1
|
Wong CHM, Nicoletti R, Mazzone E, Eapen RS. Lutetium-177-prostate-specific membrane antigen therapy for prostate cancer: current status and future prospects. Curr Opin Urol 2025; 35:46-52. [PMID: 39628406 DOI: 10.1097/mou.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
PURPOSE OF REVIEW Lutetium-177-prostate-specific membrane antigen (Lu 177-PSMA) radioligand therapy has emerged as a promising novel strategy for advanced prostate cancer. With its increasing importance alongside with a plethora of exciting results from latest trials, we would like to summarize current evidence and advancements in Lu 177-PSMA therapy across different stages of prostate cancer. RECENT FINDINGS In metastatic castration-resistant prostate cancer (mCRPC), early studies like the LuPSMA trial and TheraP trial demonstrated promising PSA response rates. The landmark VISION trial had established the oncological efficacy of Lu 177-PSMA as salvage therapy and demonstrated its benefit on survival outcomes. Explorations into earlier treatment settings have also been encouraging. Studies like that the PSMAfore trial, Enza-P trial and the UpFrontPSMA trial explored an earlier role of Lu 177-PSMA in mCRPC, and showed benefits when used in solitary or in junction with Docetaxel or androgen receptor pathway inhibitor. Finally, the potential use of Lu 177-PSMA as neoadjuvant therapy in localized prostate cancer is also under consideration, whose safety was demonstrated in the recent LuTectomy trial. SUMMARY Lu 177-PSMA therapy represents a significant advancement in prostate cancer treatment, offering selective and targeted delivery of radiation to prostate cancer cells in patients across various disease stages. Ongoing research and collaborative efforts are essential to overcome existing challenges, optimize patient selection and integrate this therapy into standard clinical practice, ultimately improving outcomes for patients with advanced prostate cancer.
Collapse
Affiliation(s)
- Chris Ho-Ming Wong
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University Hong Kong, Hong Kong SAR, China
| | - Rossella Nicoletti
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University Hong Kong, Hong Kong SAR, China
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Renu S Eapen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| |
Collapse
|
2
|
Liontos M, Bournakis E, Bournakis A, Kostouros E, Zolota V, Papatheodoridi AP, Karalis K, Kyriazoglou A, Zakopoulou R, Vasili E, Tzovaras A, Dimitriadis I, Emmanouil G, Mauri D, Christodoulou C, Tsiatas M, Zagouri F, Bamias A. Real-World Treatment Patterns in Patients With Metastatic Castration-Resistant Prostate Cancer in Greece: The PROSPECT Study. Clin Genitourin Cancer 2024; 22:102170. [PMID: 39191062 DOI: 10.1016/j.clgc.2024.102170] [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: 01/22/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Real-world data on management of metastatic castration resistant prostate cancer (mCRPC) with novel therapies is sparse. The aim of this study was to capture real-world management strategies in patients with mCRPC who initiated first line (1L) systemic therapy with chemotherapy or novel hormonal agents (NHAs) in Greece and describe the therapeutic sequencing strategy among patients who advanced to 2L and 3L treatment. PATIENTS AND METHODS In this noninterventional, multicentre, retrospective study (PROSPECT), a medical chart review of 149 patients with mCRPC who initiated 1L systemic therapy with chemotherapy or NHAs in 7 major anticancer hospital clinics, from public, academic, and private sectors in Greece was conducted. All endpoints were descriptively analysed. Kaplan-Meier was used for time-to-event outcomes. RESULTS At 1L (N = 149), most (78.5%) patients received NHAs; enzalutamide (52.3%), and abiraterone (26.2%). At 2L (N = 68), most (72.1%) patients received chemotherapy, most frequently docetaxel (50.0% of all patients). At 3L (N = 32), 56.3% and 31.3% of patients received chemotherapy and NHAs, respectively. Regarding treatment sequencing from 1L→2L (N = 68), most patients (55.9%) advanced from NHA→chemotherapy. Regarding treatment sequencing from 1L→2L→3L (N = 32), 34.4% advanced from NHAs→chemotherapy→chemotherapy and 31.3% from NHAs→chemotherapy→NHA. Estimated median times spent on treatment at 1L, 2L, and 3L were 9.8, 4.4, and 3.7 months, respectively. CONCLUSION Most patients were treated with 1L NHAs, in accordance to established guidelines (which suggest both NHA and chemo as preferred 1st line options). There appeared to be a longer time on treatment of NHAs at 1L than chemotherapy, suggesting an unmet need for treatment optimisation/recommendations for 2L and 3L treatment in mCRPC.
Collapse
Affiliation(s)
- M Liontos
- Department of Clinical Therapeutics, Alexandra Hospital National and Kapodistrian University of Athens, Athens, Greece
| | - E Bournakis
- Oncologic Clinical Trials and Research Clinic, Metropolitan Hospital, Cholargos, Athens, Greece
| | - A Bournakis
- Oncologic Clinical Trials and Research Clinic, Metropolitan Hospital, Cholargos, Athens, Greece
| | - E Kostouros
- Oncology Department, 3rd Internal Medicine Clinic, Athens General Hospital "G. Gennimatas", Attiki, Greece
| | - V Zolota
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - A P Papatheodoridi
- Department of Clinical Therapeutics, Alexandra Hospital National and Kapodistrian University of Athens, Athens, Greece
| | - K Karalis
- Department of Oncology, Athens Medical Center, Marousi, Greece
| | - A Kyriazoglou
- Second Department of Propaedeutic, Department of Internal Medicine, Attikon University General Hospital, Athens, Greece
| | - R Zakopoulou
- Second Department of Propaedeutic, Department of Internal Medicine, Attikon University General Hospital, Athens, Greece
| | - E Vasili
- Second Department of Medical Oncology, Metropolitan Hospital, Piraeus, Greece
| | - A Tzovaras
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, Athens, Greece
| | | | - G Emmanouil
- MSD Greece, Medical Affairs, Athens, Greece.
| | - D Mauri
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
| | - C Christodoulou
- Second Department of Medical Oncology, Metropolitan Hospital, Piraeus, Greece
| | - M Tsiatas
- Department of Oncology, Athens Medical Center, Marousi, Greece
| | - F Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital National and Kapodistrian University of Athens, Athens, Greece
| | - A Bamias
- Department of Oncology, Athens Medical Center, Marousi, Greece
| |
Collapse
|
3
|
Morris MJ, Castellano D, Herrmann K, de Bono JS, Shore ND, Chi KN, Crosby M, Piulats JM, Fléchon A, Wei XX, Mahammedi H, Roubaud G, Študentová H, Nagarajah J, Mellado B, Montesa-Pino Á, Kpamegan E, Ghebremariam S, Kreisl TN, Wilke C, Lehnhoff K, Sartor O, Fizazi K, PSMAfore Investigators. 177Lu-PSMA-617 versus a change of androgen receptor pathway inhibitor therapy for taxane-naive patients with progressive metastatic castration-resistant prostate cancer (PSMAfore): a phase 3, randomised, controlled trial. Lancet 2024; 404:1227-1239. [PMID: 39293462 PMCID: PMC12121614 DOI: 10.1016/s0140-6736(24)01653-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/10/2024] [Accepted: 08/09/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND [177Lu]Lu-PSMA-617 (177Lu-PSMA-617) prolongs radiographic progression-free survival and overall survival in patients with metastatic castration-resistant prostate cancer previously treated with androgen receptor pathway inhibitor (ARPI) and taxane therapy. We aimed to investigate the efficacy of 177Lu-PSMA-617 in patients with taxane-naive metastatic castration-resistant prostate cancer. METHODS In this phase 3, randomised, controlled trial conducted at 74 sites across Europe and North America, taxane-naive patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer who had progressed once on a previous ARPI were randomly allocated (1:1) to open-label, intravenous 177Lu-PSMA-617 at a dosage of 7·4 GBq (200 mCi) ± 10% once every 6 weeks for six cycles, or a change of ARPI (to abiraterone or enzalutamide, administered orally on a continuous basis per product labelling). Crossover from ARPI change to 177Lu-PSMA-617 was allowed after centrally confirmed radiographic progression. The primary endpoint was radiographic progression-free survival, defined as the time from randomisation until radiographic progression or death, assessed in the intention-to-treat population. Safety was a secondary endpoint. This study is registered with ClinicalTrials.gov (NCT04689828) and is ongoing. In this primary report of the study, we present primary (first data cutoff) and updated (third data cutoff) analyses of radiographic progression-free survival; all other data are based on the third data cutoff. FINDINGS Overall, of the 585 patients screened, 468 met all eligibility criteria and were randomly allocated between June 15, 2021 and Oct 7, 2022 to receive 177Lu-PSMA-617 (234 [50%] patients) or ARPI change (234 [50%]). Baseline characteristics were mostly similar between groups; median number of 177Lu-PSMA-617 cycles was 6·0 (IQR 4·0-6·0). Of patients assigned to ARPI change, 134 (57%) crossed over to receive 177Lu-PSMA-617. In the primary analysis (median time from randomisation to first data cutoff 7·26 months [IQR 3·38-10·55]), the median radiographic progression-free survival was 9·30 months (95% CI 6·77-not estimable) in the 177Lu-PSMA-617 group versus 5·55 months (4·04-5·95) in the ARPI change group (hazard ratio [HR] 0·41 [95% CI 0·29-0·56]; p<0·0001). In the updated analysis at time of the third data cutoff (median time from randomisation to third data cutoff 24·11 months [IQR 20·24-27·40]), median radiographic progression-free survival was 11·60 months (95% CI 9·30-14·19) in the 177Lu-PSMA-617 group versus 5·59 months (4·21-5·95) in the ARPI change group (HR 0·49 [95% CI 0·39-0·61]). The incidence of grade 3-5 adverse events was lower in the 177Lu-PSMA-617 group (at least one event in 81 [36%] of 227 patients; four [2%] grade 5 [none treatment related]) than the ARPI change group (112 [48%] of 232; five [2%] grade 5 [one treatment related]). INTERPRETATION 177Lu-PSMA-617 prolonged radiographic progression-free survival relative to ARPI change, with a favourable safety profile. For patients with PSMA-positive metastatic castration-resistant prostate cancer who are being considered for a change of ARPI after progression on a previous ARPI, 177Lu-PSMA-617 may be an effective treatment alternative. FUNDING Novartis.
Collapse
Affiliation(s)
- Michael J Morris
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Daniel Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, I+12 Research Institute, Madrid, Spain
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, German Cancer Consortium-University Hospital Essen, Essen, Germany; National Center for Tumor Diseases, NCT West, Heidelberg, Germany
| | - Johann S de Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, UK
| | - Neal D Shore
- Carolina Urologic Research Center, AU Clinics, Myrtle Beach, SC, USA
| | | | | | | | | | - Xiao X Wei
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Hana Študentová
- Department of Oncology, Palacký University, Faculty of Medicine and Dentistry, University Hospital, Olomouc, Czech Republic
| | - James Nagarajah
- Radboud University Medical Centre, Nijmegen, Netherlands; Roentgeninstitut Düsseldorf, Düsseldorf, Germany
| | - Begoña Mellado
- Medical Oncology Department, Hospital Clínic de Barcelona, Institut d' Investigacions Biomèdiques Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Álvaro Montesa-Pino
- UGCI Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, IBIMA, Málaga, Spain
| | | | | | - Teri N Kreisl
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Karim Fizazi
- Gustave Roussy Institute, Paris-Saclay University, Paris, France
| | | |
Collapse
|
4
|
Satapathy S, Yadav MP, Ballal S, Sahoo RK, Bal C. [ 177Lu]Lu-PSMA-617 as first-line systemic therapy in patients with metastatic castration-resistant prostate cancer: a real-world study. Eur J Nucl Med Mol Imaging 2024; 51:2495-2503. [PMID: 38467922 DOI: 10.1007/s00259-024-06677-y] [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: 11/23/2023] [Accepted: 03/03/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The use of [177Lu]Lu-PSMA-617 radioligand therapy has become increasingly recognized as a viable therapeutic approach for patients in the advanced stages of metastatic castration-resistant prostate cancer (mCRPC). However, there is limited data regarding its effectiveness and safety in earlier lines. This study aims to present our institution's experience with [177Lu]Lu-PSMA-617 as a first-line systemic therapy for mCRPC. METHODS We collected and analyzed data from consecutive mCRPC patients who underwent first-line treatment with [177Lu]Lu-PSMA-617 at our center from 2015 to 2023. The various outcome measures included best prostate-specific antigen-response rate (PSA-RR) (proportion of patients achieving a ≥ 50% decline in PSA); objective radiographic response rate (ORR) (proportion of patients achieving complete or partial radiographic responses); radiographic progression-free survival (rPFS) (measured from treatment initiation until radiographic progression or death from any cause); overall survival (OS) (measured from treatment initiation until death from any cause); and adverse events. RESULTS Forty treatment-naïve mCRPC patients with PSMA-positive disease on [68Ga]Ga-PSMA-11 PET/CT were included (median age: 68.5 years, range: 45-78; median PSA: 41 ng/mL, range: 1-3028). These patients received a median cumulative activity of 22.2 GBq (range: 5.55-44.4) [177Lu]Lu-PSMA-617 over 1-6 cycles at 8-12 week intervals. A ≥ 50% decline in PSA was observed in 25/40 (62.5%) patients (best PSA-RR). Radiographic responses were evaluated for thirty-eight patients, with thirteen showing partial responses (ORR 34.2%). Over a median follow-up of 36 months, the median rPFS was 12 months (95% confidence interval, CI: 9-15), and the median OS was 17 months (95% CI: 12-22). Treatment-emergent grade ≥ 3 anemia, leucopenia, and thrombocytopenia were noted in 4/40 (10%), 1/40 (2.5%), and 3/40 (7.5%) patients, respectively. CONCLUSION The findings suggest that [177Lu]Lu-PSMA-617 is a safe and effective option as a first-line treatment in mCRPC. Further trials are needed to definitively establish its role as an upfront treatment modality in this setting.
Collapse
Affiliation(s)
- Swayamjeet Satapathy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Madhav Prasad Yadav
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Sanjana Ballal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, B.R. Ambedkar Institute Rotary Cancer Hospital (B.R.A.I.R.C.H.), All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| |
Collapse
|
5
|
Jochems KFT, Menges D, Sanchez D, de Glas NA, Wildiers H, Eberli D, Puhan MA, Bastiaannet E. Outcomes in studies regarding older patients with prostate cancer: A systematic review. J Geriatr Oncol 2024; 15:101763. [PMID: 38575500 DOI: 10.1016/j.jgo.2024.101763] [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: 10/23/2023] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Older patients are often deemed ineligible for clinical research, and many frequently-used endpoints and outcome measures are not as relevant for older patients for younger ones. This systematic review aimed to present an overview of outcomes used in clinical research regarding patients over the age of 65 years with prostate cancer. MATERIALS AND METHODS PubMed and Embase were systematically searched to identify studies on prostate cancer (treatment) in patients aged ≥65 between 2016 and 2023. Data on title, study design, number of participants and age, stage of disease, treatment, and investigated outcomes were synthesized and descriptively analyzed. RESULTS Sixty-eight studies were included. Of these most included patients over 65 years, while others used a higher age. Overall, 39 articles (57.3%) reported on survival-related outcomes, 22 (32.4%) reported on progression of disease and 38 (55.9%) used toxicity or adverse events as an outcome measure. Health-related quality of life and functional outcomes were investigated in 29.4%, and cognition in two studies. The most frequently investigated survival-related outcomes were overall and cancer-specific survival (51.3%); however, 38.5% only studied overall survival. DISCUSSION The main focus of studies included in this review remains survival and disease progression. There is limited attention for health-related quality of life and functional status, although older patients often prioritize the latter. Future research should incorporate outcome measures tailored to the aged population to improve care for older patients with prostate cancer.
Collapse
Affiliation(s)
- Kim F T Jochems
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dafne Sanchez
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Nienke A de Glas
- Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Wildiers
- Oncology, University Hospital Leuven, Leuven, Belgium
| | - Daniel Eberli
- Urology, University Hospital Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Esther Bastiaannet
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
6
|
Chi KN, Yip SM, Bauman G, Probst S, Emmenegger U, Kollmannsberger CK, Martineau P, Niazi T, Pouliot F, Rendon R, Hotte SJ, Laidley DT, Saad F. 177Lu-PSMA-617 in Metastatic Castration-Resistant Prostate Cancer: A Review of the Evidence and Implications for Canadian Clinical Practice. Curr Oncol 2024; 31:1400-1415. [PMID: 38534939 PMCID: PMC10969693 DOI: 10.3390/curroncol31030106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 05/26/2024] Open
Abstract
Prostate-specific membrane antigen (PSMA) is highly expressed in prostate cancer and a therapeutic target. Lutetium-177 (177Lu)-PSMA-617 is the first radioligand therapy to be approved in Canada for use in patients with metastatic castration-resistant prostate cancer (mCRPC). As this treatment represents a new therapeutic class, guidance regarding how to integrate it into clinical practice is needed. This article aims to review the evidence from prospective phase 2 and 3 clinical trials and meta-analyses of observational studies on the use of 177Lu-PSMA-617 in prostate cancer and discuss how Canadian clinicians might best apply these data in practice. The selection of appropriate patients, the practicalities of treatment administration, including necessary facilities for treatment procedures, the assessment of treatment response, and the management of adverse events are considered. Survival benefits were observed in clinical trials of 177Lu-PSMA-617 in patients with progressive, PSMA-positive mCRPC who were pretreated with androgen receptor pathway inhibitors and taxanes, as well as in taxane-naïve patients. However, the results of ongoing trials are awaited to clarify questions regarding the optimal sequencing of 177Lu-PSMA-617 with other therapies, as well as the implications of predictive biomarkers, personalized dosimetry, and combinations with other therapies.
Collapse
Affiliation(s)
- Kim N. Chi
- Department of Medical Oncology, BC Cancer—Vancouver, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Steven M. Yip
- Department of Oncology, Tom Baker Cancer Centre and Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Glenn Bauman
- London Regional Cancer Program, Department of Oncology, Western University, London, ON N6A 5W9, Canada;
| | - Stephan Probst
- Department of Nuclear Medicine, Jewish General Hospital, McGill University, Montreal, QC H3A 0G4, Canada
| | - Urban Emmenegger
- Department of Medicine, Odette Cancer Centre, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - Christian K. Kollmannsberger
- Department of Medical Oncology, BC Cancer—Vancouver, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Patrick Martineau
- Department of Radiology, BC Cancer—Vancouver, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Tamim Niazi
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montréal, QC H3T 1E2, Canada;
| | - Frédéric Pouliot
- Department of Urology, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC G1V 0A6, Canada;
- Department of Surgery, Université Laval, Québec, QC G1V 0A6, Canada
| | - Ricardo Rendon
- Department of Urology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Sebastien J. Hotte
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - David T. Laidley
- Department of Medical Imaging-Nuclear Medicine, London Health Sciences Centre, Western University, London, ON N6A 3K7, Canada
| | - Fred Saad
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montréal, QC H2X 0A9, Canada;
- Department of Surgery, Université de Montréal, Montréal, QC H2X 0A9, Canada
| |
Collapse
|
7
|
Fonseca NM, Maurice-Dror C, Herberts C, Tu W, Fan W, Murtha AJ, Kollmannsberger C, Kwan EM, Parekh K, Schönlau E, Bernales CQ, Donnellan G, Ng SWS, Sumiyoshi T, Vergidis J, Noonan K, Finch DL, Zulfiqar M, Miller S, Parimi S, Lavoie JM, Hardy E, Soleimani M, Nappi L, Eigl BJ, Kollmannsberger C, Taavitsainen S, Nykter M, Tolmeijer SH, Boerrigter E, Mehra N, van Erp NP, De Laere B, Lindberg J, Grönberg H, Khalaf DJ, Annala M, Chi KN, Wyatt AW. Prediction of plasma ctDNA fraction and prognostic implications of liquid biopsy in advanced prostate cancer. Nat Commun 2024; 15:1828. [PMID: 38418825 PMCID: PMC10902374 DOI: 10.1038/s41467-024-45475-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
No consensus strategies exist for prognosticating metastatic castration-resistant prostate cancer (mCRPC). Circulating tumor DNA fraction (ctDNA%) is increasingly reported by commercial and laboratory tests but its utility for risk stratification is unclear. Here, we intersect ctDNA%, treatment outcomes, and clinical characteristics across 738 plasma samples from 491 male mCRPC patients from two randomized multicentre phase II trials and a prospective province-wide blood biobanking program. ctDNA% correlates with serum and radiographic metrics of disease burden and is highest in patients with liver metastases. ctDNA% strongly predicts overall survival, progression-free survival, and treatment response independent of therapeutic context and outperformed established prognostic clinical factors. Recognizing that ctDNA-based biomarker genotyping is limited by low ctDNA% in some patients, we leverage the relationship between clinical prognostic factors and ctDNA% to develop a clinically-interpretable machine-learning tool that predicts whether a patient has sufficient ctDNA% for informative ctDNA genotyping (available online: https://www.ctDNA.org ). Our results affirm ctDNA% as an actionable tool for patient risk stratification and provide a practical framework for optimized biomarker testing.
Collapse
Affiliation(s)
- Nicolette M Fonseca
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | - Cameron Herberts
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Wilson Tu
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - William Fan
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Andrew J Murtha
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | - Edmond M Kwan
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
- Department of Medicine, School of Clinical Sciences; Monash University, Melbourne, VIC, Australia
| | - Karan Parekh
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Elena Schönlau
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Cecily Q Bernales
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Gráinne Donnellan
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Sarah W S Ng
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Takayuki Sumiyoshi
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Joanna Vergidis
- Department of Medical Oncology, BC Cancer, Victoria, BC, Canada
| | - Krista Noonan
- Department of Medical Oncology, BC Cancer, Surrey, BC, Canada
| | - Daygen L Finch
- Department of Medical Oncology, BC Cancer, Kelowna, BC, Canada
| | | | - Stacy Miller
- Department of Radiation Oncology, BC Cancer, Prince George, BC, Canada
| | - Sunil Parimi
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | | | - Edward Hardy
- Tom McMurtry & Peter Baerg Cancer Centre, Vernon Jubilee Hospital, Vernon, BC, Canada
| | - Maryam Soleimani
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Lucia Nappi
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Bernhard J Eigl
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | | | - Sinja Taavitsainen
- Prostate Cancer Research Center, Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Center, Tampere, Finland
| | - Matti Nykter
- Prostate Cancer Research Center, Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Center, Tampere, Finland
| | - Sofie H Tolmeijer
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Medical Oncology, Research Institute for Medical Innovation, Radboud University, Nijmegen, The Netherlands
| | - Emmy Boerrigter
- Department of Pharmacy, Research Institute for Medical Innovation, Radboud University, Nijmegen, The Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Research Institute for Medical Innovation, Radboud University, Nijmegen, The Netherlands
| | - Nielka P van Erp
- Department of Pharmacy, Research Institute for Medical Innovation, Radboud University, Nijmegen, The Netherlands
| | - Bram De Laere
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Johan Lindberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Daniel J Khalaf
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Matti Annala
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
- Prostate Cancer Research Center, Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Center, Tampere, Finland.
| | - Kim N Chi
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada.
| | - Alexander W Wyatt
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada.
| |
Collapse
|
8
|
Storås AH, Tsuruda K, Fosså SD, Andreassen BK. Time trends in systemic treatment for patients with metastatic prostate cancer: a national cohort study. Acta Oncol 2023; 62:1716-1722. [PMID: 37725527 DOI: 10.1080/0284186x.2023.2257876] [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: 01/06/2023] [Accepted: 06/22/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Several new systemic treatments for primary metastatic prostate cancer patients (mPCa) were introduced in the last decade for both hormone-sensitive (mHSPC) and castration-resistant prostate cancer (mCRPC). However, little is known about the introduction of these treatments in clinical practice. In this national cohort study, we described users and non-users of systemic treatment beyond androgen deprivation therapy (ADT). We also explored whether there was a shift in treatment patterns after the introduction of Docetaxel for mHSPC patients. MATERIALS AND METHODS All patients registered in the Cancer Registry of Norway with mPCa diagnosed in 2010-18 were included. Data on systemic therapy (Docetaxel, Abiraterone, Enzalutamide, Cabazitaxel, and Radium-223) were provided from the Norwegian Prescription Database, the Norwegian Patient Registry, and the Norwegian Control and Payment of Health Reimbursement Database. Descriptive results about patient and disease characteristics were presented using frequencies and proportions, means and standard deviations, or medians and interquartile ranges. RESULTS Of the 2770 patients included in this study, 48% received systemic treatment beyond ADT. The proportion of patients receiving systemic treatment increased during the study period. Systemic treatment users were younger, in better general condition, and had more aggressive tumors than non-users. A treatment shift was observed after 2015, with 48% of patients receiving systemic treatment (mainly Docetaxel) in the mHSPC phase compared to 4% of those diagnosed 2010-14. No significant treatment differences were observed across health regions. CONCLUSIONS An increasing proportion of patients received systemic treatment during the period 2010-18. However, less than 50% of patients in our study received systemic treatment. In accordance with updated guidelines, Docetaxel was introduced after 2015 with an increasing proportion of patients receiving systemic treatment as mHSPC. Further studies should address the disease course and treatment given to patients who do not receive systemic treatment.
Collapse
Affiliation(s)
- Anne Holck Storås
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Kaitlyn Tsuruda
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Sophie Dorothea Fosså
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | |
Collapse
|
9
|
Leaning D, Kaur G, Morgans AK, Ghouse R, Mirante O, Chowdhury S. Treatment landscape and burden of disease in metastatic castration-resistant prostate cancer: systematic and structured literature reviews. Front Oncol 2023; 13:1240864. [PMID: 37829336 PMCID: PMC10565658 DOI: 10.3389/fonc.2023.1240864] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/09/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose Metastatic castration-resistant prostate cancer (mCRPC) is a lethal disease that imposes a major burden on patients and healthcare systems. Three structured literature reviews (treatment guidelines, treatment landscape, and human/clinical/patient burden) and one systematic literature review (economic burden) were conducted to better understand the disease burden and unmet needs for patients with late-stage mCRPC, for whom optimal treatment options are unclear. Methods Embase®, MEDLINE®, MEDLINE® In-Process, the CENTRAL database (structured and systematic reviews), and the Centre for Reviews and Dissemination database (systematic review only) were searched for English-language records from 2009 to 2021 to identify mCRPC treatment guidelines and studies related to the treatment landscape and the humanistic/economic burden of mCRPC in adult men (aged ≥18 years) of any ethnicity. Results In total, six records were included for the treatment patterns review, 14 records for humanistic burden, nine records for economic burden, three records (two studies) for efficacy, and eight records for safety. Real-world treatment patterns were broadly aligned with treatment guidelines and provided no optimal treatment sequencing beyond second line other than palliative care. Current post-docetaxel treatments in mCRPC are associated with adverse events that cause relatively high rates of treatment discontinuation or disruption. The humanistic and economic burdens associated with mCRPC are high. Conclusion The findings highlight a lack of treatment options with novel mechanisms of action and more tolerable safety profiles that satisfy a risk-to-benefit ratio aligned with patient needs and preferences for patients with late-stage mCRPC. Treatment approaches that improve survival and health-related quality of life are needed, ideally while simultaneously reducing costs and healthcare resource utilization.
Collapse
Affiliation(s)
- Darren Leaning
- Department of Radiology and Oncology, James Cook University Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom
| | - Gagandeep Kaur
- Parexel Access Consulting, Parexel International, Mohali, Punjab, India
| | - Alicia K. Morgans
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Ray Ghouse
- Advanced Accelerator Applications, a Novartis Company, Genève, Switzerland
| | - Osvaldo Mirante
- Advanced Accelerator Applications, a Novartis Company, Genève, Switzerland
| | - Simon Chowdhury
- Department of Urological Cancer, Guy’s, King’s, and St. Thomas’ Hospitals, and Sarah Cannon Research Institute, London, United Kingdom
| |
Collapse
|