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Zhou S, Alerasool P, Kishi N, Joshi H, Sahni G, Tsao CK. Cardiovascular Toxicity Associated With Androgen Receptor Axis-Targeted Agents in Patients With Prostate Cancer: A Meta-analysis of Randomized Controlled Trials. Clin Genitourin Cancer 2024:102066. [PMID: 38584004 DOI: 10.1016/j.clgc.2024.102066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/16/2024] [Accepted: 02/12/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Second-generation androgen receptor axis-targeting (ARAT) agents have become a standard treatment for patients with advanced prostate cancer (PC), however much remains unknown about the potential cardiovascular toxicities. PATIENTS AND METHODS We performed a systematic search of PubMed, Embase, Web of Science, and Cochrane library for randomized controlled trials of patients receiving ARAT agents for PC from inception to March 2023. The odds ratios (ORs) of all-grade and high-grade cardiovascular adverse events (CVAEs) for patients treated with and without ARAT agents were pooled for meta-analysis. Subgroup analyses based on PC type and treatment regimen were conducted. RESULTS A total of 15 double-blind placebo-controlled phase 3 trials comprising 15,842 patients were included. In addition to hot flush and hypertension of any degree of severity, inclusion of ARAT agents was associated with a significantly higher risk of acute myocardial infarction (OR: 1.96, 95% CI: 1.05-3.68, P = .04), myocardial infarction (OR: 2.44, 95% CI: 1.27-4.66, P = .007) and angina pectoris (OR: 2.00, 95% CI: 1.00-4.02, P = .05). With regard to individual ARAT agents, enzalutamide was associated with a significantly higher risk of acute myocardial infarction (OR: 3.11, 95% CI: 1.17-8.28, P = .02), coronary artery disease (OR: 8.33, 95% CI: 1.54-44.95, P = .01), and high-grade hypertension (OR: 4.94, 95% CI: 1.11-22.06, P = .04), while abiraterone and apalutamide were associated with a significantly higher risk of angina pectoris (OR: 5.48, 95% CI: 1.23-24.33, P = .03) and myocardial infarction (OR: 7.00, 95% CI: 1.60-30.62, P = .01), respectively. CONCLUSION The inclusion of ARAT agents was associated with a significantly higher risk of several CVAEs. Clinicians should remain vigilant, both in pre-treatment screening and monitoring for clinical symptoms and signs, when considering ARAT agent particularly for patients with pre-existing risk factors.
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Affiliation(s)
- Susu Zhou
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY.
| | - Parissa Alerasool
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; New York Medical College, Valhalla, NY
| | - Noriko Kishi
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Himanshu Joshi
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gagan Sahni
- Mount Sinai Cardiovascular Institute, New York, NY
| | - Che-Kai Tsao
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Jones C, Gray S, Brown M, Brown J, McCloskey E, Rai BP, Clarke N, Sachdeva A. Risk of Fractures and Falls in Men with Advanced or Metastatic Prostate Cancer Receiving Androgen Deprivation Therapy and Treated with Novel Androgen Receptor Signalling Inhibitors: A Systematic Review and Meta-analysis of Randomised Controlled Trials. Eur Urol Oncol 2024:S2588-9311(24)00042-7. [PMID: 38383277 DOI: 10.1016/j.euo.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/25/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
CONTEXT The addition of androgen receptor signalling inhibitors (ARSIs) to standard androgen deprivation therapy (ADT) has improved survival outcomes in patients with advanced prostate cancer (PCa). Advanced PCa patients have a higher incidence of osteoporosis, compounded by rapid bone density loss upon commencement of ADT resulting in an increased fracture risk. The effect of treatment intensification with ARSIs on fall and fracture risk is unclear. OBJECTIVE To assess the risk of falls and fractures in men with PCa treated with ARSIs. EVIDENCE ACQUISITION A systematic review of EMBASE, MEDLINE, The Cochrane Library, and The Health Technology Assessment Database for randomised control trials between 1990 and June 2023 was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analyses guidance. Risk ratios were estimated for the incidence of fracture and fall events. Subgroup analyses by grade of event and disease state were conducted. EVIDENCE SYNTHESIS Twenty-three studies were eligible for inclusion. Fracture outcomes were reported in 17 studies (N = 18 811) and fall outcomes in 16 studies (N = 16 537). A pooled analysis demonstrated that ARSIs increased the risk of fractures (relative risk [RR] 2.32, 95% confidence interval [CI] 2.00-2.71; p < 0.01) and falls (RR 2.22, 95% CI 1.81-2.72; p < 0.01) compared with control. A subgroup analysis demonstrated an increased risk of both fractures (RR 2.13, 95% CI 1.70-2.67; p < 0.01) and falls (RR 2.19, 95% CI 1.53-3.12; p < 0.0001) in metastatic hormone-sensitive PCa patients, and an increased risk of fractures in the nonmetastatic (RR 2.27, 95% CI 1.60-3.20; p < 0.00001) and metastatic castrate-resistant (RR 2.85, 95% CI 2.16-3.76; p < 0.00001) settings. The key limitations include an inability to distinguish fragility from pathological fractures and potential for a competing risk bias. CONCLUSIONS Addition of an ARSI to standard ADT significantly increases the risk of fractures and falls in men with prostate cancer. PATIENT SUMMARY We found a significantly increased risk of both fractures and falls with a combination of novel androgen signalling inhibitors and traditional forms of hormone therapy.
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Affiliation(s)
- Craig Jones
- The Christie and Salford Royal Hospital NHS Foundation Trusts, Manchester, UK; Genito Urinary Cancer Research Group, Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Struan Gray
- The Christie and Salford Royal Hospital NHS Foundation Trusts, Manchester, UK; Genito Urinary Cancer Research Group, Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Michael Brown
- Genito Urinary Cancer Research Group, Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Janet Brown
- Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Bhavan P Rai
- Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Noel Clarke
- The Christie and Salford Royal Hospital NHS Foundation Trusts, Manchester, UK; Genito Urinary Cancer Research Group, Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Ashwin Sachdeva
- The Christie and Salford Royal Hospital NHS Foundation Trusts, Manchester, UK; Genito Urinary Cancer Research Group, Division of Cancer Sciences, University of Manchester, Manchester, UK.
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Ong CSH, Law YXT, Kyaw L, Lim QY, Loke T, Wu QH, Tiong HY, Chiong E. Cardiovascular risks of androgen receptor targeted agents in prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00792-5. [PMID: 38267540 DOI: 10.1038/s41391-024-00792-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Androgen receptor targeted agents (ARTA) have increasingly been incorporated into treatment regimens for various stages of prostate cancer. Patients are living longer with prostate cancer, and thus have a higher cumulative exposure to the treatment and its accompanying side effects, especially those of cardiovascular disease. We aim to assess the differences in the incidence of cardiac-related adverse events after treatment of prostate cancer with ARTA versus placebo. METHODS Three databases were thoroughly searched for relevant articles. The PICOS model was used to frame our clinical question, with which 2 independent authors went through several rounds of screening to select the final included studies. Meta-analysis was done using the Cochran-Mantel-Haenszel Method. Quality assessment was carried out with the Cochrane Risk of Bias tool RoB 2. RESULTS The use of ARTA in prostate cancer increases the incidence of cardiac-related adverse events (RR: 1.56, 95% CI: 1.29-1.90, p < 0.00001), such as hypertension (RR: 1.69, 95% CI: 1.46-1.97, p < 0.00001), ischaemic heart disease (RR: 1.84, 95% CI: 1.36-2.50, p < 0.0001), and arrhythmia (RR: 1.38, 95% CI: 1.11-1.71, p = 0.004), although this did not manifest in an increased incidence of cardiac arrests/deaths (RR: 1.28, 95% CI: 0.87-1.88, p = 0.21). DISCUSSION ARTA increases the risk of cardiac-related adverse events, hypertension, ischaemic heart disease and arrhythmia. Armed with this knowledge, we will be better poised to manage cardiac risks accordingly and involve a cardiologist as required when starting patients on ARTA.
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Affiliation(s)
- Chloe Shu Hui Ong
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore.
| | - Yu Xi Terence Law
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
| | - Lin Kyaw
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
| | - Qi Yang Lim
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
| | - Tim Loke
- Division of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Qing Hui Wu
- Raffles Urology Centre, Raffles Hospital, Singapore, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
| | - Edmund Chiong
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Hall ME, Padgett WJ, Klaassen Z, Magee DE, Luckenbaugh AN, Laviana AA, Satkunasivam R, Schaffer K, Wallis CJD. Association between RCT methodology and disease indication with mineralocorticoid-related toxicity for patients receiving abiraterone acetate for advanced prostate cancer: A meta-analysis of RCTs. Clin Genitourin Cancer 2023; 21:e370-e377. [PMID: 37236862 DOI: 10.1016/j.clgc.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION While abiraterone acetate (AA) has demonstrated survival benefit in advanced prostate cancer (APC), meaningful cardiotoxicity is observed. It is unclear whether the magnitude differs based on disease indication and concurrent steroid administration. METHODS We performed a systematic review and meta-analysis of phase II/III RCTs of AA in APC published as of August 11, 2020. Primary outcomes examined were all- and high-grade (grade ≥ 3) hypokalemia and fluid retention, and secondary outcomes included hypertension and cardiac events. We performed random effects meta-analysis comparing intervention (AA + steroid) and control (placebo ± steroid), stratified by treatment indication and whether patients received steroids. RESULTS Among 2,739 abstracts, we included 6 relevant studies encompassing 5901 patients. Hypokalemia and fluid retention were observed more frequently among patients receiving AA (odds ratio [OR] 3.10 [95% CI 1.69-5.67] and 1.41 [95% CI 1.19-1.66]). This was modified by whether patients in the control received steroids: trials where control patients did not demonstrated a larger association between AA and hypokalemia (OR 6.88 [95% CI 1.48-2.36] versus OR 1.86 [95% CI 4.97-9.54], P < .0001) and hypertension (OR 2.53 [95% CI 1.91-3.36] vs. OR 1.55 [95% CI 1.17-2.04], P = .1) than those where steroids were administered. We observed heterogeneity due to indication: there were greater effects on hypokalemia (P < 0001), hypertension (P = .03), and cardiac disorders (P = .01) among patients treated for mHSPC than mCRPC. CONCLUSIONS The magnitude of cardiotoxicity with AA differs based on trial design and disease indication. These data are valuable in treatment decisions and highlight utilization of appropriate data for counseling.
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Affiliation(s)
- Mary E Hall
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
| | - Whitney J Padgett
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia at Augusta University, Augusta, GA; Georgia Cancer Center, Augusta, GA
| | - Diana E Magee
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Aaron A Laviana
- Department of Surgery and Perioperative Care, University of Texas at Austin, Austin, TX
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX; Center for Outcomes Research, Houston Methodist Hospital, Houston, TX
| | - Kerry Schaffer
- Department of Medical Oncology, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Nashville. TN
| | - Christopher J D Wallis
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
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Chen HX, Tsai LH, Chang CH, Wu HC, Lin CC, Lin CH, Yeh CC, Yang CR, Lien CS, Chang YH, Liang JA, Chen GH, Hsiao PJ, Hsieh PF, Huang CP. Enzalutamide Prior to Radium-223 Is Associated with Better Overall Survival in Metastatic Castration-Resistant Prostate Cancer Patients Compared to Abiraterone-A Retrospective Study. Cancers (Basel) 2023; 15:3516. [PMID: 37444626 DOI: 10.3390/cancers15133516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Metastatic castration-resistant prostate cancer (mCRPC) is a progressive stage of prostate cancer that often spreads to the bone. Radium-223, a bone-targeting radiopharmaceutical, has been shown to improve the overall survival in mCRPC in patients without visceral metastasis. However, the impact of prior systemic therapy on the treatment outcome of mCRPC patients receiving radium-223 remains unclear. This study aimed to investigate the optimal choice of systemic therapy before radium-223 in mCRPC patients. The study included 41 mCRPC patients who received radium-223 therapy, with 22 receiving prior enzalutamide and 19 receiving prior abiraterone. The results showed that the median overall survival was significantly longer in the enzalutamide group than in the abiraterone group (25.1 months vs. 14.8 months, p = 0.049). Moreover, the number of patients requiring blood transfusion was higher in the abiraterone group than in the enzalutamide group (9.1% vs. 26.3%, p = 0.16). The study also found that the number of doses of Radium-223 received was significantly associated with overall survival (≥5 vs. <5, HR 0.028, 95%CI 0.003-0.231, p = 0.001). Our study provides insights into the optimal treatment choice for mCRPC prior to radium-223, indicating that enzalutamide prior to radium-223 administration may have better outcomes compared to abiraterone in mCRPC patients without visceral metastasis.
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Affiliation(s)
- Hao Xiang Chen
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Li-Hsien Tsai
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Hsi-Chin Wu
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin 651012, Taiwan
| | - Ching-Chan Lin
- Department of Internal Medicine, Division of Hematology and Oncology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan 70965, Taiwan
| | - Che-Hung Lin
- Department of Internal Medicine, Division of Hematology and Oncology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Chin-Chung Yeh
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Chi-Rei Yang
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Chi-Shun Lien
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Yi-Huei Chang
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung 406333, Taiwan
| | - Ji-An Liang
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Radiation Oncology, China Medical University Hospital, Taichung 40402, Taiwan
| | - Guan-Heng Chen
- Department of Urology, China Medical University Hsinchu Hospital, Hsinchu 30272, Taiwan
| | - Po-Jen Hsiao
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
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Zhuang Q, Huang S, Li Z. Prospective role of 3βHSD1 in prostate cancer precision medicine. Prostate 2023; 83:619-627. [PMID: 36842160 DOI: 10.1002/pros.24504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Prostate cancer is addicted to androgens. The steroidogenic enzyme 3β-hydroxysteroid dehydrogenase 1 (3βHSD1) recognizes pregnenolone, dehydroepiandrosterone (DHEA), and steroidal medicine abiraterone as substrates to accelerate disease progression. METHODS References for this review were identified through searches of PubMed with the search terms "prostate cancer", "HSD3B1", and "3bHSD1" from 1990 until June, 2022. RESULTS Genotype of 3βHSD1 has been reported to correlate with tumor aggressiveness of advanced prostate cancer in multiple clinical scenarios. The ethnic differences and limitations of using 3βHSD1 genotype as a prognostic biomarker have been discussed here. The activity of 3βHSD1 increases in patients treated with abiraterone and enzalutamide, giving rise to treatment resistance. Further elucidation of 3βHSD1 regulatory mechanisms will shed light on more approaches for disease intervention. We also review the recent advance on 3βHSD1 inhibitors and targeting 3βHSD1 for prostate cancer management. Novel 3βHSD1 inhibitors will be needed to provide additional options for prostate cancer management. CONCLUSION 3βHSD1 is both a predictive biomarker and a promising therapeutic target for prostate cancer.
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Affiliation(s)
- Qian Zhuang
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Shengsong Huang
- Department of Urology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Zhenfei Li
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
- Department of Urology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
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Chen J, Zhang Y, Zhang X, Zhao J, Ni Y, Zhu S, He B, Dai J, Wang Z, Wang Z, Liang J, Zhu X, Shen P, Zeng H, Sun G. Comparison of Systemic Treatments for Metastatic Castration-Resistant Prostate Cancer After Docetaxel Failure: A Systematic Review and Network Meta-analysis. Front Pharmacol 2022; 12:789319. [PMID: 35115934 PMCID: PMC8804311 DOI: 10.3389/fphar.2021.789319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Lacking head-to-head trial, the optimal treatment for patients with metastatic castration-resistant prostate cancer (mCRPC) after docetaxel failure is unclear. This study is to compare the efficacy and safety of systemic treatments in patients who progressed after docetaxel to aid clinical decision-making. Methods: Databases including MEDLINE, EMBASE, and the Cochrane Library were searched from inception to June 15th, 2021. The outcomes of interest include overall survival (OS), biochemical progression-free survival (bPFS), and serious adverse events (SAEs). The Cochrane risk of bias tools were used to assess study quality. Indirect comparisons of competing treatments were performed via Bayesian network meta-analysis. Results: Five trials with 3,862 patients comparing four treatments (abiraterone, enzalutamide, cabazitaxel, and radium-223) were identified. All the four treatments were associated with improved OS and bPFS relative to best supportive care. Among them, enzalutamide (hazard ratio [HR] = 0.58, 95% credible interval [Crl]: 0.49–0.69) had the highest probability of ranking first in terms of OS, followed by cabazitaxel (HR = 0.70, 95% Crl: 0.59–0.83), radium-223 (HR = 0.71, 95% Crl: 0.56–0.90) and abiraterone (HR = 0.73, 95% Crl: 0.63–0.84). Similarly, enzalutamide (HR = 0.25, 95% Crl: 0.20–0.31) showed the greatest improvement of bPFS, followed by abiraterone (HR = 0.60, 95% Crl: 0.51–0.71) and cabazitaxel (HR = 0.75, 95% Crl: 0.63–0.89). In terms of safety, treatments ranked from the safest to the least safe were radium-223 (OR = 0.58, 95% Crl: 0.20–1.68), enzalutamide (OR = 0.80, 95% Crl: 0.28–2.29), abiraterone (OR = 0.94, 95% Crl: 0.39–2.27) and cabazitaxel (OR = 2.50, 95% Crl: 0.84–7.44). Conclusion: For patients with mCRPC who progressed after docetaxel, enzalutamide may offer the most significant survival benefits and satisfying safety. Cabazitaxel is effective in post-docetaxel settings but associated with a high risk of SAEs. Although network meta-analysis provides indirect comparisons and ranking probabilities, the results should be treated with caution as it cannot replace randomized direct comparison. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020223040, identifier CRD42020223040.
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Affiliation(s)
- Junru Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaowen Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xingming Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinge Zhao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuchao Ni
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Sha Zhu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ben He
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jindong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhipeng Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zilin Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Liang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xudong Zhu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Pengfei Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Xiong X, Xu H, Wang S, Liao X, Yi X, Jin K, Lei H, Bai S, Qiu S, Yang L. Association of Novel Androgen Receptor Axis-Targeted Therapies With Diarrhea in Patients With Prostate Cancer: A Bayesian Network Analysis. Front Med (Lausanne) 2022; 8:800823. [PMID: 35141248 PMCID: PMC8818787 DOI: 10.3389/fmed.2021.800823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To perform a systematic review and network meta-analysis to characterize the effect of novel androgen receptor axis-target (ARAT) agents on diarrhea and constipation. Methods We searched the Pubmed, Web of Science, and ClinicalTrials.gov up to September 2021 for phase 3 randomized controlled trials (RCTs) of patients receiving novel ARAT agents for prostate cancer (CaP). A Cochrane risk-of-bias tool was used to assess trial quality. The primary outcomes were risk ratio (RR) of any-grade diarrhea and constipation for patients receiving ARAT treatment. RRs of competing treatments were evaluated by pairwise and Bayesian network meta-analysis. Results In this study, 13 trials with 15,117 participants comparing 5 treatments (abiraterone, enzalutamide, apalutamide, darolutamide, and placebo) were identified. Use of novel ARAT agents was associated with a significant increased risk of any-grade diarrhea (RR = 1.30, 95% CI [1.16, 1.44]). As for subgroup analysis, abiraterone, enzalutamide, and apalutamide were all associated with significant increased risk of any-grade diarrhea (abiraterone: RR = 1.40, 95% CI [1.09, 1.81]; enzalutamide: RR = 1.17, 95% CI [1.02, 1.35]; apalutamide: RR = 1.35, 95% CI [1.03, 1.76]). Based on Bayesian modeling, abiraterone and enzalutamide showed the highest and lowest probability to rank first in terms of increasing risk of any-grade diarrhea. There were no significant differences of risk in any-grade constipation, grade 3 or greater diarrhea, and constipation between ARAT and control group. Conclusion The present study indicates that the use of novel ARAT agents is associated with a significantly higher risk of diarrhea. Across the four agents, abiraterone may relate to the highest risk of diarrhea among patients with metastatic hormone sensitive prostate cancer (mHSPC) and castration-resistant prostate cancer (CRPC).
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Affiliation(s)
- Xingyu Xiong
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Institute of Urology, Chengdu, China
| | - Hang Xu
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Institute of Urology, Chengdu, China
| | - Sheng Wang
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Institute of Urology, Chengdu, China
| | - Xinyang Liao
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Institute of Urology, Chengdu, China
| | - Xianyanling Yi
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Institute of Urology, Chengdu, China
| | - Kun Jin
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Institute of Urology, Chengdu, China
| | - Haoran Lei
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Institute of Urology, Chengdu, China
| | - Shengjiang Bai
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Institute of Urology, Chengdu, China
| | - Shi Qiu
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Institute of Urology, Chengdu, China
- Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, China
- Shi Qiu
| | - Lu Yang
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Institute of Urology, Chengdu, China
- *Correspondence: Lu Yang
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Babkoor AA, Aljabri Y, Alzubaidi A, Alhazmi R, Alsaedi Z, Alghamdi F, Tamim T, Aldagani A, Seddiqi I, Tashkandi E. Risk of Fatigue and Anemia in Patients With Prostate Cancer Treated With Novel Oral Anti-androgens: A Meta-Analysis of Randomized Controlled Trials. Cureus 2022; 14:e21560. [PMID: 35233298 PMCID: PMC8881206 DOI: 10.7759/cureus.21560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/05/2022] Open
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10
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Poon DMC, Chan K, Chan T, Cheung F, Lam D, Lam M, Law K, Lee C, Lee EKC, Leung A, Sze H, Tong C, Wong KCW, Kwong P. Ethnic Pharmacogenomic Differences in the Management of Asian Patients with Metastatic Prostate Cancer. Cancers (Basel) 2022; 14:407. [PMID: 35053569 PMCID: PMC8773846 DOI: 10.3390/cancers14020407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Progression to metastatic disease occurs in about half of all men who develop prostate cancer (PC), one of the most common cancers in men worldwide. Androgen deprivation therapy has been the mainstay therapy for patients with metastatic PC (mPC) since the 1940s. In the last decade, there has been unprecedented advancement in systemic therapies, e.g., taxane, androgen-signalling pathway inhibitors, and biomarker-driven targeted therapies for various stages of disease, resulting in overall survival improvement. Adding to ongoing controversies over how best to treat these patients is the recognition that ethnicity may influence prognosis and outcomes. This review discusses recent evidence for the impacts of Asian ethnicity specifically, which includes environmental, sociocultural, and genetic factors, on the approach to pharmacological management of mPC. Clear inter-ethnic differences in drug tolerability, serious adverse events (AEs), and genetic heterogeneity must all be considered when dosing and scheduling for treatment, as well as designing future precision studies in PC.
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Marandino L, Vignani F, Buttigliero C, Gamba T, Necchi A, Tucci M, Di Maio M. Evaluation of Cognitive Function in Trials Testing New-Generation Hormonal Therapy in Patients with Prostate Cancer: A Systematic Review. Cancers (Basel) 2020; 12:cancers12092568. [PMID: 32916886 PMCID: PMC7564823 DOI: 10.3390/cancers12092568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 02/08/2023] Open
Abstract
Simple Summary In patients with prostate cancer, the use of new-generation hormonal therapy, added to androgen deprivation therapy, requires careful evaluation of cognitive function. The aim of this systematic review is to describe the evidence about cognitive function in randomized trials testing new-generation hormonal therapy (abiraterone, enzalutamide, apalutamide, darolutamide). For each trial, we assessed the availability of both investigator-assessed cognitive impairment and disorders and patient-reported evaluation of cognitive function. Out of 19 trials, the investigator-based evaluation of cognitive impairment was available in seven (36.8%), while patient-reported evaluation of cognitive function results was presented only in one trial (5.3%). This analysis shows that, despite cognitive deterioration could be relevant in patients with prostate cancer, clinical development of new-generation hormonal drugs has not included a systematic evaluation of cognitive function. Abstract In patients with prostate cancer, earlier use and longer duration of new-generation hormonal therapy (NGHT), added to androgen deprivation therapy, requires careful evaluation of cognitive function. The aim of this systematic review is to describe the evidence about cognitive function in all the randomized trials (RCTs) testing NGHT (abiraterone, enzalutamide, apalutamide, darolutamide). We assessed the availability of both investigator-assessed cognitive impairment and disorders and patient-reported evaluation of cognitive function. Nineteen RCTs (17,617 patients) were included. The investigator-based evaluation of cognitive impairment was available in seven RCTs (36.8%). In total, 19/19 RCTs (100%) included patient-reported outcomes (PROs) collection, but PRO tools adopted allowed evaluation of cognitive function in two RCTs (10.5%). Among them, PRO-based cognitive function results were presented only in one RCT (5.3%): in ENZAMET, mean changes from baseline were worse with enzalutamide than with placebo, but deterioration-free survival favored enzalutamide. Despite cognitive deterioration could be relevant, clinical development of NGHT has not included a systematic evaluation of cognitive function. Assessment by investigators is at risk of underreporting, and commonly used PROs do not allow proper cognitive function analysis. Furthermore, the methodology of analysis can jeopardize the interpretation of results. Although direct comparisons are scanty, there could be differences between different NGHTs.
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Affiliation(s)
- Laura Marandino
- Department of Oncology, University of Turin, 10043 Torino, Italy; (L.M.); (C.B.); (T.G.)
- Medical Oncology, Istituto Nazionale dei Tumori, Fondazione IRCCS, 20133 Milano, Italy;
| | | | - Consuelo Buttigliero
- Department of Oncology, University of Turin, 10043 Torino, Italy; (L.M.); (C.B.); (T.G.)
- Medical Oncology, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Teresa Gamba
- Department of Oncology, University of Turin, 10043 Torino, Italy; (L.M.); (C.B.); (T.G.)
- Medical Oncology, Ordine Mauriziano Hospital, 10128 Torino, Italy;
| | - Andrea Necchi
- Medical Oncology, Istituto Nazionale dei Tumori, Fondazione IRCCS, 20133 Milano, Italy;
| | - Marcello Tucci
- Medical Oncology, Cardinal Massaia Hospital, 14100 Asti, Italy;
| | - Massimo Di Maio
- Department of Oncology, University of Turin, 10043 Torino, Italy; (L.M.); (C.B.); (T.G.)
- Medical Oncology, Ordine Mauriziano Hospital, 10128 Torino, Italy;
- Correspondence: ; Tel.: +39-011-5082032
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13
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Lee HY, Chen HL, Teoh JYC, Chen TC, Hao SY, Tsai HY, Huang WH, Juan YS, Cheng HM, Chang HM. Abiraterone and enzalutamide had different adverse effects on the cardiovascular system: a systematic review with pairwise and network meta-analyses. Prostate Cancer Prostatic Dis 2020; 24:244-252. [PMID: 32860011 DOI: 10.1038/s41391-020-00275-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Abiraterone and enzalutamide may increase the risk of cardiovascular events in patients with castration-resistant prostate cancer (CRPC). METHODS A comprehensive literature search was performed using a combination of keywords related to "abiraterone," "enzalutamide," "prostate cancer," and "adverse events." Phase II-IV randomized controlled trials (RCTs) on abiraterone or enzalutamide for patients with nonmetastatic or metastatic CRPC were included. Outcome measures included (1) any grade cardiac disorder, (2) severe grade cardiac disorder, (3) any grade hypertension, and (4) severe grade hypertension, as defined by the Common Terminology Criteria for Adverse Events. Pairwise meta-analysis and Bayesian network meta-analyses were performed to investigate the risk ratios (RRs) of abiraterone and enzalutamide. Surface under cumulative ranking curves (SUCRAs) and cumulative ranking probability plots based on the probability of developing cardiac disorders or hypertension were presented. RESULTS A total of 7103 patients from seven RCTs were included. Upon pairwise meta-analysis, abiraterone was associated with increased risks of any grade (RR = 1.34, 95% confidence interval (CI) = 1.05-1.73) and severe grade cardiac disorders (RR = 1.71, 95% CI = 1.16-2.53); enzalutamide was associated with increased risks of any grade (RR = 2.66, 95% CI = 1.93-3.66) and severe grade hypertension (RR = 2.79, 95% CI = 1.86-4.18). Based on the SUCRA rankings, abiraterone had a higher probability of cardiac disorders (84.84% for any grade and 85.12% for severe grade) than enzalutamide (62.83% for any grade and 50.76% for severe grade); whereas enzalutamide had a higher probability of hypertension (99.43% for any grade and 89.71% for severe grade) than abiraterone (49.08% for any grade and 49.37% for severe grade). CONCLUSIONS Abiraterone and enzalutamide had different adverse effects on the cardiovascular system. We should take this into consideration when we are deciding on the choice of novel hormonal agents for patients with CRPC.
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Affiliation(s)
- Hsiang Ying Lee
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsiao-Ling Chen
- Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Tun-Chieh Chen
- Division of Infectious Diseases, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Shao-Yuan Hao
- Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hsin-Yi Tsai
- Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wei-Hsuan Huang
- Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hao-Min Cheng
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Institute of Public Health, National Yang-Ming University Hospital, Taipei, Taiwan. .,Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Hsiu-Mei Chang
- Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
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14
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Zheng X, Zhao X, Xu H, Han X, Xu H, Dong X, Peng R, Yang L, Wei Q, Ai J. Efficacy and safety of abiraterone and enzalutamide for castration-resistant prostate cancer: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e17748. [PMID: 31689828 PMCID: PMC6946394 DOI: 10.1097/md.0000000000017748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Previous evidence directly evaluating the efficacy and safety of abiraterone and enzalutamide treatment for castration-resistant prostate cancer (CRPC) is limited. We aim to include more randomized controlled trials (RCTs) to comprehensively assess the efficacy and safety of abiraterone and enzalutamide treatment. METHODS PubMed, Embase, and ClinicalTrial.gov were systematically searched. Pooled hazard ratios (HRs) were calculated using Stata 12.0 software. The comparison of the prostate-specific antigen (PSA) response rate and adverse events (AEs) between the treatment and control groups were performed using RevMan 5.3 software. RESULTS Eight eligible RCTs with 6,490 patients were selected. Pooled HRs were 0.72 for overall survival, 0.45 for radiographic progression-free survival (rPFS), and 0.36 for PSA PFS. abiraterone and enzalutamide could significantly increase the PSA response rate OR = 8.67, 95%CI 4.42-17.04) and any AE occurrence (OR = 1.98, 95%CI 1.46-2.68). The treatment group had more occurrence of fatigue (OR = 1.34, 95%CI 1.20-1.49), back pain (OR = 1.15, 95%CI 1.01-1.15), hot flush (OR = 1.76, 95%CI 1.50-2.06), diarrhea (OR=1.22, 95%CI 1.07-2.40) and arthralgia (OR = 1.34, 95%CI 1.16-1.54). Particularly, AEs of special interest including any grade hypertension (OR = 2.06, 95%CI 1.71-2.47), hypokalemia (OR = 1.80, 95%CI 1.42-2.30) and fluid retention or edema (OR = 1.38, 95%CI 1.17-1.63) also occurred less in the control group. Moreover, a higher incidence of high-grade hypertension (OR = 2.60, 95%CI 1.79-3.79) and extremity pain (OR = 4.46, 95%CI 2.81-7.07) was observed in the treatment group. CONCLUSION The survival benefits of abiraterone and enzalutamide for CRPC were evident and promising, while the risk of AE occurrence was also acceptably higher in the treatment group than in the placebo group.
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Affiliation(s)
- Xiaonan Zheng
- Department of Urology, Institute of Urology, Sichuan University, West China Hospital, Chengdu
| | | | - Hang Xu
- West China Medical School, Sichuan University
| | - Xin Han
- West China Medical School, Sichuan University
| | - He Xu
- Department of Urology, Institute of Urology, Sichuan University, West China Hospital, Chengdu
- Department of Urology, the Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - Xin Dong
- West China Medical School, Sichuan University
| | - Ruilin Peng
- West China Medical School, Sichuan University
| | - Lu Yang
- Department of Urology, Institute of Urology, Sichuan University, West China Hospital, Chengdu
| | - Qiang Wei
- Department of Urology, Institute of Urology, Sichuan University, West China Hospital, Chengdu
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, Sichuan University, West China Hospital, Chengdu
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15
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Marandino L, De Luca E, Zichi C, Lombardi P, Reale ML, Pignataro D, Di Stefano RF, Ghisoni E, Mariniello A, Trevisi E, Leone G, Muratori L, La Salvia A, Sonetto C, Buttigliero C, Tucci M, Aglietta M, Novello S, Scagliotti GV, Perrone F, Di Maio M. Quality-of-Life Assessment and Reporting in Prostate Cancer: Systematic Review of Phase 3 Trials Testing Anticancer Drugs Published Between 2012 and 2018. Clin Genitourin Cancer 2019; 17:332-347.e2. [PMID: 31416754 DOI: 10.1016/j.clgc.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/06/2019] [Accepted: 07/15/2019] [Indexed: 01/20/2023]
Abstract
Quality of life (QoL) is not included among the end points in many studies, and QoL results are underreported in many phase 3 oncology trials. We performed a systematic review to describe QoL prevalence and heterogeneity in QoL reporting in recently published prostate cancer phase 3 trials. A PubMed search was performed to identify primary publications of randomized phase 3 trials testing anticancer drugs in prostate cancer, issued between 2012 and 2018. We analyzed QoL inclusion among end points, presence of QoL results, and methodology of QoL analysis. Seventy-two publications were identified (15 early-stage, 20 advanced hormone-sensitive, and 37 castration-resistant prostate cancer [CRPC]). QoL was not listed among study end points in 23 studies (31.9%) (40.0% early stage, 40.0% advanced hormone sensitive, and 24.3% CRPC). QoL results were absent in 15 (30.6%) of 49 primary publications of trials that included QoL among end points. Overall, as a result of absent end point or unpublished results, QoL data were lacking in 38 (52.8%) primary publications (53.3% early stage, 55.0% in advanced hormone sensitive, and 51.4% in CRPC). The most commonly used QoL tools were Functional Assessment of Cancer Therapy-Prostate (FACT-P) (21, 53.8%) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) (14, 35.9%); most common methods of analysis were mean changes or mean scores (28, 71.8%), time to deterioration (14, 35.9%), and proportion of patients with response (10, 25.6%). In conclusion, QoL data are lacking in a not negligible proportion of recently published phase 3 trials in prostate cancer, although the presence of QoL results is better in positive trials, especially in CRPC. The methodology of QoL analysis is heterogeneous for type of instruments, analysis, and presentation of results.
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Affiliation(s)
- Laura Marandino
- Department of Oncology, University of Turin, at Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Emmanuele De Luca
- Department of Oncology, University of Turin, at Ordine Mauriziano Hospital, Turin, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, at Ordine Mauriziano Hospital, Turin, Italy
| | - Pasquale Lombardi
- Department of Oncology, University of Turin, at Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Maria Lucia Reale
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Daniele Pignataro
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Rosario F Di Stefano
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Turin, at Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Annapaola Mariniello
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Elena Trevisi
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Gianmarco Leone
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Leonardo Muratori
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Anna La Salvia
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Cristina Sonetto
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Consuelo Buttigliero
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Marcello Tucci
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, at Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Giorgio V Scagliotti
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"-IRCCS, Naples, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, at Ordine Mauriziano Hospital, Turin, Italy.
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Abstract
Oral abiraterone acetate (Zytiga®) is a selective inhibitor of CYP17 and thereby inhibits androgen biosynthesis, with androgen signalling crucial in the progression from primary to metastatic prostate cancer (PC) and subsequently, in the development of metastatic castration-resistant PC (mCRPC). In large phase 3 trials and in the clinical practice setting, oral abiraterone acetate in combination with prednisone was an effective treatment and had an acceptable, manageable tolerability and safety profile in chemotherapy-naive and docetaxel-experienced men with mCRPC. In the pivotal global phase 3 trials, relative to placebo (+prednisone), abiraterone acetate (+prednisone) prolonged overall survival (OS) at data maturity (final analysis) and radiographic progression-free survival (rPFS) at all assessed timepoints. Given its efficacy in prolonging OS and its convenient once-daily oral regimen, in combination with prednisone, abiraterone acetate is an important first-line option for the treatment of mCRPC.
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Affiliation(s)
- Lesley J Scott
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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17
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Fan L, Dong B, Chi C, Wang Y, Gong Y, Sha J, Pan J, Shangguan X, Huang Y, Zhou L, Xue W. Abiraterone acetate for chemotherapy-naive metastatic castration-resistant prostate cancer: a single-centre prospective study of efficacy, safety, and prognostic factors. BMC Urol 2018; 18:110. [PMID: 30509237 PMCID: PMC6276197 DOI: 10.1186/s12894-018-0416-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/26/2018] [Indexed: 12/26/2022] Open
Abstract
Background To evaluate the efficacy and safety of abiraterone acetate (AA) plus prednisone compared with prednisone alone in Asian patients with chemotherapy-naive metastatic castration-resistant prostate cancer (mCRPC), and to identify predictive factors. Methods We reviewed the medical records of 60 patients with chemotherapy-naive mCRPC at Renji Hospital who were treated with AA plus prednisone (n = 43) or prednisone alone (n = 17). All patients were assessed for prostate-specific antigen (PSA) response, PSA progression-free survival (PSA PFS), radiographic progression-free survival (rPFS), and overall survival (OS). The ability of several parameters to predict PSA PFS, rPFS, and OS was studied. Results The median follow-up time was 14.0 months (range 7.0–18.5 months), at which time 19 death events had been reported: 11 in the AA + prednisone group and 8 in the prednisone group. The AA + prednisone group had significantly longer median PSA PFS (10.3 vs 3.0 months, P < 0.001), rPFS (13.9 vs 3.9 months, P < 0.001), and OS (23.3 vs 17.5 months, P = 0.016) than the prednisone-alone group. The most frequently reported grade 3 or 4 adverse event in both the AA + prednisone and prednisone-alone groups was elevated alanine aminotransferase level in 5 of 43 patients (11.6%) and 2 of 17 patients (11.8%), respectively. No adverse events led to discontinuation of therapy. In multivariate analysis, time from androgen deprivation therapy (ADT) to castration resistance of ≤18 months was a determinant of shorter OS (P = 0.007). Conclusions These results support the favourable safety and efficacy profile of AA for the treatment of Asian patients with chemotherapy-naive mCRPC. Longer duration of ADT response was significantly associated with longer survival. Electronic supplementary material The online version of this article (10.1186/s12894-018-0416-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liancheng Fan
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Baijun Dong
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Chenfei Chi
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yanqing Wang
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yiming Gong
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jianjun Sha
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jiahua Pan
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xun Shangguan
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yiran Huang
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Lixin Zhou
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Wei Xue
- Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China.
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Iacovelli R, Ciccarese C, Mosillo C, Tortora G. De Novo, Progressed, and Neglected Metastatic Castration-Sensitive Prostate Cancer: Is One Therapy Fit for All? Clin Genitourin Cancer 2018; 16:482-4. [PMID: 30139716 DOI: 10.1016/j.clgc.2018.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 07/14/2018] [Indexed: 01/19/2023]
Abstract
Patients who receive a diagnosis of metastatic castration-sensitive prostate cancer (CSPC) have different phenotypes of disease. Some of them have de novo CSPC, but others receive a late diagnosis, and still others underwent prostatectomy several years before the diagnosis of metastases. We analyze the presence of these differences in recent clinical trials in CSPC and assess the possible impact on their results.
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Wang Y, Zhang H, Shen W, He P, Zhou Z. Effectiveness and tolerability of targeted drugs for the treatment of metastatic castration-resistant prostate cancer: a network meta-analysis of randomized controlled trials. J Cancer Res Clin Oncol 2018; 144:1751-1768. [PMID: 29797220 DOI: 10.1007/s00432-018-2664-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/08/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Castration-resistant prostate cancer (CRPC) refers to prostate cancer that has progressed after initial androgen deprivation therapy (ADT). Over the years, treatment strategies for metastatic CRPC (mCRPC) have undergone considerable changes. We performed a network meta-analysis to assess the effectiveness and tolerability of targeted agents for mCRPC. METHODS We search databases including MEDLINE, EMBASE, and the Cochrane Library through Sep 5, 2017. The major effectiveness outcomes were progression-free survival (PFS) and overall survival (OS). The tolerability outcome was severe adverse events (AEs) of grade ≥ 3. RESULTS Twenty-six articles assessing a total of 20,314 patients were included in this study. A random-effect analysis showed that targeted agents could significant prolong PFS in mCRPC patients (I2 = 94.3%; hazard ratio (HR): 0.74; 95% confidence interval (CI): 0.65-0.84; p < 0.001). In addition, the surface under the cumulative ranking curve (SUCRA) ranking from the network analysis showed that enzalutamide was the most effective in improving the PFS of mCRPC patients (100%), followed by abiraterone (90.1%) and tasquinimod (84.2%). Additionally, targeted agents could clearly prolong OS in mCRPC patients (I2 = 71.6%; HR: 0.91; 95% CI: 0.85-0.97; p < 0.001). Furthermore, based on SUCRA ranking, enzalutamide was the most effective in improving the OS of mCRPC patients (97.2%), followed by abiraterone (91.1%) and zibotentan (65.8%). Intetumumab was associated with the lowest incidence of severe AEs (94.9%), followed by atrasentan (85.1%) and placebo (79.3%). CONCLUSION In patients with mCRPC, enzalutamide, abiraterone and tasquinimod can prolong PFS, and enzalutamide and abiraterone can prolong OS. Additionally, enzalutamide and abiraterone can improve both PFS and OS with a low risk of causing severe AEs.
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Affiliation(s)
- Yongquan Wang
- Center of Urology, Southwest hospital Army Medical University, No. 30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Heng Zhang
- Center of Urology, Southwest hospital Army Medical University, No. 30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Wenhao Shen
- Center of Urology, Southwest hospital Army Medical University, No. 30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Peng He
- Center of Urology, Southwest hospital Army Medical University, No. 30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Zhansong Zhou
- Center of Urology, Southwest hospital Army Medical University, No. 30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China.
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Bajaj G, Gupta M, Wang HH, Barrett JS, Tan M, Rupalla K, Bertz R, Sheng J. Challenges and Opportunities With Oncology Drug Development in China. Clin Pharmacol Ther 2018; 105:363-375. [DOI: 10.1002/cpt.1017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 12/31/2022]
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Zhu J, Liao R, Su C, Liang D, Wu J, Qiu K, Li J. Toxicity profile characteristics of novel androgen-deprivation therapy agents in patients with prostate cancer: a meta-analysis. Expert Rev Anticancer Ther 2017; 18:193-198. [PMID: 29257709 DOI: 10.1080/14737140.2018.1419871] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND To investigate the toxicity profile characteristics of abiraterone acetate and enzalutamide to see if they are of critical clinical value. METHODS Prospective studies were identified by searching the PubMed, EMBASE, Cochrane Library, and American Society of Clinical Oncology Meeting abstracts. Randomized clinical trials that evaluate abiraterone acetate or enzalutamide in patients with prostate cancer were included. The risk ratio (RR) of adverse events (AEs) was calculated for each trial along with appropriate 95% CI using fixed- or random-effects methods. RESULTS Ten studies (5 abiraterone acetate, and 5 enzalutamide studies) were included in the meta-analysis. Use of abiraterone acetate was associated with an increased risk of all-grade adverse effects (RR = 1.01, 95% CI: 1.01-1.02) and high-grade adverse effects (RR = 1.29, 95% CI: 1.15-1.45). Also, there was a significantly higher incidence of some individual adverse effects (e.g. liver-function test abnormalities, arthralgia, cardiac adverse effects, diarrhea, oedema, hypertension and hypokalemia). Treatment with enzalutamide did not increase the risk of all-grade adverse effects and high-grade adverse effects, but there was a significantly higher incidence of some individual adverse effects (e.g. back pain, fatigue, hot flush and hypertension). CONCLUSIONS Both abiraterone acetate and enzalutamide have toxicity profile characteristics that need to be recognized. Understanding the toxicity profile characteristics of both drugs could promote decision making in clinical use.
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Affiliation(s)
- Jianhong Zhu
- a Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China.,b Department of pharmacy , Sun-Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China
| | - Rifang Liao
- a Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China.,b Department of pharmacy , Sun-Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China
| | - Chen Su
- a Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China.,b Department of pharmacy , Sun-Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China
| | - Dan Liang
- a Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China.,b Department of pharmacy , Sun-Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China
| | - Junyan Wu
- a Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China.,b Department of pharmacy , Sun-Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China
| | - Kaifeng Qiu
- a Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China.,b Department of pharmacy , Sun-Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China
| | - Jianfang Li
- a Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China.,b Department of pharmacy , Sun-Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , PR China
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22
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El-Amm J, Nassabein R, Aragon-Ching JB. Impact of abiraterone on patient-related outcomes in metastatic castration-resistant prostate cancer: current perspectives. Cancer Manag Res 2017; 9:299-306. [PMID: 28744160 PMCID: PMC5513839 DOI: 10.2147/cmar.s139305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abiraterone acetate has established a major role in the treatment paradigm of metastatic castration-resistant prostate cancer ever since pivotal trials, COU-AA-301 and COU-AA-302, have shown benefit in both the second-line and first-line (post- and pre-chemotherapy) setting, respectively, with improvement in overall survival as well as secondary end points such as prostate-specific antigen (PSA) and radiographic response rates, time to PSA progression, and progression-free survival. There has been a lot of interest and emphasis in the evaluation of patient-related outcomes (PROs) as it relates to quality of life, pain, adverse events, fatigue, and among others, in the use of different agents that have been shown to improve survival. This review examines the companion PROs in conjunction with abiraterone acetate use. This is particularly relevant since PROs are increasingly viewed as a key metric for drug label claims in granting approval across regulatory agencies, including the US Food and Drug Administration and the European Medicines Agency.
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Affiliation(s)
- Joelle El-Amm
- Division of Hematology and Oncology, Department of Internal Medicine, Lebanese American University, Beirut, Lebanon
| | - Rami Nassabein
- Division of Hematology and Oncology, Department of Internal Medicine, Lebanese American University, Beirut, Lebanon
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Ye D, Huang Y, Zhou F, Xie K, Matveev V, Li C, Alexeev B, Tian Y, Qiu M, Li H, Zhou T, De Porre P, Yu M, Naini V, Liang H, Wu Z, Sun Y. A phase 3, double-blind, randomized placebo-controlled efficacy and safety study of abiraterone acetate in chemotherapy-naïve patients with mCRPC in China, Malaysia, Thailand and Russia. Asian J Urol 2017; 4:75-85. [PMID: 29264210 PMCID: PMC5717983 DOI: 10.1016/j.ajur.2017.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/30/2016] [Accepted: 08/31/2016] [Indexed: 11/18/2022] Open
Abstract
Objective This double-blind, placebo-controlled phase 3 study was designed to compare efficacy and safety of abiraterone acetate + prednisone (abiraterone) to prednisone alone in chemotherapy-naïve, asymptomatic or mildly symptomatic metastatic castration-resistant prostate cancer (mCRPC) patients from China, Malaysia, Thailand and Russia. Methods Adult chemotherapy-naïve patients with confirmed prostate adenocarcinoma, Eastern Cooperative Oncology Group (ECOG) performance status (PS) grade 0–1, ongoing androgen deprivation (serum testosterone <50 ng/dL) with prostate specific antigen (PSA) or radiographic progression were randomized to receive abiraterone acetate (1000 mg, QD) + prednisone (5 mg, BID) or placebo + prednisone (5 mg, BID), until disease progression, unacceptable toxicity or consent withdrawal. Primary endpoint was improvements in time to PSA progression (TTPP). Results Totally, 313 patients were randomized (abiraterone: n = 157; prednisone: n = 156); and baseline characteristics were balanced. At clinical cut-off (median follow-up time: 3.9 months), 80% patients received treatment (abiraterone: n = 138, prednisone: n = 112). Median time to PSA progression was not reached with abiraterone versus 3.8 months for prednisone, attaining 58% reduction in PSA progression risk (HR = 0.418; p < 0.0001). Abiraterone-treated patients had higher confirmed PSA response rate (50% vs. 21%; relative odds = 2.4; p < 0.0001) and were 5 times more likely to achieve radiographic response than prednisone-treated patients (22.9% vs. 4.8%, p = 0.0369). Median survival was not reached. Most common (≥10% abiraterone vs. prednisone-treated) adverse events: bone pain (7% vs. 14%), pain in extremity (6% vs. 12%), arthralgia (10% vs. 8%), back pain (7% vs. 11%), and hypertension (15% vs. 14%). Conclusion Interim analysis confirmed favorable benefit-to-risk ratio of abiraterone in chemotherapy-naïve men with mCRPC, consistent with global study, thus supporting use of abiraterone in this patient population.
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Affiliation(s)
- Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yiran Huang
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fangjian Zhou
- Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Keji Xie
- Guangzhou First Municipal People's Hospital, Guangzhou, Guangdong, China
| | - Vsevolod Matveev
- Department of Urology, Russian Academy of Medical Sciences, Moscow, Russia
| | - Changling Li
- Department of Urology, Cancer Institute (Hospital), Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Boris Alexeev
- Department of Oncology, Moscow Oncology Research Institute, Moscow, Russia
| | - Ye Tian
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mingxing Qiu
- Department of Urology, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Hanzhong Li
- Department of Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Tie Zhou
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Peter De Porre
- Department of Oncology, Janssen Research & Development, Beerse, Belgium
| | - Margaret Yu
- Department of Medical Oncology, Janssen Research & Development, San Diego, CA, USA
| | - Vahid Naini
- Department of Medical Oncology, Janssen Research & Development, San Diego, CA, USA
| | - Hongchuan Liang
- Department of Urology, Janssen Research & Development, Beijing, China
| | - Zhuli Wu
- Department of Urology, Janssen Research & Development, Beijing, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Roviello G, Cappelletti MR, Zanotti L, Gobbi A, Senti C, Bottini A, Ravelli A, Bonetta A, Paganini G, Generali D. Targeting the androgenic pathway in elderly patients with castration-resistant prostate cancer: A meta-analysis of randomized trials. Medicine (Baltimore) 2016; 95:e4636. [PMID: 27787354 PMCID: PMC5089083 DOI: 10.1097/md.0000000000004636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The novel hormonal drugs have recently entered in the armamentarium of therapies for treatment of metastatic castration-resistant prostate cancer (CRPC). First reports are available for their use in elderly men with CRPC. METHOD A meta-analysis of randomized controlled trials (RCTs) has been performed. PubMed, the Cochrane Library, and American Society of Clinical Oncology (ASCO) University Meeting were searched for data on the use of new hormonal treatment in elderly patients with CRPC. RESULTS Nine studies for a total of 3512 elderly patients were available for meta-analysis. Six studies reported outcomes of patients aged >75 years old while 2 studies reported on patients aged >70 years old. The pooled analysis of the androgen synthesis inhibitors revealed significantly increased overall survival (OS) due to antiandrogen agents compared with placebo or placebo and prednisone (hazard ratio (HR) for death: HR = 0.74, 95% CI: 0.67-0.82; P < 0.00001). Moreover, the new antiandrogenic therapy significantly improved the progression-free survival (HR = 0.45, 95% CI: 0.31-0.65; P < 0.0001). The incidence of any grade ≥3 adverse effect was only moderately higher during with the antiandrogenic therapy as compared to the control arms (response rate = 1.03, 95% CI: 0.88-1.20; P = 0.72). CONCLUSION This study confirmed that agents targeting the androgen axis (i.e., enzalutamide, abiraterone) significantly prolonged OS in elderly men with CRPC.
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Affiliation(s)
- Giandomenico Roviello
- Section of Pharmacology and University Center DIFF-Drug Innovation Forward Future, Department of Molecular and Translational Medicine, University of Brescia, Brescia
- U.S. Terapia Molecolare e Farmacogenomica
- Correspondence: Giandomenico Roviello, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy (e-mail: )
| | | | | | | | | | | | - Andrea Ravelli
- Section of Experimental Oncology, Department of Clinical and Experimental Medicine, University of Parma, Parma
| | | | - Giovanni Paganini
- Unit of General Medicine, Azienda Ospedaliera “C. Poma” Presidio Ospedaliero di Pieve di Coriano, Mantova
| | - Daniele Generali
- U.S. Terapia Molecolare e Farmacogenomica
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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