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La J, Wang L, Corrigan JK, Lang D, Lee MH, Do NV, Brophy MT, Paller CJ, Fillmore NR. Abiraterone or Enzalutamide for Patients With Metastatic Castration-Resistant Prostate Cancer. JAMA Netw Open 2024; 7:e2428444. [PMID: 39150709 PMCID: PMC11329885 DOI: 10.1001/jamanetworkopen.2024.28444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/21/2024] [Indexed: 08/17/2024] Open
Abstract
Importance Abiraterone acetate and enzalutamide are recommended as preferred treatments for metastatic castration-resistant prostate cancer (mCRPC), but differences in their relative efficacy are unclear due to a lack of head-to-head clinical trials. Clear guidance is needed for making informed mCRPC therapeutic choices. Objective To compare clinical outcomes in patients with mCRPC treated with abiraterone acetate or enzalutamide. Design, Setting, and Participants This retrospective, multicenter cohort study included patients with mCRPC in the US Department of Veterans Affairs health care system who initiated treatment with abiraterone acetate or enzalutamide between January 1, 2014, and October 30, 2022. Exposures Abiraterone acetate or enzalutamide. Main Outcomes and Measures The study used inverse probability of treatment weighting to balance baseline characteristics between patients initiating abiraterone acetate or enzalutamide and evaluated restricted mean survival time (RMST) differences in overall survival (OS), prostate cancer-specific survival (PCS), time to next treatment switching or death (TTS), and time to prostate-specific antigen (PSA) response (TTR) at different time points after treatment initiation. Results The study included 5779 patients (median age, 74.42 years [IQR, 68.94-82.14 years]). Median follow-up was between 38 and 60 months. Patients initiating enzalutamide on average had longer OS than those initiating abiraterone acetate, with RMSTs of 24.29 months (95% CI, 23.58-24.99 months) and 23.38 months (95% CI, 22.85-23.92 months), respectively, and a difference in RMST of 0.90 months (95% CI, 0.02-1.79 months) at 4 years. Similarly, TTS and TTR were improved in patients initiating enzalutamide, with an RMST at 4 years of 1.95 months (95% CI, 0.92-2.99 months) longer for TTS and 3.57 months (95% CI, 1.76-5.38 months) shorter for TTR. For PCS, the RMST at 2 years was 0.48 months (95% CI, 0.01-0.95 months) longer. An examination of subgroups identified that enzalutamide initiation was associated with longer RMST in OS among patients without prior docetaxel treatment (1.14 months; 95% CI, 0.19-2.10 months) and in those with PSA doubling time of 3 months or longer (2.23 months; 95% CI, 0.81-3.66 months) but not among patients with prior docetaxel (-0.25 months; 95% CI, -2.59 to 2.09 months) or with PSA doubling time of less than 3 months (0.05 months; 95% CI, -1.05 to 1.15 months). Conclusions and Relevance In this cohort study of patients with mCRPC, initiation of enzalutamide was associated with small but statistically significant improvements in OS, PCS, TTS, and TTR compared with initiation of abiraterone acetate. The improvements were more prominent in short-term outcomes, including TTS and TTR, and in patient subgroups without prior docetaxel or with PSA doubling time longer than 3 months.
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Affiliation(s)
- Jennifer La
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lin Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - June K. Corrigan
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, Massachusetts
| | - Deborah Lang
- Department of Dermatology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Michelle H. Lee
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Mass General Cancer Center, Massachusetts General Hospital, Boston
| | - Nhan V. Do
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, Massachusetts
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Mary T. Brophy
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, Massachusetts
- Section of Hematology & Medical Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Channing J. Paller
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, Massachusetts
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathanael R. Fillmore
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Ding H, Li S, Xu X, Xu W, He C, Xin W, Zhan Z, Fang L. Cost-effectiveness analysis of rezvilutamide versus bicalutamide in the treatment of metastatic hormone-sensitive prostate cancer. BMJ Open 2024; 14:e073170. [PMID: 39002960 PMCID: PMC11253765 DOI: 10.1136/bmjopen-2023-073170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/17/2024] [Indexed: 07/15/2024] Open
Abstract
OBJECTIVES The economic implications of combining rezvilutamide with androgen deprivation therapy (ADT) remain uncertain, despite the observed survival advantages compared with bicalutamide plus ADT. Therefore, this study evaluates the cost-effectiveness of rezvilutamide plus ADT as the first-line treatment of metastatic hormone-sensitive prostate cancer (mHSPC) from the perspective of the Chinese healthcare system. DESIGN A partitioned survival model was developed to assess the cost-effectiveness of rezvilutamide combined with ADT. Clinical data were obtained from the CHART trial. Costs and utility values were obtained from local estimate and published literature. Only direct medical costs were included in the model. INTERVENTIONS Rezvilutamide was administered at 240 mg daily or bicalutamide at 50 mg daily until progression. OUTCOME MEASURES The main outputs of the model included costs and quality-adjusted life years (QALYs), which were used to determine the incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analysis (PSA) were used to explore model uncertainties. RESULTS The rezvilutamide group showed an expected gain of 2.28 QALYs and an incremental cost of US$60 758.82 compared with the bicalutamide group. The ICER for rezvilutamide group versus bicalutamide group was US$26 656.94 per QALY. The variables with the greatest impact on the model results were the utility for progression-free survival state and the price of rezvilutamide. PSA revealed that rezvilutamide group had 100% probability of being cost-effective at a willingness-to-pay threshold of US$35707.5 per QALY. CONCLUSION Rezvilutamide in combination with ADT is more cost-effective compared with bicalutamide plus ADT as the first-line treatment of mHSPC from the perspective of the Chinese healthcare system.
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Affiliation(s)
- Haiying Ding
- Department of Pharmacy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Shujing Li
- Zhejiang University of Technology, Hangzhou, China
| | - Xinglu Xu
- Department of Pharmacy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Weiben Xu
- Zhejiang University of Technology, Hangzhou, China
| | - Chaoneng He
- Department of Pharmacy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Wenxiu Xin
- Department of Pharmacy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - ZhaJun Zhan
- Zhejiang University of Technology, Hangzhou, China
| | - Luo Fang
- Department of Pharmacy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
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Gebrael G, Jo Y, Swami U, Plets M, Hage Chehade C, Narang A, Gupta S, Myint ZW, Sayegh N, Tangen CM, Hussain M, Dorff T, Lara PN, Lerner SP, Thompson I, Agarwal N. Bone Pain and Survival Among Patients With Metastatic, Hormone-Sensitive Prostate Cancer: A Secondary Analysis of the SWOG-1216 Trial. JAMA Netw Open 2024; 7:e2419966. [PMID: 38980676 PMCID: PMC11234233 DOI: 10.1001/jamanetworkopen.2024.19966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Importance The presence of bone pain is significantly associated with worse overall survival (OS) in patients with castration-resistant prostate cancer. However, there are few data regarding bone pain and survival outcomes in the context of metastatic, hormone-sensitive prostate cancer (MHSPC). Objective To compare survival outcomes among patients with MHSPC by presence or absence of baseline bone pain at diagnosis. Design, Setting, and Participants This post hoc secondary analysis, conducted from September 1 to December 31, 2023, used patient-level data from SWOG-1216, a phase 3, prospective randomized clinical trial that enrolled patients with newly diagnosed MHSPC from 248 academic and community centers across the US from March 1, 2013, to July 15, 2017. All patients in the intention-to-treat population who had available bone pain status were eligible and included in this secondary analysis. Interventions In the SWOG-1216 trial, patients were randomized (1:1) to receive either androgen deprivation therapy (ADT) with orteronel, 300 mg orally twice daily (experimental group), or ADT with bicalutamide, 50 mg orally daily (control group), until disease progression, unacceptable toxic effects, or patient withdrawal. Main Outcomes and Measures Overall survival was the primary end point; progression-free survival (PFS) and prostate-specific antigen (PSA) response were secondary end points. Cox proportional hazards regression models were used for both univariable and multivariable analyses adjusting for age, treatment type, Gleason score, disease volume, Zubrod performance status, and PSA level. Results Of the 1279 male study participants, 301 (23.5%) had baseline bone pain at MHSPC diagnosis and 896 (70.1%) did not. Bone pain status was unavailable in 82 patients (6.4%). The median age of the 1197 patients eligible and included in this secondary analysis was 67.6 years (IQR, 61.8-73.6 years). Compared with patients who did not experience bone pain, those with baseline bone pain were younger (median age, 66.0 [IQR, 60.1-73.4] years vs 68.2 [IQR, 62.4-73.7] years; P = .02) and had a higher incidence of high-volume disease (212 [70.4%] vs 373 [41.6%]; P < .001). After adjustment, bone pain was associated with shorter PFS and OS. At a median follow-up of 4.0 years (IQR, 2.5-5.4 years), patients with bone pain had median PFS of 1.3 years (95% CI, 1.1-1.7 years) vs 3.7 years (95% CI, 3.3-4.2 years) in patients without initial bone pain (adjusted hazard ratio [AHR], 1.46; 95% CI, 1.22-1.74; P < .001) and OS of 3.9 years (95% CI, 3.3-4.8 years) vs not reached (NR) (95% CI, 6.6 years to NR) in patients without initial bone pain (AHR, 1.66; 95% CI, 1.34-2.05; P < .001). Conclusions and Relevance In this post hoc secondary analysis of the SWOG-1216 randomized clinical trial, patients with baseline bone pain at MHSPC diagnosis had worse survival outcomes than those without bone pain. These data suggest prioritizing these patients for enrollment in clinical trials, may aid patient counseling, and indicate that the inclusion of bone pain in prognostic models of MHSPC may be warranted. Trial Registration ClinicalTrials.gov Identifier: NCT01809691.
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Affiliation(s)
- Georges Gebrael
- Huntsman Cancer Institute at the University of Utah, Salt Lake City
| | - Yeonjung Jo
- Huntsman Cancer Institute at the University of Utah, Salt Lake City
| | - Umang Swami
- Huntsman Cancer Institute at the University of Utah, Salt Lake City
| | - Melissa Plets
- SWOG Statistics and Data Management Center, Seattle, Washington
| | | | - Arshit Narang
- Huntsman Cancer Institute at the University of Utah, Salt Lake City
| | - Shilpa Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Zin W Myint
- Department of Internal Medicine-Division of Medical Oncology, University of Kentucky, Lexington
| | - Nicolas Sayegh
- Huntsman Cancer Institute at the University of Utah, Salt Lake City
| | | | - Maha Hussain
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tanya Dorff
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Primo N Lara
- University of California, Davis Comprehensive Cancer Center, Sacramento
| | | | - Ian Thompson
- University of Texas Health Science Center at San Antonio, San Antonio
| | - Neeraj Agarwal
- Huntsman Cancer Institute at the University of Utah, Salt Lake City
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Alonso-Gordoa T, Goodman M, Vulsteke C, Roubaud G, Zhang J, Parikh M, Piulats JM, Azaro A, James GD, Cavazzina R, Gangl ET, Thompson J, Pouliot G, Kumar R, Sweeney C. A phase II study (AARDVARC) of AZD4635 in combination with durvalumab and cabazitaxel in patients with progressive, metastatic, castration-resistant prostate cancer. ESMO Open 2024; 9:103446. [PMID: 38838502 PMCID: PMC11190476 DOI: 10.1016/j.esmoop.2024.103446] [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: 01/25/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND This phase II nonrandomized study evaluated the efficacy and safety of AZD4635 in combination with durvalumab (Arm A) or durvalumab plus cabazitaxel (Arm B) in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with docetaxel and ≥1 novel hormonal agent. PATIENTS AND METHODS The primary endpoint was radiographic progression-free survival (rPFS) per RECIST v1.1 (soft tissue) or the Prostate Cancer Clinical Trials Working Group 3 (bone). Secondary endpoints included safety, tolerability, overall survival, confirmed prostate-specific antigen (PSA50) response, pharmacokinetics, and objective response rate. Enrollment in Arm A was stopped following a sponsor decision unrelated to safety. The study was stopped based on the planned futility analysis due to low PSA50 response in Arm B. RESULTS In the final analysis (1 November 2021), 30 patients were treated (Arm A, n = 2; Arm B, n = 28). The median rPFS in Arm B was 5.8 months (95% confidence interval 4.2-not calculable). Median rPFS was 5.8 months versus 4.2 months for patients with high versus low blood-based adenosine signature. The most common treatment-related adverse events in Arm B were nausea (50.0%), diarrhea (46.4%), anemia and neutropenia (both 35.7%), asthenia (32.1%), and vomiting (28.6%). Overall, AZD4635 in combination with durvalumab or AZD4635 in combination with cabazitaxel and durvalumab showed limited efficacy in patients with mCRPC. CONCLUSIONS Although the safety profile of both combinations was consistent with known safety data of the individual agents, the results of this trial do not support further development of the combinations.
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Affiliation(s)
| | - M Goodman
- Atrium Health Wake Forest Baptist, Winston-Salem, USA
| | - C Vulsteke
- Integrated Cancer Center, Maria Middelares General Hospital, Ghent; Center for Oncological Research, University of Antwerp, Antwerp, Belgium
| | | | - J Zhang
- H. Lee Moffitt Cancer Center & Research Institute, Tampa
| | - M Parikh
- Hematology/Oncology Clinic, UC Davis Comprehensive Cancer Center, Sacramento, USA
| | - J M Piulats
- Catalan Institute of Oncology, Barcelona, Spain
| | - A Azaro
- Oncology R&D, AstraZeneca, Cambridge
| | - G D James
- Medical Statistics Consultancy Ltd, London, UK
| | | | | | | | | | - R Kumar
- Oncology R&D, AstraZeneca, Gaithersburg
| | - C Sweeney
- Dana-Farber Cancer Institute, Boston, USA
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Al-Samsam S, Bartos J, Samal V, Dvorak J, Kolarova H, Richter I. Abiraterone and enzalutamide in the first line therapy of metastatic castration resistant prostate cancer. Rep Pract Oncol Radiother 2024; 29:1-9. [PMID: 39165601 PMCID: PMC11333069 DOI: 10.5603/rpor.99028] [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: 06/05/2023] [Accepted: 01/09/2024] [Indexed: 08/22/2024] Open
Abstract
Background The aim was to assess therapeutic outcomes and tolerance in patients with metastatic castration resistant prostate cancer (mCRPC) treated with androgen receptor targeted agents (ARTA) treatment at one oncological center in the Czech Republic. Materials and methods Retrospective analysis of 64 patients with mCRPC treated with abiraterone (50 patients) and enzalutamide (14 patients) in the first line of this disease was conducted. Kaplan-Meier analysis was used to calculate progression free survival (PFS) and overall survival (OS). We performed a multivariate analysis of risk factors for treatment outcomes (PFS, OS) by Cox regression analysis. Results The median follow-up was 28.4 months. The median PFS was 15.4 months [95% confidence interval (CI): 12.3-18.5], median OS was 38.2 months (95% CI: 19.9-56.5). Regression analysis demonstrated a favorable prognostic effect on PFS in patients with reduction of PSA ≥ 50 %, in patients with early reduction of prostate-specific antigen (PSA) ≥ 50% within 3 months, in patients younger than 74 years and in overall performance status (PS) 0. Regression analysis demonstrated a favorable prognostic effect on OS in patients with reduction of PSA ≥ 50 %, in patients with early reduction of PSA ≥ 50 % within 3 months and in patients with overall PS 0. Adverse effects grade 3-4 were reported in 17 (27.9%) patients in abirateron arm and in 1 (7.1%) patient in enzalutamide arm. Conclusion The analysis of patients with mCRPC treated with ARTA in the first line showed that ARTA represents an effective and safe therapy and contributes to longer survival.
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Affiliation(s)
- Sofya Al-Samsam
- Department of Oncology, Regional Hospital Liberec, Czech Republic
| | - Jiri Bartos
- Department of Oncology, Regional Hospital Liberec, Czech Republic
| | - Vladimir Samal
- Department of Urology, Regional Hospital Liberec, Czech Republic
| | - Josef Dvorak
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | | | - Igor Richter
- Department of Oncology, Regional Hospital Liberec, Czech Republic
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
- Technical University of Liberec, Czech Republic
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You H, Song G, Xu Z, Chen S, Shen W, Liu H, Deng B, Li J, Huang G. HuR promotes castration-resistant prostate cancer progression by altering ERK5 activation via posttranscriptional regulation of BCAT1. J Transl Med 2024; 22:178. [PMID: 38369471 PMCID: PMC10874581 DOI: 10.1186/s12967-024-04970-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/09/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Castration-resistant prostate cancer (CRPC) is refractory to hormone treatment, and the underlying mechanism has not been fully elucidated. This study aimed to clarify the role and mechanism of Human antigen R (HuR) as a therapeutic target for CRPC progression. METHODS HuR was knocked out by Cas9 or inhibited by the HuR-specific inhibitor KH-3 in CRPC cell lines and in a mouse xenograft model. The effects of HuR inhibition on tumour cell behaviors and signal transduction were examined by proliferation, transwell, and tumour xenograft assays. Posttranscriptional regulation of BCAT1 by HuR was determined by half-life and RIP assays. RESULTS HuR knockout attenuated the proliferation, migration, and invasion of PC3 and DU145 cells in vitro and inhibited tumour progression in vivo. Moreover, BCAT1 was a direct target gene of HuR and mediated the oncogenic effect of HuR on CRPC. Mechanistically, HuR directly interacted with BCAT1 mRNA and upregulated BCAT1 expression by increasing the stability and translation of BCAT1, which activated ERK5 signalling. Additionally, the HuR-specific inhibitor KH-3 attenuated CRPC progression by disrupting the HuR-BCAT1 interaction. CONCLUSIONS We confirmed that the HuR/BCAT1 axis plays a crucial role in CRPC progression and suggest that inhibiting the HuR/BCAT1 axis is a promising therapeutic approach for suppressing CRPC progression.
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Affiliation(s)
- Hang You
- Department of Urologic Oncology Surgery, Chongqing University Cancer Hospital, HanYu Road 181, Chongqing, 400030, China
- School of Medicine, Chongqing University, Chongqing, 400030, China
- Department of Biochemistry and Molecular Biology, College of Basic Medical Science, Army Medical University, GaoTanYan Main Street 30, Chongqing, 400038, China
| | - Guojing Song
- Department of Biochemistry and Molecular Biology, College of Basic Medical Science, Army Medical University, GaoTanYan Main Street 30, Chongqing, 400038, China
- Department of Urology, Southwest Hospital, Amy Medical University, Chongqing, 400038, China
| | - Zhizhen Xu
- Department of Biochemistry and Molecular Biology, College of Basic Medical Science, Army Medical University, GaoTanYan Main Street 30, Chongqing, 400038, China
| | - Saipeng Chen
- Department of Urology, Southwest Hospital, Amy Medical University, Chongqing, 400038, China
| | - Wenhao Shen
- Department of Urology, Southwest Hospital, Amy Medical University, Chongqing, 400038, China
| | - Heting Liu
- Department of Biochemistry and Molecular Biology, College of Basic Medical Science, Army Medical University, GaoTanYan Main Street 30, Chongqing, 400038, China
| | - Bingqian Deng
- Department of Biochemistry and Molecular Biology, College of Basic Medical Science, Army Medical University, GaoTanYan Main Street 30, Chongqing, 400038, China
| | - Jun Li
- Department of Urologic Oncology Surgery, Chongqing University Cancer Hospital, HanYu Road 181, Chongqing, 400030, China.
| | - Gang Huang
- Department of Biochemistry and Molecular Biology, College of Basic Medical Science, Army Medical University, GaoTanYan Main Street 30, Chongqing, 400038, China.
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Liao H, Lei Y. Application of ERAS concept in clinical nursing of patients with advanced cancer pain of gynecological malignant tumors. Front Oncol 2023; 13:1173333. [PMID: 37817768 PMCID: PMC10561091 DOI: 10.3389/fonc.2023.1173333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/09/2023] [Indexed: 10/12/2023] Open
Abstract
Gynecological malignant tumors refer to malignant tumors of organs and tissues centered on the uterus, ovaries, and fallopian tubes. Among gynecological tumors, endometrial cancer is the most malignant, accounting for more than 80% of malignant tumors in the female reproductive tract. Common symptoms are vaginal bleeding and pain. This article aims to explore the application and analysis of the concept of ERAS (Enhanced Recovery After Surgery) in the clinical care of patients with advanced cancer pain from gynecological malignancies. ERAS aims to reduce complications, shorten hospitalization time, reduce medical costs, and enable patients to recover quickly by adopting a series of perioperative management measures for patients. This article analyzes the pain caused by late-stage cancer, proposes an ERAS multimodal analgesia method, and uses image fusion technology to detect cancer patients. This article finally conducts an experimental exploration of the clinical nursing of the ERAS concept in the treatment of advanced cancer pain in gynecological malignancies. The results of this study showed that in terms of pain impact score, before treatment, the score of group M was 39.07 and the score of group N was 38.92, and the difference was not statistically significant. The score after ERAS concept treatment was 58.14, and the score after traditional treatment was 43.79, with a significant difference. Research shows that the pain impact score after treatment is significantly better than before treatment, and the improvement effect of ERAS concept treatment is more obvious.
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Affiliation(s)
- Haijing Liao
- Gynaecology Second area, First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
- Gynaecology One area, First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
| | - Yuanxiu Lei
- Gynaecology One area, First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
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García Trevijano Cabetas M, Escario-Gómez M, González-Del Valle L, Sobrino Jiménez C, Bilbao Gomez-Martino C, Romero-Garrido JA, Benedi-González J, Espinosa Arranz E, Díaz Almirón M, Herrero Ambrosio A. Real-world outcomes of abiraterone and enzalutamide in first-line treatment of metastatic castration-resistant prostate cancer: which patients benefit most? Eur J Hosp Pharm 2023; 30:268-272. [PMID: 34620687 PMCID: PMC10447949 DOI: 10.1136/ejhpharm-2021-002798] [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: 03/16/2021] [Accepted: 09/28/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Abiraterone and enzalutamide are two oral novel androgen receptor axis-targeted agents approved for the treatment of castration-resistant prostate cancer (mCRPC). Despite the availability of multiple treatments, there is a need to improve the knowledge and management of these drugs in the real-world setting, especially in patient groups under-represented in clinical trials. Our aim was to review the outcome of patients with chemotherapy-naïve mCRPC treated with abiraterone or enzalutamide in routine clinical practice in order to identify factors that are predictive for response. METHODS This observational retrospective study was performed in a Spanish tertiary hospital and included men with chemotherapy-naïve mCPRC who started treatment with abiraterone or enzalutamide between September 2012 and November 2018. The study end date was 30 October 2020. RESULTS Ninety patients with mCRPC were included, 57 with abiraterone and 33 with enzalutamide. Median overall survival (OS) was 26.87 months (95% CI 19.68 to 34.05), with no difference found between the two treatment groups. Nine variables were related to increased OS in the univariate analysis: Eastern Cooperative Oncology Group (ECOG) performance status (0-1 vs 2), pain (need of opioids for cancer pain), visceral disease, ≥3 bone lesions, exclusively lymph node metastases, baseline prostate specific antigen (PSA) (<50 vs ≥50 ng/dL and <20 vs ≥20 ng/dL), haemoglobin (<12 vs ≥12 g/dL) and alkaline phosphatase (≤116 vs >116 IU/L). A PSA response >50% was observed in 65 patients (76.5%). In the multivariate analysis, ECOG performance status, pain, visceral disease and alkaline phosphatase provided independent prognostic information. Median OS by Kaplan-Meier analysis was significantly longer for patients with a PSA response (32.1 vs 17.9 months; HR 0.46, 95% CI 0.27 to 0.78; p=0.003). CONCLUSIONS This study assessed the efficacy of abiraterone and enzalutamide in a real-world setting, including patients under-represented in pivotal studies. Some clinical factors were correlated with improved OS in chemotherapy-naïve men with mCPRC treated with these drugs.
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Affiliation(s)
| | | | | | | | | | | | - Juana Benedi-González
- Pharmacy Department, Universidad Complutense de Madrid, Madrid, Comunidad de Madrid, Spain
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9
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Kakkat S, Pramanik P, Singh S, Singh AP, Sarkar C, Chakroborty D. Cardiovascular Complications in Patients with Prostate Cancer: Potential Molecular Connections. Int J Mol Sci 2023; 24:ijms24086984. [PMID: 37108147 PMCID: PMC10138415 DOI: 10.3390/ijms24086984] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
Cardiovascular diseases (CVDs) and complications are often seen in patients with prostate cancer (PCa) and affect their clinical management. Despite acceptable safety profiles and patient compliance, androgen deprivation therapy (ADT), the mainstay of PCa treatment and chemotherapy, has increased cardiovascular risks and metabolic syndromes in patients. A growing body of evidence also suggests that patients with pre-existing cardiovascular conditions show an increased incidence of PCa and present with fatal forms of the disease. Therefore, it is possible that a molecular link exists between the two diseases, which has not yet been unraveled. This article provides insight into the connection between PCa and CVDs. In this context, we present our findings linking PCa progression with patients' cardiovascular health by performing a comprehensive gene expression study, gene set enrichment (GSEA) and biological pathway analysis using publicly available data extracted from patients with advanced metastatic PCa. We also discuss the common androgen deprivation strategies and CVDs most frequently reported in PCa patients and present evidence from various clinical trials that suggest that therapy induces CVD in PCa patients.
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Affiliation(s)
- Sooraj Kakkat
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
- Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
| | - Paramahansa Pramanik
- Department of Mathematics and Statistics, University of South Alabama, Mobile, AL 36688, USA
| | - Seema Singh
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
- Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
- Department of Biochemistry and Molecular Biology, University of South Alabama, Mobile, AL 36688, USA
| | - Ajay Pratap Singh
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
- Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
- Department of Biochemistry and Molecular Biology, University of South Alabama, Mobile, AL 36688, USA
| | - Chandrani Sarkar
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
- Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
- Department of Biochemistry and Molecular Biology, University of South Alabama, Mobile, AL 36688, USA
| | - Debanjan Chakroborty
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
- Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
- Department of Biochemistry and Molecular Biology, University of South Alabama, Mobile, AL 36688, USA
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10
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de Jong AC, Danyi A, van Riet J, de Wit R, Sjöström M, Feng F, de Ridder J, Lolkema MP. Predicting response to enzalutamide and abiraterone in metastatic prostate cancer using whole-omics machine learning. Nat Commun 2023; 14:1968. [PMID: 37031196 PMCID: PMC10082805 DOI: 10.1038/s41467-023-37647-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/22/2023] [Indexed: 04/10/2023] Open
Abstract
Response to androgen receptor signaling inhibitors (ARSI) varies widely in metastatic castration resistant prostate cancer (mCRPC). To improve treatment guidance, biomarkers are needed. We use whole-genomics (WGS; n = 155) with matching whole-transcriptomics (WTS; n = 113) from biopsies of ARSI-treated mCRPC patients for unbiased discovery of biomarkers and development of machine learning-based prediction models. Tumor mutational burden (q < 0.001), structural variants (q < 0.05), tandem duplications (q < 0.05) and deletions (q < 0.05) are enriched in poor responders, coupled with distinct transcriptomic expression profiles. Validating various classification models predicting treatment duration with ARSI on our internal and external mCRPC cohort reveals two best-performing models, based on the combination of prior treatment information with either the four combined enriched genomic markers or with overall transcriptomic profiles. In conclusion, predictive models combining genomic, transcriptomic, and clinical data can predict response to ARSI in mCRPC patients and, with additional optimization and prospective validation, could improve treatment guidance.
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Affiliation(s)
- Anouk C de Jong
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Alexandra Danyi
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Job van Riet
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martin Sjöström
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Felix Feng
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Jeroen de Ridder
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
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11
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Thomsen LCV, Honoré A, Reisæter LAR, Almås B, Børretzen A, Helle SI, Førde K, Kristoffersen EK, Kaada SH, Melve GK, Haslerud TM, Biermann M, Bigalke I, Kvalheim G, Azeem W, Olsen JR, Gabriel B, Knappskog S, Halvorsen OJ, Akslen LA, Bahn D, Pantel K, Riethdorf S, Ragde H, Gjertsen BT, Øyan AM, Kalland KH, Beisland C. A phase I prospective, non-randomized trial of autologous dendritic cell-based cryoimmunotherapy in patients with metastatic castration-resistant prostate cancer. Cancer Immunol Immunother 2023:10.1007/s00262-023-03421-7. [PMID: 36939854 DOI: 10.1007/s00262-023-03421-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 03/03/2023] [Indexed: 03/21/2023]
Abstract
Metastatic castration-resistant prostate cancer (mCRPC) is an immunologically cold disease with dismal outcomes. Cryoablation destroys cancer tissue, releases tumor-associated antigens and creates a pro-inflammatory microenvironment, while dendritic cells (DCs) activate immune responses through processing of antigens. Immunotherapy combinations could enhance the anti-tumor efficacy. This open-label, single-arm, single-center phase I trial determined the safety and tolerability of combining cryoablation and autologous immature DC, without and with checkpoint inhibitors. Immune responses and clinical outcomes were evaluated. Patients with mCRPC, confirmed metastases and intact prostate gland were included. The first participants underwent prostate cryoablation with intratumoral injection of autologous DCs in a 3 + 3 design. In the second part, patients received cryoablation, the highest acceptable DC dose, and checkpoint inhibition with either ipilimumab or pembrolizumab. Sequentially collected information on adverse events, quality of life, blood values and images were analyzed by standard descriptive statistics. Neither dose-limiting toxicities nor adverse events > grade 3 were observed in the 18 participants. Results indicate antitumor activity through altered T cell receptor repertoires, and 33% durable (> 46 weeks) clinical benefit with median 40.7 months overall survival. Post-treatment pain and fatigue were associated with circulating tumor cell (CTC) presence at inclusion, while CTC responses correlated with clinical outcomes. This trial demonstrates that cryoimmunotherapy in mCRPC is safe and well tolerated, also for the highest DC dose (2.0 × 108) combined with checkpoint inhibitors. Further studies focusing on the biologic indications of antitumor activity and immune system activation could be considered through a phase II trial focusing on treatment responses and immunologic biomarkers.
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Affiliation(s)
| | - Alfred Honoré
- Department of Urology, Haukeland University Hospital , Bergen, Norway
| | | | - Bjarte Almås
- Department of Urology, Haukeland University Hospital , Bergen, Norway
| | - Astrid Børretzen
- Department of Pathology, Haukeland University Hospital, Bergen, Norway.,Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Svein Inge Helle
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Kristina Førde
- Department of Urology, Haukeland University Hospital , Bergen, Norway
| | - Einar Klæboe Kristoffersen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, UiB, Bergen, Norway
| | - Silje Helland Kaada
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Guro Kristin Melve
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Martin Biermann
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Iris Bigalke
- Department of Cellular Therapy, Oslo University Hospital, Oslo, Norway
| | - Gunnar Kvalheim
- Department of Cellular Therapy, Oslo University Hospital, Oslo, Norway
| | - Waqas Azeem
- Department of Clinical Science, UiB, Bergen, Norway
| | | | | | - Stian Knappskog
- Department of Oncology, Haukeland University Hospital, Bergen, Norway.,K.G. Jebsen Center for Genome-Directed Cancer Therapy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ole Johan Halvorsen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Lars Andreas Akslen
- Department of Pathology, Haukeland University Hospital, Bergen, Norway.,Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Duke Bahn
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Klaus Pantel
- Institut Für Tumorbiologie, Zentrum Für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Riethdorf
- Institut Für Tumorbiologie, Zentrum Für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Haakon Ragde
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen , Bergen, Norway
| | - Bjørn Tore Gjertsen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen , Bergen, Norway
| | | | - Karl-Henning Kalland
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen , Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital , Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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12
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Li J, Liu N, Zhou H, Xian P, Song Y, Tang X, Li Y, Basler M. Immunoproteasome inhibition prevents progression of castration-resistant prostate cancer. Br J Cancer 2023; 128:1377-1390. [PMID: 36681728 PMCID: PMC10050322 DOI: 10.1038/s41416-022-02129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/04/2022] [Accepted: 12/15/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Castration-resistant prostate cancer (CRPC) is refractory to hormone treatment. This study aims to explore the effect and underlying mechanisms of immunoproteasome inhibition, a novel immunotherapy, on the progression of CRPC. METHODS The immunoproteasome subunit LMP7 was silenced by using gene knockout or inhibited by the epoxyketone inhibitor ONX 0914 in a mouse CRPC tumour graft model and in interferon-γ-pretreated human CRPC cell lines in vitro. RESULTS CRPC tissues reveal a significant "tumour-elicited" Th17-type inflammatory response which induces immunoproteasome subunit expression. LMP7 deficiency in host mice or in CRPC tumour grafts had no effect on the "tumour-elicited" Th17-type inflammatory response and tumour progression. However, the selective LMP7 inhibitor ONX 0914 strongly suppressed the "tumour-elicited" Th17-type inflammatory response and CRPC tumour progression. Treatment of wild-type mice receiving LMP7-deficient CRPC tumour grafts with ONX 0914 further suggested that immunoproteasome inhibition prevents CRPC progression through suppressing IL-17-induced angiogenesis and epithelial-mesenchymal transition via inactivation of COX-2/VEGF-A signalling and β-catenin/Snail signalling. Treatment of LMP7-deficient mice receiving wild-type CRPC tumour grafts with ONX 0914 and inhibition of LMP7 in PC3 and 22Rv.1 cells with ONX 0914 showed that immunoproteasome inhibition also prevents CRPC progression through inducing CRPC cell apoptosis via activation of the unfolded protein response. CONCLUSIONS We define a critical role of the immunoproteasome in CRPC and propose immunoproteasome inhibition as a promising therapeutic approach to suppress CRPC progression.
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Affiliation(s)
- Jun Li
- Department of Urologic Oncology Surgery, Chongqing University Cancer Hospital, 400030, Chongqing, China.
| | - Nan Liu
- Department of Urologic Oncology Surgery, Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Hong Zhou
- Department of Urologic Oncology Surgery, Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Peng Xian
- Department of Urologic Oncology Surgery, Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Yanping Song
- Department of Urologic Oncology Surgery, Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Xianli Tang
- Department of Urologic Oncology Surgery, Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Yuan Li
- Department of Urologic Oncology Surgery, Chongqing University Cancer Hospital, 400030, Chongqing, China
| | - Michael Basler
- Division of Immunology, Department of Biology, University of Konstanz, D-78457, Konstanz, Germany.
- Biotechnology Institute Thurgau (BITg) at the University of Konstanz, CH-8280, Kreuzlingen, Switzerland.
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13
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Impact of trough abiraterone level on adverse events in patients with prostate cancer treated with abiraterone acetate. Eur J Clin Pharmacol 2023; 79:89-98. [PMID: 36378297 DOI: 10.1007/s00228-022-03420-0] [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: 09/24/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE We assessed the impact of plasma trough concentrations of abiraterone (ABI) and its metabolite Δ4-abiraterone (D4A) and related polymorphisms on adverse events (AEs) in patients with metastatic prostate cancer who received abiraterone acetate (AA). METHODS This prospective study enrolled patients with advanced prostate cancer treated with AA between 2016 and 2021. Plasma trough concentrations of ABI and D4A were measured using high-performance liquid chromatography. The impact of HSD3B1 rs1047303, SRD5A2 rs523349, and cytochrome P450 family 3A member 4 rs2242480 polymorphisms on plasma concentrations of ABI and D4A and the incidence of AEs were also assessed. RESULTS In 68 patients treated with AA, the median ABI and D4A concentrations were 18.1 and 0.94 ng/mL, respectively. The high plasma trough concentration of ABI (≥ 20.6 ng/mL) was significantly associated with the presence of any AE and its independent risk factor based on multivariable analysis (odds ratio, 7.20; 95% confidence interval (CI): 2.20-23.49). Additionally, a high plasma trough concentration of ABI was an independent risk factor of time to withdraw AA (hazard ratio, 4.89; 95% CI: 1.66-14.38). The risk alleles of three polymorphisms were not statistically associated with the ABI and D4A concentrations and the incidence of AEs. CONCLUSIONS The plasma trough concentration of ABI is associated with the presence of AEs and treatment failure after AA administration. ABI concentration monitoring may be useful in patients with prostate cancer who received AA.
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14
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Synthesis and Preclinical Evaluation of Small-Molecule Prostate-Specific Membrane Antigen-Targeted Abiraterone Conjugate. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27248795. [PMID: 36557929 PMCID: PMC9783881 DOI: 10.3390/molecules27248795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Prostate cancer is the second most common type of cancer among men. The main method of its treatment is androgen deprivation therapy, which has a wide range of side effects. One of the solutions to this challenge is the targeted delivery of drugs to prostate cancer cells. In this study, we performed the synthesis of a novel small-molecule PSMA-targeted conjugate based on abiraterone. Cytotoxicity, the induction of intracellular reactive oxygen species, and P450-cytochrome species inhibition were investigated for this conjugate PSMA-abiraterone. The conjugate demonstrated a preferential effect on prostate tumor cells, remaining inactive at up to 100 µM in human fibroblast cells. In addition, it revealed preferential efficacy, specifically on PSMA-expressing lines with a 65% tumor growth inhibition level on 22Rv1 (PSMA+) xenografts after 14-fold oral administration of PSMA-Abi at a single dose of 500 mg/kg (7.0 g/kg total dose) was observed. This compound showed significantly reduced acute toxicity with comparable efficacy compared to AbiAc.
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15
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Ueda T, Fujita K, Nishimoto M, Shiraishi T, Miyashita M, Kayukawa N, Nakamura Y, Sako S, Ogura R, Fujihara A, Minami T, Hongo F, Okihara K, Yoshimura K, Uemura H, Ukimura O. Predictive factors for the efficacy of abiraterone acetate therapy in high-risk metastatic hormone-sensitive prostate cancer patients. World J Urol 2022; 40:2939-2946. [PMID: 36331614 DOI: 10.1007/s00345-022-04200-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE There is a discrepancy in the efficacy of abiraterone acetate for overall survival (OS) in patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC). This study aimed to identify predictive factors for the efficacy of abiraterone acetate for OS in high-risk mHSPC patients by analyzing them over a longer observation period. METHODS Five hundred high-risk mHSPC patients were retrospectively identified at our hospital and affiliated hospitals in the Kindai Oncology Study Group and Kyoto Prefectural University of Medicine Oncology Study Group between December 2013 and March 2022. Two hundred patients were treated with abiraterone acetate (1000 mg/day) plus prednisolone (5 mg/day) combined with androgen deprivation therapy (ADT). A total of 300 patients were treated with bicalutamide (80 mg/day) in combination with ADT. RESULTS OS was not significantly different between the two treatments in the overall cohort (p = 0.1643). In the subgroup without Gleason pattern 5 at the primary lesion, OS was significantly better in patients treated with abiraterone acetate than in those treated with bicalutamide (p = 0.0192). In the subgroup with Gleason pattern 5 at the primary lesion, no significant difference was found between the two treatments (p = 0.1799). Univariate and multivariate analyses in the subgroup without Gleason pattern 5 at the primary lesion suggested that abiraterone therapy may be an important and independent predictor of OS in high-risk mHSPC patients. CONCLUSION The presence of Gleason pattern 5 at the primary lesion may be a predictor for high-risk mHSPC patients who could benefit from abiraterone acetate treatment.
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Affiliation(s)
- Takashi Ueda
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan.
| | - Kazutoshi Fujita
- Department of Urology, Kindai University, Faculty of Medicine, Sayama-City, Osaka, Japan
| | - Mitsuhisa Nishimoto
- Department of Urology, Kindai University, Faculty of Medicine, Sayama-City, Osaka, Japan
| | - Takumi Shiraishi
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
| | - Masatsugu Miyashita
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
| | - Naruhiro Kayukawa
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
| | - Yuichi Nakamura
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
| | - Satoshi Sako
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
| | - Ryota Ogura
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
| | - Atsuko Fujihara
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
| | - Takafumi Minami
- Department of Urology, Kindai University, Faculty of Medicine, Sayama-City, Osaka, Japan
| | - Fumiya Hongo
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
| | - Koji Okihara
- Department of Urology, North Medical Center, Kyoto Prefectural University of Medicine, Yosano-Gun, Kyoto, Japan
| | - Kazuhiro Yoshimura
- Department of Urology, Kindai University, Faculty of Medicine, Sayama-City, Osaka, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University, Faculty of Medicine, Sayama-City, Osaka, Japan
| | - Osamu Ukimura
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-City, Kyoto, 602-8566, Japan
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16
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Identification of Calcium Channel-Related Gene P2RX2 for Prognosis and Immune Infiltration in Prostate Cancer. DISEASE MARKERS 2022; 2022:8058160. [PMID: 36246559 PMCID: PMC9553555 DOI: 10.1155/2022/8058160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
Abstract
Prostate cancer is one of the most common malignancies in men. Calcium signaling is implicated in the progression of prostate cancer and plays a critical role in immune cell function. However, whether specific calcium channel-related genes play a crucial role in the immune cell infiltration levels of prostate cancer requires further research. In this study, we performed an integrated analysis of transcriptional, clinical, and somatic mutation data from The Cancer Genome Atlas database and identified the hub calcium channel-related gene P2RX2 to be associated with the prognosis and immune infiltration of prostate cancer. P2RX2 expression was positively correlated with immune cell infiltration levels and the expression of immune checkpoint genes, and downregulation of P2RX2 led to poor survival in patients with prostate cancer. Furthermore, we validated the molecular and clinical characteristics of P2RX2 by using multiple databases and conducting in-vitro experiments. Additionally, drug sensitivity analysis revealed that patients with low P2RX2 expression were sensitive to docetaxel and Bicalutamide. In conclusion, we revealed an association between calcium channel-related genes and prostate cancer, and identified P2RX2 as a biomarker for early diagnosis, prognosis prediction, and aiding treatment decisions for patients with prostate cancer.
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17
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Verry C, Vincendeau S, Massetti M, Blachier M, Vimont A, Bazil ML, Bernardini P, Pettré S, Timsit MO. Pattern of Clinical Progression Until Metastatic Castration-Resistant Prostate Cancer: An Epidemiological Study from the European Prostate Cancer Registry. Target Oncol 2022; 17:441-451. [PMID: 35841526 PMCID: PMC9345837 DOI: 10.1007/s11523-022-00899-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 12/24/2022]
Abstract
Background Prostate cancer (PCa) is the most frequently diagnosed cancer in men in Europe. The impact of PCa natural history and therapeutic management on the outcomes of castration-resistant prostate cancer patients with metastasis (mCRPC) remains unclear. Objective The objective of this study was to describe retrospectively patterns of clinical progression through diagnosis sequences before the mCRPC stage and to assess how these sequences impacted patients’ disease progression and overall survival at mCRPC stage. Patients and Methods Patients with mCRPC were identified from the Prostate Cancer Registry (PCR), an observational study in a real-world setting in 16 countries between 2013 and 2016. Patients were grouped in diagnosis sequences before mCRPC and defined by date of PCa diagnosis, first metastasis, and castration resistance. Distribution of time-to-event variables were estimated using Kaplan-Meier product-limit survival curves for overall survival (OS) and progression-free survival (PFS). Non-adjusted Cox models were conducted for efficacy endpoints (OS, PFS) to estimate hazard ratios between diagnosis sequences. Results At the end of study, 2859 mCRPC patients were included in this analysis. Among mCRPC four diagnosis sequences were identified: 35% developed metastases (mHSPC) before becoming castration resistant (sequence 1, metachronous mHSPC), 10% developed castration resistance (nmCRPC) before metastases (sequence 2), 27% developed metastases and castration resistance within 4 months (sequence 3) and 28% of patients were de novo mHSPC (sequence 4). Median OS was 17.7 months (interquartile range (IQR): 8.8–29.9) and PFS was 6.4 months (IQR: 3.2–12.0). The univariate analyses showed no correlation between mCRPC patients’ OS or PFS and the diagnosis sequence. Conclusion This large European study describe four different patterns of prostate cancer progression to mCRPC stage. Our results indicate that patient survival becomes comparable after progression to mCRPC, regardless of the diagnosis sequence. Trial Registration ClinicalTrials.gov identifier NCT02236637; registered September 2014. Supplementary Information The online version contains supplementary material available at 10.1007/s11523-022-00899-6.
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Affiliation(s)
- Camille Verry
- Department of Radiotherapy, Grenoble Alpes University Hospital, Grenoble, France.
| | | | | | | | | | | | | | | | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
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18
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The effect of ambient temperature on in-hospital mortality: a study in Nanjing, China. Sci Rep 2022; 12:6304. [PMID: 35428808 PMCID: PMC9012784 DOI: 10.1038/s41598-022-10395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 03/31/2022] [Indexed: 12/05/2022] Open
Abstract
To reduce the inpatient mortality and improve the quality of hospital management, we explore the relationship between temperatures and in-hospital mortality in a large sample across 10 years in Nanjing, Jiangsu. We collected 10 years’ data on patient deaths from a large research hospital. Distributed lag non-linear model (DLNM) was used to find the association between daily mean temperatures and in-hospital mortality. A total of 6160 in-hospital deaths were documented. Overall, peak RR appeared at 8 °C, with the range of 1 to 20 °C having a significantly high mortality risk. In the elderly (age ≥ 65 years), peak RR appeared at 5 °C, with range − 3 to 21 °C having a significantly high mortality risk. In males, peak RR appeared at 8 °C, with the range 0 to 24 °C having a significantly high mortality risk. Moderate cold (define as 2.5th percentile of daily mean temperatures to the MT), not extreme temperatures (≤ 2.5th percentile or ≥ 97.5th percentile of daily mean temperatures), increased the risk of death in hospital patients, especially in elderly and male in-hospital patients.
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19
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Meisel A, de Wit R, Oudard S, Sartor O, Stenner-Liewen F, Shun Z, Foster M, Ozatilgan A, Eisenberger M, de Bono JS. Neutropenia, neutrophilia, and neutrophil-lymphocyte ratio as prognostic markers in patients with metastatic castration-resistant prostate cancer. Ther Adv Med Oncol 2022; 14:17588359221100022. [PMID: 35677318 PMCID: PMC9168856 DOI: 10.1177/17588359221100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background and purpose Chemotherapy-induced neutropenia and neutrophil-to-lymphocyte ratio (NLR) are potentially useful prognostic markers in patients with metastatic castration-resistant prostate cancer (mCRPC). This post hoc analysis investigated whether these markers can be utilized for dose considerations and evaluated the prognostic impact of leukocyte subtypes. Patients and methods PROSELICA assessed the non-inferiority of cabazitaxel 20 mg/m2 (C20; n = 598) versus 25 mg/m2 (C25; n = 602) for overall survival (OS) in patients with mCRPC previously treated with docetaxel. The association of grade ⩾ 3 neutropenia, NLR, baseline neutrophilia and lymphopenia with OS, progression-free survival (PFS), and prostate-specific antigen response rate (PSArr) was investigated by an unplanned uni- and multivariate analyses. Results PROSELICA confirmed the negative prognostic value of increased baseline NLR [⩾3, hazard ratio (HR) 1.40; p < 0.0001], but did not identify a subgroup of patients benefiting more from C20 or C25. In this post hoc analysis, patients who developed grade ⩾3 neutropenia (n = 673) had a significantly improved OS [∆OS = 2.7 months, HR = 0.78 (95% CI 0.68-0.89)] with the greatest advantage observed in patients with baseline neutrophilia [n = 85; 5.3 months, 0.60 (0.42-0.84)]. After adjustment for the Halabi criteria, neutropenia grade ⩾ 3 was the only biomarker that remained significantly associated with OS [ (HR 0.86 (0.75-0.98)], PFS [HR 0.78 (0.68-0.88)], and PSArr [odds ratio (OR) 1.82 (1.37-2.41)] while neutrophilia showed the strongest association with OS [1.53 (1.29-1.81)]. Conclusions Grade ⩾ 3 neutropenia was the only leukocyte-based biomarker associated with all key outcome parameters in mCRPC patients receiving cabazitaxel and might be able to overcome the negative prognostic effect of baseline neutrophilia. NCT number NCT01308580.
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Affiliation(s)
| | - Ronald de Wit
- Medical Oncology, Erasmus University Medical
Center, Rotterdam, The Netherlands
| | - Stephane Oudard
- Service d'Oncologie Médicale, Georges Pompidou
European Hospital, Rene Descartes University, Paris, France
| | - Oliver Sartor
- Medicine and Urology, Tulane Cancer Center, New
Orleans, LA, USA
| | | | | | | | - Ayse Ozatilgan
- Global Medical Affairs Oncology, Sanofi,
Cambridge, MA, USA
| | - Mario Eisenberger
- The Sidney Kimmel Comprehensive Cancer Center,
Johns Hopkins Hospital, Baltimore, MD, USA
| | - Johann S. de Bono
- Division of Clinical Studies, Drug Development
Unit, The Royal Marsden NHS Foundation Trust/The Institute of Cancer
Research, London, UK
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20
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Current Treatment Modalities Targeting Tumor Microenvironment in Castration-Resistant Prostate Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 34664246 DOI: 10.1007/978-3-030-73119-9_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Prostate cancer (PCa) is responsible for significant cancer-related morbidity and mortality following local treatment failure in men. The initial stages of PCa are typically managed with a combination of surgical resection and/or androgen deprivation therapy (ADT). Unfortunately, a significant proportion of PCa continues to progress despite being at castrate levels of testosterone (<50 ng/dl), at which point it is coined castration-resistant prostate cancer (CRPC). In recent years, many novel therapeutics and drug combinations have been created for CRPC patients. These include immune checkpoint inhibitors, chemokine receptor antagonists, steroidogenic enzyme inhibition, and novel tyrosine kinase inhibitors as well as combinations of drugs. The selection of the most appropriate therapy depends on several factors like stage of the disease, age of the patient, metastasis, functional status, and response towards previous therapies. Here, we review the current state of the literature regarding treatment modalities, focusing on the treatment recommendations per the American Urological Association (AUA), recent clinical trials, and their limitations. An accurate and reliable overview of the strengths and limitations of PCa therapeutics could also allow personalized therapeutic interventions against PCa.
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21
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Spetsieris N, Boukovala M, Alafis I, Davis J, Zurita A, Wang X, Tu SM, Chapin BF, Aparicio A, Corn P, Wang J, Subudhi SK, Araujo J, Papadopoulos J, Pruitt L, Weldon JA, Logothetis CJ, Efstathiou E. Abiraterone acetate plus prednisone in non-metastatic biochemically recurrent castration-naïve prostate cancer. Eur J Cancer 2021; 157:259-267. [PMID: 34536949 DOI: 10.1016/j.ejca.2021.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/04/2021] [Accepted: 06/11/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Intermittent androgen deprivation therapy (ADT) in biochemically recurrent castration-naïve prostate cancer is non-inferior to continuous therapy. We hypothesised that finite-duration abiraterone acetate plus prednisone (Abi +P) added to ADT will further reduce the duration of treatment exposure by prolonging time to prostate-specific antigen (PSA) recurrence without impacting eugonad state recovery. METHODS This phase II, randomised, open-label trial enrolled patients with rising PSA ≥ 0.2 ng/ml after radical prostatectomy and/or a PSA ≥ 1 following radiotherapy. Patients were randomised 1:1 to receive Abi (1 g PO daily) + P (5 mg PO daily) + ADT or ADT alone for 8 months. The primary end-point was PSA-free survival difference at 1 year following completion of therapy. RESULTS Between February 2013 and July 2016, 200 patients were enrolled. Of 100 patients randomised to each arm, 99 in the Abi +P arm and 98 in the ADT arm were evaluable. Median follow-up was 64.4 months. Median PSA-free survival was 27.0 months for the Abi +P-treated group versus 19.9 months for the ADT-treated group (hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.47-0.87). The PSA-free survival at 1 year post-treatment completion was 98% for the Abi +P group and 88% for the ADT group. Median time to eugonad state was 13.1 months for the abiraterone-treated group and 12.8 months for the ADT-treated group. Median eugonad PSA-free survival was 12.5 months for the abiraterone-treated group versus 9.0 for the ADT-treated group (HR 0.72, 95% CI 0.53-0.98). There were no significant between-group differences in androgen deprivation-related adverse events. CONCLUSIONS In men with biochemically recurrent prostate cancer following definitive treatment of the primary, finite duration treatment with ADT and Abi +P results in a significantly longer PSA relapse-free interval than treatment with ADT alone.
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Affiliation(s)
- Nicholas Spetsieris
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Myrto Boukovala
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ioannis Alafis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amado Zurita
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shi-Ming Tu
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ana Aparicio
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul Corn
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer Wang
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sumit K Subudhi
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John Araujo
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John Papadopoulos
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisa Pruitt
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Justin A Weldon
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher J Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eleni Efstathiou
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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22
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Wei Z, Chen C, Li B, Li Y, Gu H. Efficacy and Safety of Abiraterone Acetate and Enzalutamide for the Treatment of Metastatic Castration-Resistant Prostate Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:732599. [PMID: 34513709 PMCID: PMC8429926 DOI: 10.3389/fonc.2021.732599] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/09/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The androgen receptor-targeting drugs abiraterone acetate and enzalutamide have shown positive results as treatments for metastatic castration-resistant prostate cancer (mCRPC). Therefore, a meta-analysis was conducted to compare the efficacy and safety of abiraterone acetate and enzalutamide in patients with mCRPC. METHODS We retrieved relevant articles from PubMed, Cochrane, and EMBASE published before December 31, 2020. Eleven articles were initially selected, and four phase III, double-blind, randomized controlled trials of abiraterone acetate and enzalutamide that involved 5199 patients with mCRPC were included. The end points were time to prostate-specific antigen progression (TTPP), according to the prostate-specific antigen working group criteria; overall survival (OS); and radiographic progression-free survival (rPFS). RESULTS Four randomized, controlled clinical trials involving 5199 patients were included in this study. The results of the meta-analysis showed that compared with placebo alone, abiraterone significantly improved OS (HR=0.69, 95% CI: 0.60-0.8, P<0.00001), rPFS (HR=0.64, 95% CI: 0.57-0.71, P < 0.00001), and TTPP (HR=0.52, 95% CI: 0.45-0.59, P < 0.00001) in patients with mCRPC. Compared with placebo, enzalutamide significantly improved OS (HR=0.67, 95% CI: 0.59-0.75, P<0.00001), rPFS (HR=0.33, 95% CI: 0.29-0.37, P< 0.00001), and TTPP (HR=0.19, 95% CI: 0.17-0.22, P < 0.00001). An indirect comparison was performed to compare the efficacy of abiraterone and enzalutamide. The results showed that there was no significant difference between abiraterone and enzalutamide with regard to improving the OS of patients with mCRPC (HR=1.03, 95% CI: 0.854-1.242). Enzalutamide was superior to abiraterone with regard to improving rPFS in patients with mCRPC (HR=0.516, 95% CI: 0.438-0.608). With regard to improving TTPP, the efficacy of enzalutamide was better than that of abiraterone (HR=0.365, 95% CI: 0.303-0.441). In sAE, there was no difference between abiraterone and enzalutamide (P=0.21, I2 = 38%). CONCLUSIONS Compared with placebo, both abiraterone and enzalutamide significantly prolonged OS, rPFS, and TTPP in patients with mCRPC. There was no difference in safety between abiraterone and enzalutamide. In addition, enzalutamide had better efficacy than abiraterone with regard to improving rPFS and TTPP but not OS, but the level of evidence was low. Therefore, a large direct comparison trial is needed to compare the efficacy of the two drugs. SYSTEMATIC REVIEW REGISTRATION PROSPERO, identifier (CRD42021226808).
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Affiliation(s)
- ZhenHeng Wei
- Inner Mongolia Medical University, Hohhot, China
| | - ChuXin Chen
- Peking Union Medical College Hospital, Beijing, China
| | - BoWen Li
- Inner Mongolia Medical University, Hohhot, China
| | - YongYue Li
- Inner Mongolia Medical University, Rehabilitation Department of Baotou Steel Hospital, Baotou, China
| | - Hong Gu
- Inner Mongolia Baotou Steel Hospital, The Third Clinical Medical College of Inner Mongolia Medical University, Baotou, China
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23
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Francini E, Montagnani F, Nuzzo PV, Gonzalez-Velez M, Alimohamed NS, Rosellini P, Moreno-Candilejo I, Cigliola A, Rubio-Perez J, Crivelli F, Shaw GK, Zhang L, Petrioli R, Bengala C, Francini G, Garcia-Foncillas J, Sweeney CJ, Higano CS, Bryce AH, Harshman LC, Lee-Ying R, Heng DYC. Association of Concomitant Bone Resorption Inhibitors With Overall Survival Among Patients With Metastatic Castration-Resistant Prostate Cancer and Bone Metastases Receiving Abiraterone Acetate With Prednisone as First-Line Therapy. JAMA Netw Open 2021; 4:e2116536. [PMID: 34292336 PMCID: PMC8299314 DOI: 10.1001/jamanetworkopen.2021.16536] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Bone resorption inhibitors (BRIs) are recommended by international guidelines to prevent skeletal-related events (SREs) among patients with metastatic castration-resistant prostate cancer (mCRPC) and bone metastases. Abiraterone acetate with prednisone is currently the most common first-line therapy for the treatment of patients with mCRPC; however, the clinical impact of the addition of BRIs to abiraterone acetate with prednisone in this disease setting is unknown. OBJECTIVE To evaluate the association of the use of concomitant BRIs with overall survival (OS) and time to first SRE among patients with mCRPC and bone metastases receiving abiraterone acetate with prednisone as first-line therapy. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study collected data from 745 consecutive patients who began receiving abiraterone acetate with prednisone as first-line therapy for mCRPC with bone metastases between January 1, 2013, and December 31, 2016. Data were collected from 8 hospitals in Canada, Europe, and the US from June 15 to September 15, 2019. EXPOSURES Patients were classified by receipt vs nonreceipt of concomitant BRIs and subclassified by volume of disease (high volume or low volume, using definitions from the Chemohormonal Therapy Vs Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer [CHAARTED] E3805 study) at the initiation of abiraterone acetate with prednisone therapy. MAIN OUTCOMES AND MEASURES The primary end point was OS. The secondary end point was time to first SRE. The Kaplan-Meier method and Cox proportional hazards models were used. RESULTS Of the 745 men (median age, 77.6 years [interquartile range, 68.1-83.6 years]; 699 White individuals [93.8%]) included in the analysis, 529 men (71.0%) received abiraterone acetate with prednisone alone (abiraterone acetate cohort), and 216 men (29.0%) received abiraterone acetate with prednisone plus BRIs (BRI cohort). A total of 420 men (56.4%) had high-volume disease, and 276 men (37.0%) had low-volume disease. The median follow-up was 23.5 months (95% CI, 19.8-24.9 months). Patients in the BRI cohort experienced significantly longer OS compared with those in the abiraterone acetate cohort (31.8 vs 23.0 months; hazard ratio [HR], 0.65; 95% CI, 0.54-0.79; P < .001). The OS benefit in the BRI cohort was greater for patients with high-volume vs low-volume disease (33.6 vs 19.7 months; HR, 0.51; 95% CI, 0.38-0.68; P < .001). The BRI cohort also had a significantly shorter time to first SRE compared with the abiraterone acetate cohort (32.4 vs 42.7 months; HR, 1.27; 95% CI, 1.00-1.60; P = .04), and the risk of a first SRE was more than double in the subgroup with low-volume disease (HR, 2.29; 95% CI, 1.57-3.35; P < .001). In the multivariable analysis, concomitant BRIs use was independently associated with longer OS (HR, 0.64; 95% CI, 0.52-0.79; P < .001). CONCLUSIONS AND RELEVANCE In this study, the addition of BRIs to abiraterone acetate with prednisone as first-line therapy for the treatment of patients with mCRPC and bone metastases was associated with longer OS, particularly in patients with high-volume disease. These results suggest that the use of BRIs in combination with abiraterone acetate with prednisone as first-line therapy for the treatment of mCRPC with bone metastases could be beneficial.
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Affiliation(s)
- Edoardo Francini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Pier Vitale Nuzzo
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | | | - Pietro Rosellini
- Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | | | - Antonio Cigliola
- Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Jaime Rubio-Perez
- University Hospital Fundacion Jimenez Diaz, Autonomous University of Madrid, Madrid, Spain
| | | | - Grace K. Shaw
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Li Zhang
- DFCI at Geisinger Medical Center, Danville, Pennsylvania
| | - Roberto Petrioli
- Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Carmelo Bengala
- Medical Oncology Unit, Misericordia Hospital, Grosseto, Italy
| | - Guido Francini
- Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Jesus Garcia-Foncillas
- University Hospital Fundacion Jimenez Diaz, Autonomous University of Madrid, Madrid, Spain
| | - Christopher J. Sweeney
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Celestia S. Higano
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle
| | - Alan H. Bryce
- Genomic Oncology Clinic, Mayo Clinic, Phoenix, Arizona
| | - Lauren C. Harshman
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Richard Lee-Ying
- Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Daniel Y. C. Heng
- Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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24
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Zhang J, Sun J, Bakht S, Hassan W. Recent Development and Future Prospects of Molecular Targeted Therapy in Prostate Cancer. Curr Mol Pharmacol 2021; 15:159-169. [PMID: 34102978 DOI: 10.2174/1874467214666210608141102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 11/22/2022]
Abstract
Prostate cancer (PC) is a rapidly increasing ailment worldwide. The previous decade has observed a rapid advancement in PC therapies that was evident from the number of FDA approvals during this phase. Androgen deprivation therapies (ADT) have traditionally remained a mainstay for the management of PCs, but the past decade has experienced the emergence of newer classes of drugs that can be used with or without the administration of ADT. FDA approved poly (ADP-ribose) polymerase inhibitors (PARPi), such as olaparib and rucaparib, after successful clinical trials against gene-mutated metastatic castration-resistant prostate cancer. Furthermore, drugs like apalutamide, darolutamide, and enzalutamide with an androgen-targeted mechanism of action have manifested superior results in non-metastatic castration-resistant prostate cancer (nmCRPC), metastatic castration-sensitive prostate cancer (mCSPC), and metastatic castration-resistant prostate cancer (mCRPC), respectively, with or without previously administered docetaxel. Relugolix, an oral gonadotropin-releasing hormone antagonist, and a combination of abiraterone acetate plus prednisone were also approved by FDA after a successful trial in advanced PC and mCRPC, respectively. This review aims to analyze the FDA-approved agents in PC during the last decade and provide a summary of their clinical trials. It also presents an overview of the ongoing progress of prospective molecules still under trial.
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Affiliation(s)
- Jinku Zhang
- Department of Pathology, First center Hospital of Baoding city, Hebei, 071000, China
| | - Jirui Sun
- Department of Pathology, First center Hospital of Baoding city, Hebei, 071000, China
| | - Sahar Bakht
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Waseem Hassan
- Department of Pharmacy, COMSATS University Islamabad, Lahore Campus, 54000, Pakistan
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25
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Rossi L, Cimino G, Gozzi E, Sinjari M, Brandi M, Ceddia S, Cosimati A, Raimondi L, Fontana A, Filippi L, Bagni O, Spinelli GP. Stunning Response with Low-Dose Enzalutamide after Abiraterone Acetate Failure in a Patient Diagnosed with Metastatic Castration-Resistant Prostate Cancer: A Case Report. Case Rep Oncol 2021; 14:634-640. [PMID: 33976646 PMCID: PMC8077606 DOI: 10.1159/000514979] [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: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 11/19/2022] Open
Abstract
We report a case of an elderly patient with metastatic castration-resistant prostate cancer, initially treated with abiraterone acetate (1,000 mg/day) combined with LH-RH antagonist, prednisone (10 mg/day), and zoledronic acid to manage bone metastases. In consideration of his poor performance status, radiological and biochemical progression of the disease, we decided to switch abiraterone to enzalutamide (160 mg/day). Due to adverse events, we reduced enzalutamide to a dose of 80 mg/day. Currently, the disease is under control despite the use of a low dose of enzalutamide.
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Affiliation(s)
- Luigi Rossi
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Giuseppe Cimino
- Department of Cellular Biotechnology and Hematology, University of Rome "Sapienza", Rome, Italy
| | - Elisa Gozzi
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Marsela Sinjari
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Martina Brandi
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Serena Ceddia
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Antonella Cosimati
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Lucrezia Raimondi
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
| | - Antonella Fontana
- Department of Radiotherapy, Santa Maria Goretti Hospital, Latina, Italy
| | - Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy
| | - Oreste Bagni
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy
| | - Gian Paolo Spinelli
- UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy
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26
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Spetsieris N, Boukovala M, Weldon JA, Tsikkinis A, Hoang A, Aparicio A, Tu SM, Araujo JC, Zurita AJ, Corn PG, Pagliaro L, Kim J, Wang J, Subudhi SK, Tannir NM, Logothetis CJ, Troncoso P, Wang X, Wen S, Efstathiou E. A Phase 2 Trial of Abiraterone Followed by Randomization to Addition of Dasatinib or Sunitinib in Men With Metastatic Castration-Resistant Prostate Cancer. Clin Genitourin Cancer 2021; 19:22-31.e5. [PMID: 32675015 PMCID: PMC10014037 DOI: 10.1016/j.clgc.2020.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Resistance to novel androgen signaling inhibition and metastatic castration-resistant prostate cancer (mCRPC) progression is likely dependent on tumor microenvironment interactions. The Src pathway and neoangiogenesis have been implicated in prostate cancer progression. We studied the effect of adding the targeted agents dasatinib and sunitinib to abiraterone acetate (AA) in men with mCRPC. PATIENTS AND METHODS In this open-label randomized phase 2 study, mCRPC patients received AA. At resistance to AA, they were randomized 1:1 to combination with dasatinib or sunitinib. At second progression, patients crossed over. The primary end point was time to treatment failure (TTF), defined as time to progression or death. Secondary end points included overall survival and safety. RESULTS From March 2011 to February 2015, a total of 179 patients were enrolled and 132 subsequently randomized. Median TTF was 5.7 months in the dasatinib group and 5.5 months in the sunitinib group. There was no difference between the two groups in terms of TTF (hazard ratio, 0.85; 95% confidence interval, 0.59-1.22). Median overall survival from study entry was 26.3 months in the dasatinib group and 27.7 months in the sunitinib group (hazard ratio, 1.02; 95% confidence interval, 0.71-1.47). Grade 3 or higher adverse events related to study medication were more frequent with sunitinib (n = 44, 46%) compared to dasatinib (n = 26, 24%). At data cutoff, 7 patients were experiencing a continuous response to AA, with a median duration of treatment of 5.7 years. CONCLUSION There is no difference in overall survival and TTF between dasatinib and sunitinib combined with abiraterone in the treatment of patients with bone mCRPC.
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Affiliation(s)
- Nicholas Spetsieris
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Myrto Boukovala
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Justin A Weldon
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alexandros Tsikkinis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anh Hoang
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ana Aparicio
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shi-Ming Tu
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John C Araujo
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amado J Zurita
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul G Corn
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lance Pagliaro
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeri Kim
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer Wang
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sumit K Subudhi
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher J Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Patricia Troncoso
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sijin Wen
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, WV
| | - Eleni Efstathiou
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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27
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Efficace F, Collins GS, Cottone F, Giesinger JM, Sommer K, Anota A, Schlussel MM, Fazi P, Vignetti M. Patient-Reported Outcomes as Independent Prognostic Factors for Survival in Oncology: Systematic Review and Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:250-267. [PMID: 33518032 DOI: 10.1016/j.jval.2020.10.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/05/2020] [Accepted: 10/19/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Assessment of patient-reported outcomes (PROs) in oncology is of critical importance because it provides unique information that may also predict clinical outcomes. METHODS We conducted a systematic review of prognostic factor studies to examine the prognostic value of PROs for survival in cancer. A systematic literature search was performed in PubMed for studies published between 2013 and 2018. We considered any study, regardless of the research design, that included at least 1 PRO domain in the final multivariable prognostic model. The protocol (EPIPHANY) was published and registered in the International Prospective Register of Systematic Reviews (CRD42018099160). RESULTS Eligibility criteria selected 138 studies including 158 127 patients, of which 43 studies were randomized, controlled trials. Overall, 120 (87%) studies reported at least 1 PRO to be statistically significantly prognostic for overall survival. Lung (n = 41, 29.7%) and genitourinary (n = 27, 19.6%) cancers were most commonly investigated. The prognostic value of PROs was investigated in secondary data analyses in 101 (73.2%) studies. The EORTC QLQ-C30 questionnaire was the most frequently used measure, and its physical functioning scale (range 0-100) the most frequent independent prognostic PRO, with a pooled hazard ratio estimate of 0.88 per 10-point increase (95% CI 0.84-0.92). CONCLUSIONS There is convincing evidence that PROs provide independent prognostic information for overall survival across cancer populations and disease stages. Further research is needed to translate current evidence-based data into prognostic tools to aid in clinical decision making.
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Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy.
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Johannes M Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Sommer
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Amelie Anota
- French National Platform Quality of Life and Cancer, Besançon, France; Methodology and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Michael Maia Schlussel
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Paola Fazi
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
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Gschwend JE, Miller K. Abiraterone acetate plus prednisone/prednisolone in hormone-sensitive and castration-resistant metastatic prostate cancer. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020. [DOI: 10.1080/23808993.2021.1863781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Jürgen E Gschwend
- Department of Urology, Technical University of Munich, Universitätsklinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Kurt Miller
- Klinik Für Urologie, Charité, Universitätsmedizin Berlin, Berlin, Germany
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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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Tong T, Lei H, Guan Y, Yang X, Liao G, Li Y, Jiang D, Pang J. Revealing Prognostic Value of Skeletal-Related Parameters in Metastatic Castration-Resistant Prostate Cancer on Overall Survival: A Systematic Review and Meta-Analysis of Randomized Controlled Trial. Front Oncol 2020; 10:586192. [PMID: 33330067 PMCID: PMC7710983 DOI: 10.3389/fonc.2020.586192] [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: 07/22/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The skeleton is a preferred site for prostate cancer metastasis, and once metastases occur, the disease becomes incurable. Increasing evidence indicates the prognostic value of skeletal-related parameters, but remains controversial. OBJECTIVE To perform a systematic review of the existing literature on assessing the prognostic value of alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BSAP), urinary N-telopeptide (uNTx), bone scan index (BSI), and Brief Pain Inventory Short Form (BPI-SF) score in castration-resistant prostate cancer (CRPC) patients with skeleton metastasis. EVIDENCE ACQUISITION PubMed, Web of Science, Cochrane Library, Medline, OVID, and Embase between 2010 and 2019 were reviewed. Key terms included randomized trials, prostate cancer, alkaline phosphatase, bone-specific alkaline phosphatase, urinary N-telopeptide, bone scan index, and Brief Pain Inventory Short Form. Data were collected, checked, and analyzed from December 2019 to March 2020. Hazard ratios (HRs) and overall survival (OS) were extracted to estimate the relationship between the above parameters and OS in patients with metastatic prostate cancer (mPCa). EVIDENCE SYNTHESIS A total of 1,055 studies were identified via initial screening, including 1,032 from database research and 23 from other sources. After deduplication, 164 records were further excluded according to titles and abstracts. The remaining 36 potential articles were carefully screened. In the end, 15 eligible studies syntheses, which were published between 2010 and 2019, comprised data for a total of 11,378 patients, whose mean age ranged from 66 to 72 years. The sample size ranged from 82 to 1,901 patients. And the median follow-up time ranged from 24 to 55 months. Based on 15 randomized controlled trials published between 2010 and 2019, higher ALP levels (HR = 1.60, 95% CI: 1.38-1.87 P < 0.001), higher BSAP levels (HR = 1.31, 95% CI: 1.11-1.54 P = 0.001), higher uNTx levels (HR = 1.40, 95% CI: 1.29-1.52 P < 0.001), BSI progression (HR = 1.18, 95% CI: 1.08-1.29 P < 0.001), and higher BPI-SF score (HR = 1.47, 95% CI: 1.35-1.61 P < 0.001) had an association with inferior OS. CONCLUSIONS Higher levels of ALP/BSAP and uNTx, a higher BPI-SF score, and progression of BSI predict inferior OS in patients with mCRPC. More randomized control trials are needed to investigate the promising value of these parameters.
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Affiliation(s)
| | | | | | | | | | | | - Donggen Jiang
- Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jun Pang
- Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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Iacovelli R, Ciccarese C, Caffo O, De Giorgi U, Tucci M, Mosillo C, Bimbatti D, Pierantoni F, Maines F, Casadei C, Buttigliero C, Milella M, Tortora G. The prognostic value of pain in castration-sensitive prostate cancer. Prostate Cancer Prostatic Dis 2020; 23:654-660. [PMID: 32651468 DOI: 10.1038/s41391-020-0255-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/07/2020] [Accepted: 07/02/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cancer-related pain, usually associated with bone metastases, is a frequent and debilitating morbidity in patients with prostate cancer. To date there are only limited data regarding the prognostic role of pain in men with metastatic castration-sensitive prostate cancer (mCSPC). The objective of our analysis was to assess if the presence of pain can be considered an independent prognostic factor in mCSPC patients. METHODS A retrospective analysis was performed on patients with mCSPC referring to six oncology centers in Italy. Clinical and pathological features were recorded. Patients were considered to have pain if this was reported within the patient's file or in case of a chronic analgesic therapy was found among the concomitant medications. Survivals were estimated by the Kaplan-Meier method, and compared across groups using the log-rank test. Cox proportional hazard models, stratified according to the baseline characteristics, were used to estimate hazard ratios for overall survival (OS). All the variables were significant if p < 0.05. RESULTS Data about pain were available for 365 cases and pain was present in 34.8% of patients. Pain was mainly associated with high value of prostate-specific antigen, metastatic bone extension regardless of the site, and lymph node involvement. mCSPC patients with pain had in most of the cases high-volume or Hr disease, and significant shorter OS (27.0 vs. 58.2 months, p < 0.001) and PFS (10.1 vs. 17.4 months, p < 0.001) compared to those without pain. The negative impact of pain on OS remained significant even if adjusted for CHAARTED or LATITUDE classification, and other significant baseline prognostic factors. CONCLUSIONS This analysis supports the poor prognostic role of cancer-related pain in the setting of mCSPC patients. A prospective validation is required.
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Affiliation(s)
- Roberto Iacovelli
- Medical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Chiara Ciccarese
- Medical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, 38112, Trento, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Scientific Institute Romagnolo for the Study and Treatment of Cancer (IRST) IRCCS, Meldola, Italy
| | | | - Claudia Mosillo
- Medical Oncology Unit, Azienda Ospedaliera Santa Maria di Terni, Terni, Italy
| | - Davide Bimbatti
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | | | - Francesca Maines
- Department of Medical Oncology, Santa Chiara Hospital, 38112, Trento, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Scientific Institute Romagnolo for the Study and Treatment of Cancer (IRST) IRCCS, Meldola, Italy
| | - Consuelo Buttigliero
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Michele Milella
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Giampaolo Tortora
- Medical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Fujita N, Hatakeyama S, Momota M, Tobisawa Y, Yoneyama T, Yamamoto H, Imai A, Ito H, Yoneyama T, Hashimoto Y, Yoshikawa K, Mariya Y, Ohyama C. Safety and Feasibility of Radiation Therapy to the Primary Tumor in Patients With Metastatic Castration-resistant Prostate Cancer. Clin Genitourin Cancer 2020; 18:e523-e530. [PMID: 32278839 DOI: 10.1016/j.clgc.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The objective of this study was to evaluate the safety and feasibility of radiation therapy (RT) to the primary tumor in patients with metastatic castration-resistant prostate cancer (mCRPC). PATIENTS AND METHODS This retrospective study included 105 patients with mCRPC who were treated between April 2004 and May 2019. We divided the patients into 2 groups: patients treated with RT to the primary tumor after they developed CRPC (RT group) and without (non-RT group). The primary purpose was safety assessed using the Common Terminology Criteria for Adverse Events. The secondary purpose included prostate-specific antigen (PSA) response, cancer-specific survival (CSS), and overall survival (OS). Background-adjusted multivariate analyses, with the inverse probability of treatment weighting (IPTW) method, were performed to evaluate impact of RT on CSS and OS. RESULTS The median age at CRPC diagnosis was 75 years, and the median follow-up period after CRPC diagnosis was 21 months. The adverse events rates related to RT in any grade and grade ≥ 3 were 55% and 23%, respectively. Nine (29%) patients achieved ≥ 30% PSA decline with RT. In multivariate analyses with the IPTW method, the CSS and OS in the RT group were significantly longer than those in the non-RT group. In subgroup analyses with the IPTW method, RT was significantly associated with improved OS in patients aged ≥ 75 years and patients with initial PSA ≥ 500 ng/mL, cT4, Gleason score ≥ 8, and high-volume metastatic burden. CONCLUSIONS RT to the primary tumor is safe and feasible, and it has potential benefits on oncologic outcomes in patients with mCRPC.
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Affiliation(s)
- Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Atsushi Imai
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroyuki Ito
- Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Yasushi Mariya
- Department of Radiology, Mutsu General Hospital, Mutsu, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Valero J, Peleteiro P, Henríquez I, Conde A, Piquer T, Lozano A, Soler CC, Muñoz J, Illescas A, Jove J, Flores MM, Baquedano J, Diezhandino P, de Celis RP, Pardo EH, Samper P, Villoslada I, Eguiguren M, Millan V. Age, Gleason Score, and PSA are important prognostic factors for survival in metastatic castration-resistant prostate cancer. Results of The Uroncor Group (Uro-Oncological Tumors) of the Spanish Society of Radiation Oncology (SEOR). Clin Transl Oncol 2020; 22:1378-1389. [PMID: 31989474 DOI: 10.1007/s12094-019-02274-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 12/16/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The treatment of metastatic castration-resistant prostate cancer (mCRPC) has changed significantly in recent years. Inhibitors of androgen receptors have shown especially significant benefits in overall (OS) and progression-free survival (PFS), with a good toxicity profile. Treatment selection depends on the patient's individual clinical, radiological, and biological characteristics. OBJECTIVE To describe treatment outcomes (efficacy, toxicity) in a cohort of patients with mCRPC in Spain. MATERIALS AND METHODS Multicenter, retrospective study of patients with mCRPC included in a database of the Urological Tumour Working Group (URONCOR) of the Spanish Society of Radiation Oncology (SEOR). Metastatic CRPC was defined according to the prostate cancer working group 3 (PCWG3) criteria. The Kaplan-Meier technique was used to evaluate OS and the Common Terminology Criteria for Adverse Events (CTCAE, v.4.0) were used to assess toxicity. Univariate and multivariate Cox regression analyses were performed to identify the factors significantly associated with OS. RESULTS A total of 314 patients from 17 hospitals in Spain diagnosed with mCRPC between June 2010 and September 2017 were included in this study. Mean age at diagnosis was 68 years (range 45-89). At a median follow-up of 35 months, OS at 1, 3, and 5 years were 92%, 38%, and 28%, respectively. Grades 1-2 and grade 3 toxicity rates were, respectively, 68% and 19%. No grade 4 toxicities were observed. On the multivariate analysis, the following factors were significantly associated with OS: age (hazard ratio [HR] 0.42, p = 0.010), PSA value at diagnosis of mCRPC (HR 0.55, p = 0.008), and Gleason score (HR 0.61, p = 0.009). CONCLUSIONS Age, Gleason score, and PSA at diagnosis of mCRPC are independently associated with overall survival in patients with mCRPC. The efficacy and toxicity outcomes in this patient cohort treated in radiation oncology departments in Spain are consistent with previous reports.
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Affiliation(s)
- J Valero
- Hospital Universitario HM Sanchinarro, Madrid, Spain.
| | - P Peleteiro
- Hospital Clinico Universitario de Santiago de Compostela, Santiago, Spain
| | - I Henríquez
- Hospital Universitario Sant Joan de Reus, Tarragona, Spain
| | - A Conde
- Hospital La Fe de Valencia, Valencia, Spain
| | - T Piquer
- Hospital de Castellon, Castellón, Spain
| | - A Lozano
- Hospital Virgen de la Arrixaca de Murcia, El Palmar, Spain
| | - C C Soler
- Hospital Torrecardenas Almeria, Almería, Spain
| | - J Muñoz
- Hospital Universitario Infanta Cristina de Badajoz, Badajoz, Spain
| | - A Illescas
- Hospital Virgen de la Macarena de Sevilla, Sevilla, Spain
| | - J Jove
- Instituto Catalan de Oncologia Badalona, Barcelona, Spain
| | - M M Flores
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - J Baquedano
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - P Diezhandino
- Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - R P de Celis
- Hospital Txagorritxu de Vitoria, Vitoria-Gasteiz, Spain
| | - E H Pardo
- Hospital Txagorritxu de Vitoria, Vitoria-Gasteiz, Spain
| | - P Samper
- Hospital Universitario Rey Juan Carlos de Mostoles, Madrid, Spain
| | | | - M Eguiguren
- Hospital Universitario Donostia, Donostia-San Sebastian, Spain
| | - V Millan
- Hospital Clinico Universitario de Zaragoza, Zaragoza, Spain
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Clinical progression is associated with poor prognosis whatever the treatment line in metastatic castration resistant prostate cancer: The CATS international database. Eur J Cancer 2020; 125:153-163. [DOI: 10.1016/j.ejca.2019.10.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022]
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Rice MA, Malhotra SV, Stoyanova T. Second-Generation Antiandrogens: From Discovery to Standard of Care in Castration Resistant Prostate Cancer. Front Oncol 2019; 9:801. [PMID: 31555580 PMCID: PMC6723105 DOI: 10.3389/fonc.2019.00801] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022] Open
Abstract
Prostate cancer is the most commonly diagnosed cancer affecting men in the United States. The prostate is a hormone-dependent gland in which androgen hormones testosterone and dihydrotestosterone bind to and activate the androgen receptor, initiating nuclear translocation of androgen receptor and a subsequent signaling cascade. Due to the androgen dependency of the prostate, androgen deprivation therapies have emerged as first line treatment for aggressive prostate cancer. Such therapies are effective until the point at which prostate cancer, through a variety of mechanisms including but not limited to generation of ligand-independent androgen receptor splice variants, or intratumoral androgen production, overcome hormone deprivation. These cancers are androgen ablation resistant, clinically termed castration resistant prostate cancer (CRPC) and remain incurable. First-generation antiandrogens established androgen receptor blockade as a therapeutic strategy, but these therapies do not completely block androgen receptor activity. Efficacy and potency have been improved by the development of second-generation antiandrogen therapies, which remain the standard of care for patients with CRPC. Four second-generation anti-androgens are currently approved by the Food and Drug Administration (FDA); abiraterone acetate, enzalutamide, and recently approved apalutamide and darolutamide. This review is intended to provide a thorough overview of FDA approved second-generation antiandrogen discovery, treatment application, strategies for combination therapy to overcome resistance, and an insight for the potential future approaches for therapeutic inhibition of androgen receptor.
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Affiliation(s)
- Meghan A. Rice
- Department of Radiology, Canary Center at Stanford for Cancer Early Detection, Stanford University, Palo Alto, CA, United States
| | - Sanjay V. Malhotra
- Department of Radiology, Canary Center at Stanford for Cancer Early Detection, Stanford University, Palo Alto, CA, United States
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, United States
| | - Tanya Stoyanova
- Department of Radiology, Canary Center at Stanford for Cancer Early Detection, Stanford University, Palo Alto, CA, United States
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Boegemann M, Schlack K, Früchtenicht L, Steinestel J, Schrader AJ, Wennmann Y, Krabbe LM, Eminaga O. A prognostic score for overall survival in patients treated with abiraterone in the pre- and post-chemotherapy setting. Oncotarget 2019; 10:5082-5091. [PMID: 31489117 PMCID: PMC6707939 DOI: 10.18632/oncotarget.27133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/21/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Therapy resistance remains a serious dilemma in metastatic castration-resistant prostate cancer (mCRPC) with primary or secondary resistance frequently occurring against any given therapy. Available prognostic models for Abiraterone Acetate (AA) are specifically designed for either pre- or post-chemotherapy settings and mostly based on trial datasets not necessarily reflecting real-life.
Results: A score of 0–2 (low-risk) is associated with an OS-probability of 80.0% (95%CI: 71.3–90.6) and 50.5% (95%CI: 38.7–66.0) after 1 and 2 years while a score of 3–4 (high risk) is associated with an OS-probability of 35.3% (95%CI: 22.3–55.8) and 5.7% (95%CI: 1.5–21.8), respectively. The bootstrapping survival analysis of the scoring-system revealed a median c-index of 0.80 (IQR: 0.79–0.82).
Material and Methods: We developed a scoring-system using four real-life parameters 117 mCRPC patients treated with AA either pre- or post-chemotherapy. These parameters were evaluated using COX regression analysis. The scoring-system consists of binary-categorized parameters; when any of these exceeds the given cut-off, one point is added up to a final score ranging between 0–4 points. The final score was stratified by a median threshold of 2 into low- and high-risk groups. We evaluated the discriminative ability of our scoring-system using concordance probability (C-index) and Kaplan–Meier-analysis and applied a 100-times bootstrap for survival analysis.
Conclusions: Our study introduces a novel prognostic scoring-system for OS of real-life mCRPC patients receiving AA treatment irrespective of the line of therapy. The scoring-system is simple and can be easily utilized based on PSA and LDH values, neutrophil to lymphocyte ratio, and ECOG performance status.
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Affiliation(s)
- Martin Boegemann
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Katrin Schlack
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Lena Früchtenicht
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Julie Steinestel
- Department of Urology, Augsburg Medical Center, Augburg, Germany
| | - Andres Jan Schrader
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Yvonne Wennmann
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Laura-Maria Krabbe
- Department of Urology, University of Muenster Medical Center, Muenster, Germany.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Okyaz Eminaga
- Department of Urology, Stanford Medical School, Stanford, CA, USA
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Mori K, Kimura S, Parizi MK, Enikeev DV, Glybochko PV, Seebacher V, Fajkovic H, Mostafaei H, Lysenko I, Janisch F, Egawa S, Shariat SF. Prognostic Value of Lactate Dehydrogenase in Metastatic Prostate Cancer: A Systematic Review and Meta-analysis. Clin Genitourin Cancer 2019; 17:409-418. [PMID: 31558410 DOI: 10.1016/j.clgc.2019.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 02/08/2023]
Abstract
The purpose of this study was to assess the prognostic value of lactate dehydrogenase (LDH) in patients with metastatic prostate cancer (PC). A systematic review and meta-analysis was performed in March 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared patients with PC with high versus low LDH to determine the predictive value of LDH for overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). We performed a formal meta-analysis for both OS and PFS. A total of 59 articles with 14,851 patients were included in the systematic review and 45 studies with 12,224 patients for the qualitative assessment. High LDH was associated with both worse OS (pooled hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.75-2.44) and PFS (pooled HR, 1.08; 95% CI, 1.01-1.16). In subgroup analyses of both patients with castration-resistant prostate cancer (CRPC) and those with hormone-sensitive prostate cancer (HSPC), LDH was associated with OS (pooled HR, 2.02; 95% CI, 1.69-2.42 and pooled HR, 2.25; 95% CI, 1.78-2.84, respectively). In patients with CRPC, LDH was associated with OS in those treated with docetaxel systemic chemotherapy and androgen receptor-axis-targeting agents (pooled HR, 2.03; 95% CI, 1.37-3.00 and pooled HR, 1.79; 95% CI, 1.25-2.57, respectively). Elevated serum levels of LDH were associated with an increased risk of mortality and progression in patients with metastatic PC. LDH was independently associated with OS in both patients with CRPC and HSPC. LDH could be integrated into prognostic tools that help guide treatment strategy, thereby facilitating the shared decision-making process.
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Affiliation(s)
- Keiichiro Mori
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kimura
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mehdi Kardoust Parizi
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Teheran, Iran
| | - Dmitry V Enikeev
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Petr V Glybochko
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Harun Fajkovic
- Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Hadi Mostafaei
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Hamburg, Hamburg, Germany
| | - Ivan Lysenko
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Florian Janisch
- Department of Urology, Medical University of Vienna, Vienna, Austria; Research Center for Evidence-based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern, Dallas, TX; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
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38
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Caron P, Turcotte V, Lévesque E, Guillemette C. An LC-MS/MS method for quantification of abiraterone, its active metabolites D(4)-abiraterone (D4A) and 5α-abiraterone, and their inactive glucuronide derivatives. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1104:249-255. [DOI: 10.1016/j.jchromb.2018.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/15/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
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Chiong E, Murphy DG, Akaza H, Buchan NC, Chung BH, Kanesvaran R, Khochikar M, Letran J, Lojanapiwat B, Ng CF, Ong T, Pu YS, Saad M, Schubach K, Türkeri L, Umbas R, Le Chuyen V, Williams S, Ye DW, Davis ID. Management of patients with advanced prostate cancer in the Asia Pacific region: 'real-world' consideration of results from the Advanced Prostate Cancer Consensus Conference (APCCC) 2017. BJU Int 2018; 123:22-34. [PMID: 30019467 DOI: 10.1111/bju.14489] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The Asia Pacific Advanced Prostate Cancer Consensus Conference (APAC APCCC 2018) brought together 20 experts from 15 APAC countries to discuss the real-world application of consensus statements from the second APCCC held in St Gallen in 2017 (APCCC 2017). FINDINGS Differences in genetics, environment, lifestyle, diet and culture are all likely to influence the management of advanced prostate cancer in the APAC region when compared with the rest of the world. When considering the strong APCCC 2017 recommendation for the use of upfront docetaxel in metastatic castration-naïve prostate cancer, the panel noted possible increased toxicity in Asian men receiving docetaxel, which would affect this recommendation in the APAC region. Although androgen receptor-targeting agents appear to be well tolerated in Asian men with metastatic castration-resistant prostate cancer, access to these drugs is very limited for financial reasons across the region. The meeting highlighted that cost and access to contemporary treatments and technologies are key factors influencing therapeutic decision-making in the APAC region. Whilst lower cost/older treatments and technologies may be an option, issues of culture and patient or physician preference mean, these may not always be acceptable. Although generic products can reduce cost in some countries, costs may still be prohibitive for lower-income patients or communities. The panellists noted the opportunity for a coordinated approach across the APAC region to address issues of access and cost. Developments in technologies and treatments are presenting new opportunities for the diagnosis and treatment of advanced prostate cancer. Differences in genetics and epidemiology affect the side-effect profiles of some drugs and influence prescribing. CONCLUSIONS As the field continues to evolve, collaboration across the APAC region will be important to facilitate relevant research and collection and appraisal of data relevant to APAC populations. In the meantime, the APAC APCCC 2018 meeting highlighted the critical importance of a multidisciplinary team-based approach to treatment planning and care, delivery of best-practice care by clinicians with appropriate expertise, and the importance of patient information and support for informed patient choice.
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Affiliation(s)
- Edmund Chiong
- Department of Urology, National University Hospital, National University Health System Singapore, Singapore City, Singapore
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre Melbourne, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Hideyuki Akaza
- Strategic Investigation on Comprehensive Cancer Network, The University of Tokyo, Tokyo, Japan
| | - Nicholas C Buchan
- Canterbury Urology Research Trust, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Byung Ha Chung
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Ravindran Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore City, Singapore
| | | | - Jason Letran
- Section of Urology, Department of Surgery, University of Santo Tomas, Manila, Philippines
| | - Bannakij Lojanapiwat
- Division of Urology, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chi-Fai Ng
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Teng Ong
- Division of Urology, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Yeong-Shiau Pu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Marniza Saad
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kathryn Schubach
- Australian and New Zealand Urology Nurses (ANZUNS), Melbourne, VIC, Australia
| | - Levent Türkeri
- Department of Urology, Acıbadem University, Istanbul, Turkey
| | - Rainy Umbas
- Department of Urology, University of Indonesia, Jakarta, Indonesia
| | - Vu Le Chuyen
- Department of Urology, Binh dan Hospital, Ho Chi Minh City, Vietnam
| | - Scott Williams
- Division of Radiation Oncology, Peter MacCallum Cancer Centre Melbourne, Melbourne, VIC, Australia.,ANZUP Cancer Trials Group, Sydney, NSW, Australia
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
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- Lifehouse, Camperdown, Sydney, NSW, Australia
| | - Ian D Davis
- Monash University, Melbourne, VIC, Australia.,Eastern Health, Melbourne, VIC, Australia.,ANZUP Cancer Trials Group, Sydney, NSW, Australia
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Tang Y, Pan J, Huang S, Peng X, Zou X, Luo Y, Ren D, Zhang X, Li R, He P, Wa Q. Downregulation of miR-133a-3p promotes prostate cancer bone metastasis via activating PI3K/AKT signaling. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2018; 37:160. [PMID: 30021600 PMCID: PMC6052526 DOI: 10.1186/s13046-018-0813-4] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/23/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Bone metastasis is a leading cause of morbidity and mortality in advanced prostate cancer (PCa). Downexpression of miR-133a-3p has been found to contribute to the progression, recurrence and distant metastasis in PCa. However, clinical significance of miR-133a-3p in bone metastasis of PCa, and the biological role of miR-133a-3p and its molecular mechanisms underlying bone metastasis of PCa remain unclear. METHODS miR-133a-3p expression was evaluated in 245 clinical PCa tissues by real-time PCR. Statistical analysis was performed to evaluate the clinical correlation between miR-133a-3p expression and clinicopathological features, and overall and bone metastasis-free survival in PCa patients. The biological roles of miR-133a-3p in the bone metastasis of PCa were investigated both in vitro and in vivo. Bioinformatics analysis, real-time PCR, western blot and luciferase reporter analysis were applied to demonstrate the relationship between miR-133a-3p and its potential targets. Western blotting and luciferase assays were examined to identify the underlying pathway involved in the anti-tumor role of miR-133a-3p. Clinical correlation of miR-133a-3p with its targets was verified in human PCa tissues. RESULTS miR-133a-3p expression is reduced in PCa tissues compared with the adjacent normal tissues and benign prostate lesion tissues, particularly in bone metastatic PCa tissues. Low expression of miR-133a-3p is significantly correlated with advanced clinicopathological characteristics and shorter bone metastasis-free survival in PCa patients by statistical analysis. Moreover, upregulating miR-133a-3p inhibits cancer stem cell-like phenotypes in vitro and in vivo, as well as attenuates anoikis resistance in vitro in PCa cells. Importantly, administration of agomir-133a-3p greatly suppresses the incidence of PCa bone metastasis in vivo. Our results further demonstrate that miR-133a-3p suppresses bone metastasis of PCa via inhibiting PI3K/AKT signaling by directly targeting multiple cytokine receptors, including EGFR, FGFR1, IGF1R and MET. The negative clinical correlation of miR-133a-3p with EGFR, FGFR1, IGF1R, MET and PI3K/AKT signaling activity is determined in clinical PCa tissues. CONCLUSION Our results unveil a novel mechanism by which miR-133a-3p inhibits bone metastasis of PCa, providing the evidence that miR-133a-3p may serve as a potential bone metastasis marker in PCa, and delivery of agomir-133a-3p may be an effective anti-bone metastasis therapeutic strategy in PCa.
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Affiliation(s)
- Yubo Tang
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Jincheng Pan
- Department of Urology Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Shuai Huang
- Department of Orthopaedic Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China.,Department of Orthopaedic Surgery, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2rd Road, Guangzhou, 510080, Guangdong Province, China
| | - Xinsheng Peng
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2rd Road, Guangzhou, 510080, Guangdong Province, China
| | - Xuenong Zou
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,Department of Orthopaedic Surgery, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2rd Road, Guangzhou, 510080, Guangdong Province, China
| | - Yongxiang Luo
- Department of biomedical engineering, health science center, Shenzhen University, Shenzhen, 518060, China
| | - Dong Ren
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2rd Road, Guangzhou, 510080, Guangdong Province, China
| | - Xin Zhang
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, 529030, China
| | - Ronggang Li
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, 529030, China
| | - Peiheng He
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2rd Road, Guangzhou, 510080, Guangdong Province, China.
| | - Qingde Wa
- Department of Orthopaedic Surgery, the Affiliated Hospital of Zunyi Medical college, 149 Dalian Road, Zunyi, 563003, Guizhou Province, China.
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41
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Culine S. Customizing Daily Management of Castrate-resistant Prostate Cancer: Waiting for the Next Step. Eur Urol 2018; 74:24-25. [DOI: 10.1016/j.eururo.2017.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 11/25/2022]
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42
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Statin use and survival in patients with metastatic castration-resistant prostate cancer treated with abiraterone or enzalutamide after docetaxel failure: the international retrospective observational STABEN study. Oncotarget 2018; 9:19861-19873. [PMID: 29731989 PMCID: PMC5929432 DOI: 10.18632/oncotarget.24888] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/27/2018] [Indexed: 12/03/2022] Open
Abstract
Background Statins may potentiate the effects of anti-hormonal agents for metastatic castration-resistant prostate cancer (mCRPC) through further disruption of essential steroidogenic processes. We investigated the effects of statin use on clinical outcomes in patients with mCRPC receiving abiraterone or enzalutamide. Materials and methods This was a retrospective multicenter study including patients that received abiraterone or enzalutamide for mCRPC. The effect of concurrent statin use on outcomes was evaluated. The associations of statins with early (≤12 weeks) prostate-specific antigen (PSA) declines (> 30%), cancer-specific survival and overall survival (OS) were evaluated after controlling for known prognostic factors. Results Five hundred and ninety-eight patients treated with second-line abiraterone or enzalutamide after docetaxel for mCRPC were included. A total of 199 men (33.3%) received statins during abiraterone/enzalutamide treatment. Median OS was 20.8 months (95% CI = 18.3–23.2) for patients who received statins, versus 12.9 months (95% CI = 11.4–14.6) for patients who did not receive statins (P < 0.001). After adjusting for age, alkaline phosphatase, PSA, neutrophil-to-lymphocytes ratio, Charlson comorbidity score, Gleason score, visceral disease, hemoglobin, opiate use and abiraterone versus enzalutamide treatment, the use of statin therapy was associated with a 53% reduction in the overall risk of death (hazard ratio [HR] = 0.47; 95% CI = 0.35–0.63; P < 0.001). Statin use was also associated with a 63% increased odds of a > 30% PSA decline within the first 12 weeks of treatment (OR = 1.63; 95% CI = 1.03–2.60; P = 0.039). Conclusions In this retrospective cohort, statin use was significantly associated with both prolonged OS and cancer-specific survival and increased early > 30% PSA declines. Prospective validation is warranted.
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Cindolo L, Natoli C, De Nunzio C, De Tursi M, Valeriani M, Giacinti S, Micali S, Rizzo M, Bianchi G, Martorana E, Scarcia M, Ludovico GM, Bove P, Laudisi A, Selvaggio O, Carrieri G, Bada M, Castellan P, Boccasile S, Ditonno P, Chiodini P, Verze P, Mirone V, Schips L. Safety and efficacy of abiraterone acetate in chemotherapy-naive patients with metastatic castration-resistant prostate cancer: an Italian multicenter "real life" study. BMC Cancer 2017; 17:753. [PMID: 29126389 PMCID: PMC5681753 DOI: 10.1186/s12885-017-3755-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To evaluate the safety and efficacy of abiraterone acetate (AA) in the "real life" clinical practice for men with chemotherapy-naïve metastatic castration-resistant prostate. METHODS A consecutive series of patients with mCRPC in 9 Italian tertiary centres treated with AA was collected. Demographics, clinical parameters, treatment outcomes and toxicity were recorded. The Brief Pain Inventory scale Q3 was tracked and patient treatment satisfaction was evaluated. Survival curves were estimated by the method of Kaplan-Meier and Cox regression and compared by the log-rank test statistic. RESULTS We included 145 patients (mean age 76.5y). All patients were on androgen deprivation therapy. Patients had prior radiotherapy, radical prostatectomy, both treatments or exclusive androgen deprivation therapy in 17%, 33%, 9% and 40%, respectively. 57% of the patients had a Gleason score higher more than 7 at diagnosis. 62% were asymptomatic patients. The median serum total PSA at AA start was 17 ng/mL (range 0,4-2100). The median exposure to AA was 10 months (range 1-35). The proportion of patients achieving a PSA decline ≥50% at 12 weeks was 49%. Distribution of patient satisfaction was 32% "greatly improved", 38% "improved", 24% "not changed", 5.5% "worsened". Grade 3 and 4 toxicity was recorded in 17/145 patients 11.7% (70% cardiovascular events, 30% critical elevation of AST/ALT levels). At the last follow-up, median progression free and overall survival were 17 and 26.5 months, respectively. Both outcomes significantly correlated with the presence of pain, patient satisfaction, PSA baseline and PSA decline. CONCLUSIONS The AA is effective and well tolerated in asymptomatic or slightly symptomatic mCRPC in a "real life" setting. The survival outcomes are influenced by the presence of pain, patient satisfaction, baseline PSA and PSA decline. TRIAL REGISTRATION The study was retrospectively registered at ISRCTN as DOI: 10.1186/ISRCTN 52513758 in date April the 30th 2016.
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Affiliation(s)
- Luca Cindolo
- Department of Urology, ASL Abruzzo2, Via dei Vestini, Chieti, Italy. .,Department of Urology, ASL Abruzzo2 , "S. Pio da Pietrelcina" Hospital, Via San Camillo de Lellis 1, Vasto, Italy.
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale (CeSI-MeT), Chieti, Italy
| | - Cosimo De Nunzio
- Department of Urology, "Sant'Andrea" Hospital , Sapienza University", Rome, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale (CeSI-MeT), Chieti, Italy
| | - Maurizio Valeriani
- Radiation therapy Unit, "Sant'Andrea" Hospital, "Sapienza University", Rome, Italy
| | - Silvana Giacinti
- Oncology Unit, "Sant'Andrea" Hospital, "Sapienza University", Rome, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena & Reggio Emilia, Baggiovara Hospital, Via Giardini, 1355, Baggiovara, Italy
| | - Mino Rizzo
- Department of Urology, University of Modena & Reggio Emilia, Baggiovara Hospital, Via Giardini, 1355, Baggiovara, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena & Reggio Emilia, Baggiovara Hospital, Via Giardini, 1355, Baggiovara, Italy
| | - Eugenio Martorana
- Department of Urology, University of Modena & Reggio Emilia, Baggiovara Hospital, Via Giardini, 1355, Baggiovara, Italy
| | - Marcello Scarcia
- Ente Ecclesiastico Ospedale "F. Miulli", S.P. per Santeramo Km 4.100, Acquaviva delle Fonti, Italy
| | - Giuseppe Mario Ludovico
- Ente Ecclesiastico Ospedale "F. Miulli", S.P. per Santeramo Km 4.100, Acquaviva delle Fonti, Italy
| | - Pierluigi Bove
- Department Of Experimental Medicine and Surgery, Azienda Policlinico Tor Vergata, Rome, Italy
| | - Anastasia Laudisi
- UOSD of Medical Oncology Azienda Policlinico Tor Vergata, Rome, Italy
| | - Oscar Selvaggio
- Department of Urology, University of Foggia, V.le L. Pinto, Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology, University of Foggia, V.le L. Pinto, Foggia, Italy
| | - Maida Bada
- Department of Urology, ASL Abruzzo2, Via dei Vestini, Chieti, Italy
| | - Pietro Castellan
- Department of Urology, ASL Abruzzo2, Via dei Vestini, Chieti, Italy
| | - Stefano Boccasile
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Piazza G. Cesare 11, Bari, Italy
| | - Pasquale Ditonno
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Piazza G. Cesare 11, Bari, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli", via L. Armanni 5, Naples, Italy
| | - Paolo Verze
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Luigi Schips
- Department of Urology, ASL Abruzzo2, Via dei Vestini, Chieti, Italy
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Ryan CJ, Kheoh T, Li J, Molina A, De Porre P, Carles J, Efstathiou E, Kantoff PW, Mulders PFA, Saad F, Chi KN. Prognostic Index Model for Progression-Free Survival in Chemotherapy-Naïve Metastatic Castration-Resistant Prostate Cancer Treated With Abiraterone Acetate Plus Prednisone. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30211-2. [PMID: 28844792 PMCID: PMC5785489 DOI: 10.1016/j.clgc.2017.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/21/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Radiographic progression-free survival (rPFS) is associated with overall survival (OS) in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) patients. Using readily assessable baseline clinical and laboratory parameters, we developed a prognostic index model for rPFS in chemotherapy-naïve mCRPC patients without visceral disease who were treated with abiraterone acetate plus prednisone. METHODS Data from the abiraterone acetate plus prednisone arm of COU-AA-302 were used. rPFS was defined based on modified Prostate Cancer Working Group 2 criteria. Baseline variables were assessed for association with rPFS through univariate Cox modeling. The lower (LLN) and upper (ULN) limits of laboratory normal were used to dichotomize most laboratory parameters; baseline median was used to dichotomize prostate-specific antigen (PSA). Prognostic factors for rPFS were identified by multivariate Cox modeling. Model accuracy was estimated by the C-index. RESULTS Presence of lymph node metastasis (hazard ratio [HR] = 1.76, P < .0001), lactate dehydrogenase > ULN (234 IU/L) (HR = 1.71, P = .0001), ≥ 10 bone metastases (HR = 1.71, P = .0015), hemoglobin ≤ LLN (12.7 g/dL) (HR = 1.47, P = .0030) and PSA > 39.5 ng/mL (HR = 1.42, P = .0078) were associated with poor outcome. Patients were categorized into 3 prognostic groups (good, n = 230; intermediate, n = 152; poor, n = 164) based on number of risk factors. Median rPFS was calculated (27.6, 16.6, and 8.3 months for good, intermediate, and poor, respectively). The C-index was 0.83 (95% confidence interval = 0.73-0.91). CONCLUSIONS The prognostic index model for rPFS reveals differential outcomes based on factors readily available in clinical practice. If validated, this model can be integrated into clinical practice and design of risk-stratified trials.
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Affiliation(s)
- Charles J Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA.
| | - Thian Kheoh
- Janssen Research & Development, San Diego, CA
| | - Jinhui Li
- Johnson & Johnson Medical China, Shanghai, China
| | | | | | - Joan Carles
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Fred Saad
- Centre Hospitalier de l'Université de Montréal/CRCHUM, Montréal, QC, Canada
| | - Kim N Chi
- BC Cancer Agency, Vancouver, BC, Canada
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