseguer, Biobanco Nodo 3, Instituto Murciano de Investigación Biosanitaria-Universidad de Murcia, Murcia, Spain
| | - Albert Font
- Institut Catala d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alfredo Berruti
- University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY
| | - Rob Jones
- University of Glasgow, The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | - Shibu Thomas
- Janssen Research and Development, Spring House, PA
| | | | - Dong Shen
- Janssen Research and Development, Spring House, PA
| | | | | | | | - Bertrand Tombal
- Institut de Recherche Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Matti Annala
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Prostate Cancer Research Center, University of Tampere, Tampere, Finland
| | - Kim N Chi
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada.,BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy
| | - Enrique Gonzalez-Billalabeitia
- Hospital Universitario Morales Meseguer, Biobanco Nodo 3, Instituto Murciano de Investigación Biosanitaria-Universidad de Murcia, Murcia, Spain
| | - Alexander W Wyatt
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerhardt Attard
- University College London Cancer Institute, London, United Kingdom
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Values of alkaline phosphatase at the diagnosis of castration resistance and response to primary androgen deprivation therapy as predictors of subsequent metastasis in non-metastatic castration-resistant prostate cancer. Int J Clin Oncol 2019; 25:479-485. [PMID: 31512007 DOI: 10.1007/s10147-019-01541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/01/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Among various therapeutic options available for metastatic castration-resistant prostate cancer (mCRPC), only apalutamide and enzalutamide have shown evidences of improved metastasis-free survival (MFS) for non-metastatic castration-resistant prostate cancer (nmCRPC). However, there is a paucity of evidence to indicate who may be targeted for aggressive therapy among patients with nmCRPC. The objectives of this retrospective study were to explore predictors of metastasis in patients with nmCRPC and to identify a subpopulation of patients with nmCRPC who may benefit from aggressive therapy. METHODS A total of 115 patients with CRPC who had no metastasis detected at the time of diagnosis of CRPC were included in this retrospective study. All patients were treated at Jikei University and its affiliated hospitals. The primary outcome measure was MFS from the time of diagnosis of CRPC. Predictors of MFS were also explored with a multivariate Cox hazard model. RESULTS The median observation period after diagnosis of CRPC was 30 months (range 2-143 months). Kaplan-Meier analysis revealed a median MFS of 76. Multivariate analysis demonstrated that low alkaline phosphatase (ALP) values at diagnosis of CRPC and favorable response to primary androgen deprivation therapy (ADT) were significant predictors of longer MFS (P = 0.011, and 0.031, respectively). CONCLUSIONS Results of this study suggest that high ALP values at diagnosis of CRPC and poor response to primary ADT may predict the propensity of metastasis in patients with nmCRPC. Further prospective studies will be required enrolling more patients to confirm our findings.
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Braadland PR, Ramberg H, Grytli HH, Urbanucci A, Nielsen HK, Guldvik IJ, Engedal A, Ketola K, Wang W, Svindland A, Mills IG, Bjartell A, Taskén KA. The β 2-Adrenergic Receptor Is a Molecular Switch for Neuroendocrine Transdifferentiation of Prostate Cancer Cells. Mol Cancer Res 2019; 17:2154-2168. [PMID: 31395667 DOI: 10.1158/1541-7786.mcr-18-0605] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 04/25/2019] [Accepted: 08/06/2019] [Indexed: 11/16/2022]
Abstract
The incidence of treatment-related neuroendocrine prostate cancer (t-NEPC) is rising as more potent drugs targeting the androgen signaling axis are clinically implemented. Neuroendocrine transdifferentiation (NEtD), an putative initial step in t-NEPC development, is induced by androgen-deprivation therapy (ADT) or anti-androgens, and by activation of the β2-adrenergic receptor (ADRB2) in prostate cancer cell lines. Thus, understanding whether ADRB2 is involved in ADT-initiated NEtD may assist in developing treatment strategies that can prevent or reverse t-NEPC emergence, thereby prolonging therapeutic responses. Here we found that in primary, treatment-naïve prostate cancers, ADRB2 mRNA was positively correlated with expression of luminal differentiation markers, and ADRB2 protein levels were inversely correlated with Gleason grade. ADRB2 mRNA was upregulated in metastatic prostate cancer, and progressively downregulated during ADT and t-NEPC emergence. In androgen-deprivated medium, high ADRB2 was required for LNCaP cells to undergo NEtD, measured as increased neurite outgrowth and expression of neuron differentiation and neuroendocrine genes. ADRB2 overexpression induced a neuroendocrine-like morphology in both androgen receptor (AR)-positive and -negative prostate cancer cell lines. ADRB2 downregulation in LNCaP cells increased canonical Wnt signaling, and GSK3α/β inhibition reduced the expression of neuron differentiation and neuroendocrine genes. In LNCaP xenografts, more pronounced castration-induced NEtD was observed in tumors derived from high than low ADRB2 cells. In conclusion, high ADRB2 expression is required for ADT-induced NEtD, characterized by ADRB2 downregulation and t-NEPC emergence. IMPLICATIONS: This data suggest a potential application of β-blockers to prevent cancer cells committed to a neuroendocrine lineage from evolving into t-NEPC.
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Affiliation(s)
- Peder R Braadland
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Håkon Ramberg
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Helene Hartvedt Grytli
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Alfonso Urbanucci
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo, Oslo, Norway.,Department of Core Facilities, Institute of Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Heidi Kristin Nielsen
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Jenny Guldvik
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Andreas Engedal
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Kirsi Ketola
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Wanzhong Wang
- Clinical Pathology/Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Aud Svindland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Ian G Mills
- Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo, Oslo, Norway.,Movember FASTMAN Centre of Excellence, Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, United Kingdom.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Division of Urological Cancers, Lund University, Malmø, Sweden
| | - Kristin Austlid Taskén
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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29
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Shiota M, Kobayashi T, Kashiwagi E, Takeuchi A, Inokuchi J, Tatsugami K, Eto M. Prognostic significance of antihypertensive agents in men with castration-resistant prostate cancer. Urol Oncol 2019; 37:813.e21-813.e26. [PMID: 31202731 DOI: 10.1016/j.urolonc.2019.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/29/2019] [Accepted: 04/17/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Comorbidity with hypertension (HTN) may affect the outcome of castration-resistant prostate cancer (CRPC). In this study, we evaluated the prognostic impact of antihypertensive agents in patients with CRPC treated with androgen receptor axis-targeting (ARAT) agents or docetaxel chemotherapy. PATIENTS AND METHODS This study included 156 Japanese men with CRPC who were treated with ARAT agents (n = 85) or docetaxel (n = 71) at our hospital between 2008 and 2017. Associations between clinicopathological factors, HTN status, progression-free survival (PFS) and overall survival (OS) were evaluated by univariate and multivariate analysis. RESULTS When adjusted for age, prostate-specific antigen levels at pretreatment, Gleason score, and clinical M-stage, comorbid HTN was significantly associated with better OS (hazards ratio, 95% confidence interval: 0.41, 0.21-0.77; P = 0.0051), but not with PFS (hazards ratio, 95% confidence interval: 0.64, 0.38-1.11; P = 0.11) in patients treated with ARAT agent. However, HTN was not associated with PFS or OS for patients treated with docetaxel. CONCLUSIONS Use of antihypertensive agents has prognostic significance for patients with CRPC treated with ARAT agent, but not docetaxel.
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Affiliation(s)
- Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Takeshi Kobayashi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiji Kashiwagi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ario Takeuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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30
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Higher Serum Testosterone Levels Associated with Favorable Prognosis in Enzalutamide- and Abiraterone-Treated Castration-Resistant Prostate Cancer. J Clin Med 2019; 8:jcm8040489. [PMID: 30978937 PMCID: PMC6518240 DOI: 10.3390/jcm8040489] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 12/19/2022] Open
Abstract
Testosterone plays a significant role in maintaining the tumor microenvironment. The role of the target serum testosterone (TST) level in enzalutamide- (Enza) and abiraterone (Abi)-treated castration-resistant prostate cancer (CRPC) patients was studied. In total, 107 patients treated with Enza and/or Abi at Chiba University Hospital and affiliated hospitals were studied. The relationships between progression-free survival (PFS), overall survival (OS), and clinical factors were studied by Cox proportional hazard and Kaplan–Meier models. In the Abi and Enza groups overall, TST ≥ 13 ng/dL (median) (Hazard Ratio (HR) 0.43, p = 0.0032) remained an independent prognostic factor for PFS. In the Enza group, TST ≥ 13 ng/dL (median) was found to be a significant prognostic factor (HR 0.28, p = 0.0044), while, in the Abi group, TST ≥ 12 ng/dL (median) was not significant (HR 0.40, p = 0.0891). TST showed significant correlation with PFS periods (r = 0. 32, p = 0.0067), whereas, for OS, TST ≥ 13 ng/dL (median) showed no significant difference in the Abi and Enza groups overall. According to Kaplan–Meier analysis, a longer PFS at first-line therapy showed a favorable prognosis in the Enza group (p = 0.0429), while no difference was observed in the Abi group (p = 0.6051). The TST level and PFS of first-line therapy may be considered when determining the treatment strategy for CRPC patients.
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31
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Therapeutic options for first-line metastatic castration-resistant prostate cancer: Suggestions for clinical practise in the CHAARTED and LATITUDE era. Cancer Treat Rev 2019; 74:35-42. [DOI: 10.1016/j.ctrv.2019.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 12/11/2022]
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32
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Boegemann M, Khaksar S, Bera G, Birtle A, Dopchie C, Dourthe LM, Everaert E, Hatzinger M, Hercher D, Hilgers W, Matus G, Alvarez LG, Antoni L, Lukac M, Pissart G, Robinson P, Elliott T. Abiraterone acetate plus prednisone for the Management of Metastatic Castration-Resistant Prostate Cancer (mCRPC) without prior use of chemotherapy: report from a large, international, real-world retrospective cohort study. BMC Cancer 2019; 19:60. [PMID: 30642291 PMCID: PMC6332550 DOI: 10.1186/s12885-019-5280-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/07/2019] [Indexed: 12/01/2022] Open
Abstract
Background With the recent introduction of novel treatment options, real-world data from patients with metastatic castration-resistant prostate cancer (mCRPC) are required to better understand the impact on routine clinical practice. This study primarily aimed to describe the time to treatment failure (TTF) of mCRPC patients treated with abiraterone acetate plus prednisone or the corticosteroid of choice (AAP) in the pre-chemotherapy setting. Other relevant outcomes, clinical and treatment characteristics of these patients were also evaluated. Methods This retrospective, observational study collected data from chemotherapy-naïve mCRPC patients treated with AAP from four European countries. Kaplan-Meier curves were used to estimate TTF, progression-free survival (PFS), and time to first skeletal-related event. The impact of baseline characteristics on TTF and PFS was explored using univariate and multivariate Cox proportional hazard models. Log-rank test was used to assess the potential role of duration of response to ADT in predicting response to AAP treatment. Results Data from 481 eligible patients (Belgium: 68; France: 61; Germany: 150; UK: 202) were analysed. At AAP initiation, the median age of patients was 75.0 years (interquartile range [IQR]: 69.0–81.0), and the median PSA was 56.2 ng/mL (IQR: 22.2–133.1), with over 50% of patients presenting an ECOG score of 0 or 1. Visceral metastases were present in 7.5% of patients; an exclusion criterion in the COU-AA-302 clinical trial. The median TTF with AAP was 10.0 months (95%CI: 9.2–11.1) and the median PFS was 10.8 months (95%CI: 9.6–11.8). Shorter TTF was significantly associated with higher ALP (> 119 units/L), higher PSA (> 56.2 ng/mL), or poorer ECOG PS scores at AAP initiation (p < 0.05). Patients with longer duration of response to ADT (≥12 months) presented longer TTF and longer time to progression (p < 0.0001). Conclusions This European real-world study provides valuable insights into the characteristics, treatment, and outcomes of chemotherapy-naïve patients with mCRPC who received AAP in routine clinical practice. Treatment effectiveness of AAP in the real-world is maintained despite patients having poorer clinical features at initiation than those observed in the COU-AA-302 trial population. Electronic supplementary material The online version of this article (10.1186/s12885-019-5280-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin Boegemann
- Department of Urology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, GB A1, D-48149, Muenster, Germany.
| | - Sara Khaksar
- St Luke's Cancer Centre, The Royal Surrey County Hospital, Guildford, UK
| | - Guillaume Bera
- Groupe Hospitalier Bretagne Sud, Hôpital du Scorff, Lorient, France
| | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital & University of Manchester, Manchester, UK
| | | | | | | | | | - Dirko Hercher
- Refrath Urological Center, Bergisch Gladbach, Germany
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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.
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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.
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Shiota M, Kashiwagi E, Murakami T, Takeuchi A, Imada K, Inokuchi J, Tatsugami K, Eto M. Serum testosterone level as possible predictive marker in androgen receptor axis-targeting agents and taxane chemotherapies for castration-resistant prostate cancer. Urol Oncol 2018; 37:180.e19-180.e24. [PMID: 30446464 DOI: 10.1016/j.urolonc.2018.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/23/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Currently, several therapeutic options for castration-resistant prostate cancer (CRPC) are available, for which predictive biomarkers have not been established. Therefore, we aimed to reveal the association between pretreatment serum testosterone level and antitumor outcomes when treated with androgen receptor axis-targeting agents and taxane chemotherapies for CRPC. PATIENTS AND METHODS The present study included Japanese patients with metastatic prostate cancer whose serum testosterone levels during androgen-deprivation therapy were available. The antitumor outcomes when treated with enzalutamide, abiraterone, docetaxel, and cabazitaxel with clinicopathological parameters including serum testosterone levels during androgen-deprivation therapy, as well as prognoses including progression-free survival and overall survival, were examined. RESULTS Progression-free survival among men with higher serum testosterone level was superior to that among men with lower serum testosterone level when treated with enzalutamide. On the contrary, progression-free survival and overall survival among men with higher serum testosterone level were significantly inferior to those among men with lower serum testosterone level when treated with docetaxel and cabazitaxel, respectively. CONCLUSIONS The present study indicated distinct prognostic values of serum testosterone level when treated with androgen receptor axis-targeting agent and taxane chemotherapy for CRPC, suggesting that serum testosterone level may be useful predictive biomarker to navigate the appropriate therapy in patients with CRPC.
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Affiliation(s)
- Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Eiji Kashiwagi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiko Murakami
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ario Takeuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenjiro Imada
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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35
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Angelergues A, Efstathiou E, Gyftaki R, Wysocki PJ, Lainez N, Gonzalez I, Castellano DE, Ozguroglu M, Carbonero IG, Flechon A, Borrega P, Guillot A, Balea BC, Le Moulec S, Esteban E, Munarriz J, Rubio G, Birtle AJ, Delanoy N, Bellmunt J, Oudard S. Results of the FLAC European Database of Metastatic Castration-Resistant Prostate Cancer Patients Treated With Docetaxel, Cabazitaxel, and Androgen Receptor–Targeted Agents. Clin Genitourin Cancer 2018; 16:e777-e784. [DOI: 10.1016/j.clgc.2018.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/14/2018] [Accepted: 02/18/2018] [Indexed: 10/18/2022]
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36
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Delanoy N, Hardy-Bessard AC, Efstathiou E, Le Moulec S, Basso U, Birtle A, Thomson A, Krainer M, Guillot A, De Giorgi U, Hasbini A, Daugaard G, Bahl A, Chowdhury S, Caffo O, Beuzeboc P, Spaeth D, Eymard JC, Fléchon A, Alexandre J, Helissey C, Butt M, Priou F, Lechevallier É, Deville JL, Goupil MG, Morales R, Thiery-Vuillemin A, Gavrikova T, Barthelemy P, Sella A, Fizazi K, Baciarello G, Fererro JM, Laguerre B, Verret B, Hans S, Oudard S. Sequencing of Taxanes and New Androgen-targeted Therapies in Metastatic Castration-resistant Prostate Cancer: Results of the International Multicentre Retrospective CATS Database. Eur Urol Oncol 2018; 1:467-475. [PMID: 31158090 DOI: 10.1016/j.euo.2018.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/09/2018] [Accepted: 05/16/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The optimal sequence of life-extending therapies in metastatic castration-resistant prostate cancer (mCRPC) is unknown. OBJECTIVE To evaluate outcomes among mCRPC patients treated with docetaxel (DOC), cabazitaxel (CABA), and a novel androgen receptor-targeted agent (ART; abiraterone acetate or enzalutamide) according to three different sequences. DESIGN, SETTING, AND PARTICIPANTS Data from 669 consecutive mCRPC patients were retrospectively collected between November 2012 and October 2016. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the prostate-specific antigen (PSA) response (decrease ≥50% from baseline) to each therapy. Secondary endpoints included best clinical benefit, time to PSA progression, radiological progression-free survival (rPFS), overall survival (OS), and toxicity. RESULTS AND LIMITATIONS A total of 158 patients received DOC→CABA→ART (group 1), 456 received DOC→ART→CABA (group 2), and 55 received ART→DOC→CABA (group 3). At baseline, PSA progression only and Gleason <8 were more common in group 3. PSA response on DOC was lower in group 3 than in other groups (p=0.02) and PSA response on CABA was higher in the second than in the third line (p=0.001). In Group 3, rPFS on ART (6.6 mo) and DOC (9.2 mo) was also shorter than in the other groups. OS calculated from the first life-extending therapy reached 34.8, 35.8, and 28.9 mo in groups 1, 2 and 3, respectively (p=0.007). Toxicity was comparable between the arms. The main limitations of the trial are its retrospective design and the low number of patients in group 3. CONCLUSIONS In this retrospective trial, sequencing of DOC, CABA, and one ART, was associated with median OS of up to 35.8 mo. CABA seemed to retain its activity regardless of treatment sequence. DOC activity after ART appeared to be reduced, but the data are insufficient to conclude that cross-resistance occurs. PATIENT SUMMARY The order of drugs administered to patients with metastatic castration-resistant prostate cancer could impact their efficacy, with cabazitaxel appearing to retain its activity whatever the therapeutic sequence.
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Affiliation(s)
| | | | - Eleni Efstathiou
- Alexandra Hospital, University of Athens, Athens, Greece; Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Alison Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK; University Hospitals of Morecombe Bay, NHS Foundation Trust, Lancaster, UK
| | | | | | - Aline Guillot
- Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | | | - Amit Bahl
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | | | | | | | | | | | - Carole Helissey
- Hôpital d'Instruction des armées, Bégin, Saint Mandé, France
| | - Mohamed Butt
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Frank Priou
- CHD Vendee-Hopital Les Oudairies, La Roche Sur Yon, France
| | | | | | | | | | | | | | | | | | - Karim Fizazi
- Gustave Roussy, University of Paris Sud, Villejuif, France
| | | | | | | | | | - Sophie Hans
- European Georges Pompidou Hospital, Paris, France
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Zhang L, Xu LJ, Zhu J, Li J, Xue BX, Gao J, Sun CY, Zang YC, Zhou YB, Yang DR, Shan YX. ATM‑JAK‑PD‑L1 signaling pathway inhibition decreases EMT and metastasis of androgen‑independent prostate cancer. Mol Med Rep 2018; 17:7045-7054. [PMID: 29568923 PMCID: PMC5928660 DOI: 10.3892/mmr.2018.8781] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/12/2018] [Indexed: 12/19/2022] Open
Abstract
Castration-resistant prostate cancer (CRPC), also known as androgen-independent prostate cancer, frequently develops local and distant metastases, the underlying mechanisms of which remain undetermined. In the present study, surgical specimens obtained from patients with clinical prostate cancer were investigated, and it was revealed that the expression levels of ataxia telangiectasia mutated kinase (ATM) were significantly enhanced in prostate cancer tissues isolated from patients with CRPC compared with from patients with hormone-dependent prostate cancer. CRPC C4-2 and CWR22Rv1 cells lines were subsequently selected to establish prostate cancer models, and ATM knockout cells were established via lentivirus infection. The results of the present study demonstrated that the migration and epithelial-mesenchymal transition (EMT) of ATM knockout cells were significantly decreased, which suggested that ATM is closely associated with CRPC cell migration and EMT. To further investigate the mechanisms underlying this process, programmed cell death 1 ligand 1 (PD-L1) expression was investigated in ATM knockout cells. In addition, inhibitors of Janus kinase (JAK) and signal transducer and activator of transcription 3 (STAT3; Stattic) were added to C4-2-Sc and CWR22Rv1-Sc cells, and the results demonstrated that PD-L1 expression was significantly decreased following the addition of JAK inhibitor 1; however, no significant change was observed following the addition of Stattic. Furthermore, a PD-L1 antibody and JAK inhibitor 1 were added to C4-2-Sc and CWR22Rv1-Sc cells, and it was revealed that cell migration ability was significantly decreased and the expression of EMT-associated markers was effectively reversed. The results of the present study suggested that via inhibition of the ATM-JAK-PD-L1 signaling pathway, EMT, metastasis and progression of CRPC may be effectively suppressed, which may represent a novel therapeutic approach for targeted therapy for patients with CRPC.
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Affiliation(s)
- Lan Zhang
- Emergency Department, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Li-Jun Xu
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Jin Zhu
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Jian Li
- First Department of Urology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Bo-Xin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Jie Gao
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Chuan-Yang Sun
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Ya-Chen Zang
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Yi-Bin Zhou
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Dong-Rong Yang
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Yu-Xi Shan
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
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Sonpavde G, Huang A, Wang L, Baser O, Miao R. Taxane chemotherapy vs antiandrogen agents as first-line therapy for metastatic castration-resistant prostate cancer. BJU Int 2018; 121:871-879. [DOI: 10.1111/bju.14152] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Li Wang
- STATinMED Research; Ann Arbor MI USA
| | - Onur Baser
- STATinMED Research; Ann Arbor MI USA
- Department of Surgery; Center for Innovation & Outcomes Research; Columbia University; New York NY USA
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Komura K, Sweeney CJ, Inamoto T, Ibuki N, Azuma H, Kantoff PW. Current treatment strategies for advanced prostate cancer. Int J Urol 2018; 25:220-231. [PMID: 29266472 PMCID: PMC6053280 DOI: 10.1111/iju.13512] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/09/2017] [Indexed: 12/18/2022]
Abstract
During the past decade, treatment strategies for patients with advanced prostate cancer involving stage IV (T4N0M0, N1M0 or M1) hormone-sensitive prostate cancer and recurrent prostate cancer after treatment with curative intent, as well as castration-resistant prostate cancer, have extensively evolved with the introduction and approval of several new agents including sipuleucel-T, radium-223, abiraterone, enzalutamide and cabazitaxel, all of which have shown significant improvement on overall survival. The appropriate use of these agents and the proper sequencing of these agents are still not optimized. The results of several recently reported randomized controlled trials and retrospective studies could assist in developing a treatment strategy for advanced prostate cancer. In addition, prospective studies and molecular characterization of tumors to address these issues are ongoing.
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Affiliation(s)
- Kazumasa Komura
- Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan
| | | | - Teruo Inamoto
- Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Naokazu Ibuki
- Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Philip W. Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Verzoni E, De Giorgi U, Derosa L, Caffo O, Boccardo F, Facchini G, Porcu L, De Vincenzo F, Zaniboni A, Chiuri VE, Fratino L, Santini D, Adamo V, De Vivo R, Dinota A, Messina C, Ricotta R, Caserta C, Scavelli C, Susi M, Tartarone A, Surace G, Mosca A, Bruno M, Barni S, Grassi P, Procopio G. Predictors of long-term response to abiraterone in patients with metastastic castration-resistant prostate cancer: a retrospective cohort study. Oncotarget 2018; 7:40085-40094. [PMID: 27223078 PMCID: PMC5129994 DOI: 10.18632/oncotarget.9485] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/10/2016] [Indexed: 12/19/2022] Open
Abstract
We aimed to identify clinical predictors of long-term response to abiraterone (defined as >12 months drug exposure) in a retrospective cohort of metastatic castration-resistant prostate cancer patients treated in post-docetaxel setting at 24 Italian centers. The Cox proportional hazards model was used to analyze the association between clinical features and the duration of drug exposure. Results were expressed as hazard ratios (HR) with associated 95% confidence intervals (CI). A total of 143 patients met the inclusion criteria. Their median age was 73 years, median Gleason score 8 and median abiraterone exposure 20 months. At the univariate analysis, a significant correlation with the duration of abiraterone exposure was found for Gleason score (HR 0.82, 95% CI 0.71-0.96; p=0.012), PSA (HR 1.10, 95% CI 1.03-1.18; p=0.08) and lactic dehydrogenase levels (HR 1.22, 95% CI 1.02-1.46; p=0.027), while the association between lower alkaline phosphatase levels and treatment duration was marginally significant (HR 1.07, 95% CI 0.99-1.16; p=0.074). Only PSA and Gleason score were predictive of long-term treatment duration in the multivariate analysis. No other clinical factors resulted to be predictive of sustained response to abiraterone, including metastatic disease at diagnosis and visceral disease, suggesting that all subgroups of patients may derive a substantial clinical benefit from abiraterone treatment. These findings need to be validated in prospective, larger studies.
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Affiliation(s)
- Elena Verzoni
- Unit of Medical Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRST, IRCCS, Meldola, Italy
| | - Lisa Derosa
- Unit of Medical Oncology 2, Istituto Toscano Tumori, Pisa, Italy
| | | | | | - Gaetano Facchini
- Unit of Medical Oncology, Department of Uro-Gynecological Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale IRCCS, Naples, Italy
| | - Luca Porcu
- Department of Oncology, IRCCS- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | | | | | | | | | | | | | | | | | - Riccardo Ricotta
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | | | | | - Marina Susi
- Ospedale Madonna delle Grazie, Matera, Italy
| | - Alfredo Tartarone
- IRCCS Centro di Riferimento Oncologico della Basilicata (CROB), Rionero in Vulture, Italy
| | | | | | | | | | - Paolo Grassi
- Unit of Medical Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giuseppe Procopio
- Unit of Medical Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Poon DMC, Chan CK, Chan TW, Cheung FY, Kwong PWK, Lee EKC, Leung AKC, Leung SYL, Ma WK, So HS, Tam PC, Ho LY. Consensus statements on the management of metastatic prostate cancer from the Hong Kong Urological Association and Hong Kong Society of Uro-Oncology. BJU Int 2018; 121:703-715. [DOI: 10.1111/bju.14091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Darren Ming-Chun Poon
- Department of Clinical Oncology; State Key Laboratory in Oncology in South China; Sir YK Pao Centre for Cancer; Hong Kong Cancer Institute and Prince of Wales Hospital; Chinese University of Hong Kong; Hong Kong Hong Kong
| | - Chi-Kwok Chan
- Department of Surgery; Prince of Wales Hospital; Hong Kong Hong Kong
| | - Tim-Wai Chan
- Department of Clinical Oncology; Queen Elizabeth Hospital; Hong Kong Hong Kong
| | | | | | - Eric Ka-Chai Lee
- Department of Clinical Oncology; Tuen Mun Hospital; Hong Kong Hong Kong
| | | | | | - Wai-Kit Ma
- Department of Surgery; Queen Mary Hospital; Hong Kong Hong Kong
| | - Hing-Shing So
- Division of Urology; Department of Surgery; United Christian Hospital; Hong Kong Hong Kong
| | - Po-Chor Tam
- Department of Surgery; Queen Mary Hospital; Hong Kong Hong Kong
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Duration of response to first androgen deprivation therapy, time to castration resistance prostate cancer, and outcome of metastatic castration resistance prostate cancer patients treated with abiraterone acetate. Anticancer Drugs 2017; 28:110-115. [PMID: 27763885 DOI: 10.1097/cad.0000000000000434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abiraterone acetate (AA) demonstrated its efficacy in the treatment of patients with metastatic castration resistance prostate cancer (mCRPC) in predocetaxel and postdocetaxel setting. However, we learn from pivotal studies that forms of primary and acquired resistance to this drug exist. Patient selection becomes so crucial to optimize treatment results. Potential predictive biomarkers have been identified but are not yet validated. In this scenario, clinical features and disease characteristics may still be of value in selecting patients for different treatments. The objective of this retrospective study was to assess whether or not a correlation between duration of response to first androgen deprivation therapy (ADT), time to castration-resistant prostate cancer (TTCRPC), and outcome of AA therapy exists. A retrospective analysis of clinical data of mCRPC patients treated with AA at two Italian cancer centers was carried out. The Kaplan-Meier method and Cox proportional hazard model were used to analyze survival data. Correlation between median duration of response to first ADT or median TTCRPC and the outcome of patients treated with AA was analyzed. From January 2015 to November 2015, data of 59 patients with mCRPC were collected. We observed no differences in patient's median progression-free survival (PFS) and biochemical progression-free survival (bPFS), according to both median duration of response to first-line ADT (duration of first ADT<13 months: median PFS and bPFS were 11 and 5 months, respectively; duration of ADT≥13 months: median PFS and bPFS were 9 and 6 months, respectively) and median TTCRPC (TTCRPC<28 months: median PFS and bPFS were 8 and 5 months, respectively; TTCRPC≥28 months: median PFS and bPFS were 10 and 9 months, respectively). Overall survival, in the same group, did not differ between patients with a duration of response to first ADT over or under 13 months (P=0.90) but in patients with a TTCRPC of 28 months or more, there was a trend toward longer survival than patients with TTCRPC less than 28 months (5-year overall survival was 74 vs. 50%; P=0.14). The duration of response to first-line ADT and the TTCRPC showed no significant association with outcome of AA therapy in patients with mCRPC. However, large prospective trials are desirable to confirm these data.
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Turpin A, Pasquier D, Massard C, Berdah JF, Culine S, Penel N. First-line management of metastatic castrate-resistant prostate cancer patients: Audit of real-life practices. Bull Cancer 2017; 104:552-558. [PMID: 28390646 DOI: 10.1016/j.bulcan.2017.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/20/2016] [Accepted: 02/05/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND No reliable guidelines are available for choosing the best option between docetaxel and new hormonal therapies (NHTs) (i.e., abiraterone and enzalutamide) in first-line therapy for metastatic castration-resistant prostate cancer (mCRPC) patients. We performed an audit of real-life practices. METHODS We built an online questionnaire and distributed it with the help of French oncology networks. This questionnaire was sent to 481 physicians who treat patients with mCRPC. All of the answers were declarative, individual, and anonymized. A descriptive analysis was done. A univariate logistic regression analysis was performed for the criteria of choice between docetaxel and NHTs. RESULTS From March to July 2015, 109/481 physicians (22.6%) completed the questionnaire. The selection criteria for initially choosing docetaxel were as follows: presence of visceral metastases (79.8%), heavy tumor burden (68.8%), aggressive tumor disease (66.1%), and short-term efficacy of castration (66.1%). The selection criteria for initially choosing NHTs were as follows: long-term efficacy of castration (66.1%), higher age (67.9%), low tumor grade (56.9%), and absence of symptoms (54.1%). With docetaxel, the first tumor assessment was typically performed after three (1-6) cycles, including prostate-specific antigen (PSA) testing (96.3%), a thoraco-abdominopelvic CT scan (68.8%), and bone scintigraphy (59.6%). With NHTs, tumor assessment was mainly performed after 3 months of treatment (1-6) and included PSA testing, a thoraco-abdominopelvic CT, and bone scintigraphy in 90.8%, 61.5%, and 63.3% of cases, respectively. CONCLUSIONS This is the first study assessing real-life practices among physicians who treat patients with mCRPC. These practices were found to be homogeneous.
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Affiliation(s)
- Anthony Turpin
- CHRU de Lille, medical oncology department, rue Michel-Polonovski, 59037 Lille cedex, France; Institut de biologie de Lille, CNRS-UMR8161, 1, rue du Professeur-Calmette, 59021 Lille cedex, France.
| | - David Pasquier
- Centre Oscar-Lambret, department of radiotherapy, 3, rue F.-Combemale, 59020 Lille, France
| | - Christophe Massard
- Gustave-Roussy hospital, department of therapeutic innovation and early trials, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Jean-François Berdah
- Clinique Sainte-Marguerite, medical oncology department, oncovar, avenue Alexis-Godillot, 83400 Hyères, France
| | - Stéphane Culine
- AP-HP, Saint-Louis hospital, medical oncology, 75010 Paris, France
| | - Nicolas Penel
- Centre Oscar-Lambret, medical oncology department, 3, rue F.-Combemale, 59020 Lille, France; SIRIC ONCOLille Consortium, Clinical Research and Methodology Platform, 59000 Lille, France
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González Del Alba A, Arranz JÁ, Puente J, Méndez-Vidal MJ, Gallardo E, Grande E, Pérez-Valderrama B, González-Billalabeitia E, Lázaro-Quintela M, Pinto Á, Lainez N, Piulats JM, Esteban E, Maroto Rey JP, García JA, Suárez C. Recent advances in genitourinary tumors: A review focused on biology and systemic treatment. Crit Rev Oncol Hematol 2017; 113:171-190. [PMID: 28427506 DOI: 10.1016/j.critrevonc.2017.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/23/2016] [Accepted: 03/09/2017] [Indexed: 01/04/2023] Open
Abstract
Updated information published up to 2016 regarding major advances in renal cancer, bladder cancer, and prostate cancer is here presented. Based on an ever better understanding of the genetic and molecular alterations that govern the initial pathogenic mechanisms of tumor oncogenesis, an improvement in the characterization and treatment of urologic tumors has been achieved in the past year. According to the Cancer Genome Atlas (ATLAS) project, alterations in the MET pathway are characteristics of type 1 papillary renal cell carcinomas, and activation of NRF2-ARE pathway is associated with the biologically distinct type 2. While sunitinib and pazopanib continue to be the standard first-line treatment in metastatic renal cell carcinoma of clear cell histology, nivolumab and cabozantinib are now the agents of choice in the second-line setting. In relation to urothelial bladder carcinoma, new potential molecular targets such as FGFR3, PI3K/AKT, RTK/RAS, CDKN2A, ARIDIA, ERBB2 have been identified. Response to adjuvant cisplatin-based chemotherapy appears to be related to basal, luminal, and p53-like intrinsic subtypes. A phase II study with eribulin and a maintenance phase II trial with vinflunine have shown promising results. Similarly, the use of the check point inhibitors in advanced disease is likely to revolutionize the management of patients who have progressed after cisplatin-based chemotherapy. In prostate cancer, seven mutually exclusive molecular subtypes have been identified by the TCGA project. Chemotherapy has been consolidated as a key treatment for castration-sensitive metastatic prostate cancer, and abiraterone, enzalutamide, cabazitaxel, and radium-223 remain standard therapeutic options for men with metastatic castration-resistant prostate cancer. All this progress will undoubtedly contribute to the development of new treatments and therapeutic strategies that will improve the survival and quality of life of our patients.
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Affiliation(s)
| | - José Ángel Arranz
- Medical Oncology Department, Unit of Urological and Gynecological Tumors, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Puente
- Medical Oncology Department, Hospital Universitario San Carlos, Madrid, Spain
| | - María José Méndez-Vidal
- Oncology Department, Maimonides Institute of Medical Research (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Enrique Gallardo
- Oncology Department, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Enrique Grande
- Medical Oncology Department, GI, Endocrine and Translational Research Unit, Early Drug Development Unit-IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Álvaro Pinto
- Medical Oncology Department, Hospital Universitario La Paz, Instituto de Investigación Sanitaria Hospital La Paz (IdiPAZ), Madrid, Spain
| | - Nuria Lainez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Josep M Piulats
- Medical Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emilio Esteban
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Jorge A García
- Hematology/Oncology and Urology Departments, Cleveland Clinic, Cleveland, OH, United States
| | - Cristina Suárez
- Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Mizokami A, Izumi K, Konaka H, Kitagawa Y, Kadono Y, Narimoto K, Nohara T, Bahl AK, Namiki M. Understanding prostate-specific antigen dynamics in monitoring metastatic castration-resistant prostate cancer: implications for clinical practice. Asian J Androl 2017; 19:143-148. [PMID: 27270339 PMCID: PMC5312209 DOI: 10.4103/1008-682x.179159] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Availability of novel hormonal therapies as well as docetaxel and cabazitaxel treatment for metastatic castration-resistant prostate cancer (CRPC) has changed the outlook for this group of patients with improvements in progression-free survival and overall survival. Physicians often diagnose the progression of prostate cancer using serum prostate-specific antigen (PSA). However, serum PSA is not always correlated with the clinical status in CRPC. To evaluate the PSA dynamics with greater precision, understanding of the control of PSA and of the mechanisms of development of CRPC is needed. Moreover, it is necessary to use new hormonal therapies with an appropriate timing to optimally improve the prognosis and the QOL of the patients. In the present review, we ascertain the PSA dynamics and the mechanisms of the development of CRPC to assist in optimal utilization of the new treatments for mCRPC.
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Affiliation(s)
- Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi Kanazawa, 920-8640 Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi Kanazawa, 920-8640 Japan
| | - Hiroyuki Konaka
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi Kanazawa, 920-8640 Japan
| | - Yasuhide Kitagawa
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi Kanazawa, 920-8640 Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi Kanazawa, 920-8640 Japan
| | - Kazutaka Narimoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi Kanazawa, 920-8640 Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi Kanazawa, 920-8640 Japan
| | - Amit K Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, BS2 8ED, UK
| | - Mikio Namiki
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi Kanazawa, 920-8640 Japan
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Fizazi K, Massard C, Bono P, Kataja V, James N, Tammela TL, Joensuu H, Aspegren J, Mustonen M. Safety and Antitumour Activity of ODM-201 (BAY-1841788) in Castration-resistant, CYP17 Inhibitor-naïve Prostate Cancer: Results from Extended Follow-up of the ARADES Trial. Eur Urol Focus 2017; 3:606-614. [PMID: 28753849 DOI: 10.1016/j.euf.2017.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/23/2016] [Accepted: 01/18/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with castration-resistant prostate cancer (CRPC) had extended responses to the androgen receptor antagonist ODM-201, in phase 1/2 studies. OBJECTIVE To evaluate the safety and antitumour activity of prolonged ODM-201 treatment in patients with CRPC. DESIGN, SETTING, AND PARTICIPANTS The ARADES trial was a multicentre phase 1 (dose escalation) and phase 2 (dose expansion) trial; 134 patients with CRPC were stratified by previous chemotherapy to receive ODM-201. This paper reports extended follow-up in CYP17 inhibitor (CYP17i)-naïve patients. INTERVENTION Patients (n=77) received oral ODM-201 twice daily at daily doses of 200-1800mg. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Safety, measured as the occurrence of adverse events (AEs), prostate-specific antigen (PSA), and radiographic progression. RESULTS AND LIMITATIONS The safety profile of extended ODM-201 treatment (median treatment duration 8.2 mo, 95% confidence interval [CI] 5.6-11.0) was consistent with that reported at the time of the original data cutoff in the main ARADES trial, with no unexpected safety concerns over time. The majority of AEs (61.1%) were mild (grade 1); the most common AE was fatigue/asthenia (35.1% of patients), with no clear relationship to ODM-201. Median time to PSA progression was 25.2 mo (95% CI 11.3-25.2) for chemotherapy-naïve men and not reached (NR; 95% CI 5.5-NR) for chemotherapy-pretreated patients; a trend for improved antitumour response was observed for chemotherapy-naïve patients. The median time to radiographic progression was longer for chemotherapy-naïve (14.0 mo, 95% CI 8.1-33.3) than for chemotherapy-pretreated (7.2 mo, 95% CI 2.7-11.0) patients. CONCLUSIONS Prolonged exposure to ODM-201 was well tolerated, with no additional safety concerns; disease suppression was sustained, especially in chemotherapy-naïve patients. These data support further development of ODM-201 in men with CYP17i-naïve CRPC. PATIENT SUMMARY Extended ODM-201 therapy was well tolerated, with beneficial antitumour activity in men with advanced prostate cancer, indicating that ODM-201 may represent a new active treatment for men with CRPC. This extension trial is registered at ClinicalTrials.gov (www.clinicaltrials.gov) under identification number NCT01429064.
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Affiliation(s)
- Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France.
| | | | - Petri Bono
- Comprehensive Cancer Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Nicholas James
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Heikki Joensuu
- Comprehensive Cancer Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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The Natural History and Outcome Predictors of Metastatic Castration-resistant Prostate Cancer. Eur Urol Focus 2017; 2:480-487. [PMID: 28723513 DOI: 10.1016/j.euf.2016.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 01/04/2023]
Abstract
CONTEXT Biomarkers for the treatment of metastatic castration-resistant prostate cancer (mCRPC) are urgently needed by clinicians to facilitate treatment decisions. OBJECTIVE To review current prognostic and predictive biomarkers in mCRPC. EVIDENCE ACQUISITION We performed a nonsystematic review of the literature from 2004 to August 2016 by searching in Medline. Cross-matching references were used to search for additional articles. We reviewed clinical research and review articles written in the English language. EVIDENCE SYNTHESIS Nomograms of prognostic factors (eg, albumin, lactate dehydrogenase) enable clinicians to estimate the prognosis of men with mCRPC. These prognostic tools may aid with when to trigger treatment, therapeutic monitoring, and follow-up. However, validated predictive biomarkers in mCRPC are still lacking. Androgen receptor (AR) splice variants (ie, AR-V7), gene fusions, and point mutations determined using liquid biopsies such as circulating tumor cells (CTCs) or cell-free DNA (cfDNA) are promising biomarkers that are the subject of ongoing research. Patient biomarkers (eg, neutrophil-to-lymphocyte ratio) are readily available and come with no extra cost but need further validation before their implementation in clinical practice. CONCLUSIONS Determination of AR-V7 in CTCs is a big step towards a more personalized treatment approach in mCRPC. Genomic characterization of liquid biopsies such as CTCs, cfDNA, and circulating RNA are noninvasive tools to further personalize treatment in prostate cancer. Clinical parameters are readily available, but are derived from retrospective studies and should be interpreted with care. Only by conducting biomarker-driven studies, rather than large one-size-fits-all trials, will we be able to improve prostate cancer treatment. PATIENT SUMMARY Several biomarkers are currently under investigation that may predict which patients will respond to specific therapies in the future of metastatic castration-resistant prostate cancer treatment.
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McKay RR, Werner L, Fiorillo M, Nakabayashi M, Kantoff PW, Taplin ME. Predictors of duration of abiraterone acetate in men with castration-resistant prostate cancer. Prostate Cancer Prostatic Dis 2016; 19:398-405. [PMID: 27502737 PMCID: PMC6034654 DOI: 10.1038/pcan.2016.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/08/2016] [Accepted: 05/02/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Androgen receptor signaling remains important in castration-resistant prostate cancer (CRPC) as demonstrated by the efficacy of abiraterone acetate (henceforth abiraterone) in phase III trials. Given that heterogeneous patient responses are observed, we sought to identify clinical factors associated with duration of abiraterone. METHODS We retrospectively identified patients with CRPC treated with abiraterone in our database. Patient characteristics and types and duration of prostate cancer (PC) therapies were analyzed. These parameters were analyzed with duration of abiraterone in univariate and multivariable analyses. RESULTS We identified 161 patients who had received abiraterone. All had received primary androgen-deprivation therapy (ADT), 86% prior secondary hormone therapy (SHT) and 33% prior chemotherapy. The median duration of primary ADT was 23 months, duration of SHT (excluding abiraterone) was 17 months and duration of chemotherapy was 8 months. We demonstrated that lower PSA at abiraterone initiation, longer primary ADT duration, no prior ketoconazole, no prior chemotherapy and longer chemotherapy duration were associated with a longer duration on abiraterone in univariate analysis. In multivariable analysis, duration of primary ADT (duration of abiraterone 9 versus 13 months for ⩽12 versus >12 months, P=0.03) and no use of prior chemotherapy (duration of abiraterone 16 versus 7 months for no versus yes prior chemotherapy, P<0.01) were associated with duration of abiraterone. CONCLUSIONS Several clinical parameters, including type and duration of prior therapy, are predictive of responsiveness to abiraterone. These parameters are logical and correlate with smaller disease burden or less exposure to PC therapies. This information can help physicians counsel patients about the potential durability of efficacy of abiraterone. Identifying predictive biomarkers that inform patient selection for therapy is critical to optimizing treatment outcomes.
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Affiliation(s)
| | | | | | | | - Philip W. Kantoff
- Dana-Farber Cancer Institute, Boston, MA
- Memorial Sloan Kettering Cancer Center, New York, NY
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Lorente D, Fizazi K, Sweeney C, de Bono JS. Optimal Treatment Sequence for Metastatic Castration-resistant Prostate Cancer. Eur Urol Focus 2016; 2:488-498. [DOI: 10.1016/j.euf.2016.10.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/26/2016] [Accepted: 10/13/2016] [Indexed: 12/22/2022]
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