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Merseburger AS, Bannowsky A, Becker K, Bokemeyer C, Eichenauer R, Lehmann J, Mickisch G, Steuber T, von Amsberg G, von Kügelgen T, Wülfing C. [CARD study: relevance for the treatment of advanced prostate cancer]. Aktuelle Urol 2022; 53:54-59. [PMID: 32968994 DOI: 10.1055/a-1247-4155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Various life-prolonging therapy options are available for the treatment of metastatic castration-resistant prostate cancer (mCRPC). OBJECTIVE The optimal therapy sequence for mCRPC has been discussed for years. With the final results of the CARD study, important prospective data are available to enlighten the discussion about the therapy sequence. MATERIAL AND METHOD CARD is a randomised phase IV trial in patients with mCRPC who were previously treated with docetaxel and an anti-androgen receptor (ARTA). The study showed significant efficacy benefits in favour of further treatment with cabazitaxel versus a second ARTA therapy. The study results are presented and discussed in the context of previous study data with regard to their importance for everyday clinical practice. RESULTS The CARD study data confirm cabazitaxel as an effective therapy option for mCRPC patients previously treated with docetaxel and an ARTA. Cabazitaxel was safe to apply. The study results confirm the cross resistance between the two ARTAs Abiraterone and Enzalutamide. CONCLUSION In mCRPC patients eligible for chemotherapy, the therapy sequence should be chosen so that the patients also receive cabazitaxel. A direct therapy sequence with two ARTAs should be avoided or, at least, only considered if other substances are contraindicated.
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Affiliation(s)
| | | | - Klaus Becker
- Onkologie Lerchenfeld, Onkologie Lerchenfeld, Hamburg
| | - Carsten Bokemeyer
- Universitätsklinikum Hamburg Eppendorf Medizinische Klinik und Poliklinik II Onkologie Hämatologie, Zentrum für Onkologie, Hamburg
| | | | - Jan Lehmann
- Gesundheitszentrum Kiel-Mitte, Urologische Gemeinschaftspraxis Prüner Gang, Kiel
| | - Gerald Mickisch
- Centrum für Operative Urologie Bremen, Centrum für Operative Urologie Bremen, Bremen
| | - Thomas Steuber
- Universitätsklinikum Hamburg-Eppendorf, Martini-Klinik, Prostatakrebszentrum, Hamburg
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Shore ND, Laliberté F, Ionescu-Ittu R, Yang L, Mahendran M, Lejeune D, Yu LH, Burgents J, Duh MS, Ghate SR. Real-World Treatment Patterns and Overall Survival of Patients with Metastatic Castration-Resistant Prostate Cancer in the US Prior to PARP Inhibitors. Adv Ther 2021; 38:4520-4540. [PMID: 34282527 PMCID: PMC8342357 DOI: 10.1007/s12325-021-01823-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/08/2021] [Indexed: 12/19/2022]
Abstract
Introduction Therapeutic options for metastatic castration-resistant prostate cancer (mCRPC) patients are continuously advancing. We described mCRPC treatment patterns in the US from 2013 to 2019. Methods Patients with a confirmed mCRPC diagnosis and adenocarcinoma histology were included in the US Flatiron Health Electronic Health Record-derived de-identified database. Treatment patterns [including treatment per lines of therapies (LOTs), LOT sequences, and time on treatment] and overall survival (OS) have been described in mCRPC settings. Results Of 5213 patients (mean age: 72.6 years), 4374 (83.9%) were treated with ≥ 1 LOT post-mCRPC diagnosis (among those with ≥ 1 LOT, 55.3%, 29.5%, 14.7%, and 6.7% had ≥ 2, 3, 4, and 5 LOTs, respectively). In first line (1L), the main treatment class was next-generation hormonal agents (NHA; 62.5% of patients with ≥ 1 LOT), while the shortest and longest time on 1L were observed for chemotherapy (median 2.8 months) and NHA (median 5.1 months), respectively. The most common LOT sequences were NHA → NHA (29.4% of patients with ≥ 2 LOTs) and NHA → NHA → chemotherapy (16.7% of patients with ≥ 3 LOTs). In Kaplan–Meier analyses, the median OS was 19.4, 14.6, and 11.1 months post-1L, 2L, and 3L start, respectively. Patients who moved rapidly through LOTs had an increased risk of death. Conclusions NHA were widely used as 1L therapy in mCRPC patients from 2013 to 2019, but time on 1L NHA treatment was on average < 6 months. While NHA → NHA was the most observed 1L → 2L LOT sequence, a plethora of other LOT sequences were observed. OS was poor, highlighting an unmet need for life-prolonging treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01823-6.
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Affiliation(s)
- Neal D Shore
- Carolina Urologic Research Center, 823 82nd Pkwy Suite b, Myrtle Beach, SC, 29572, USA
| | - François Laliberté
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Raluca Ionescu-Ittu
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC, H3B 0G7, Canada.
| | - Lingfeng Yang
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | - Malena Mahendran
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Dominique Lejeune
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Louise H Yu
- Analysis Group, Inc, 111 Huntington Ave 14th Floor, Boston, MA, 02199, USA
| | - Joseph Burgents
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | - Mei Sheng Duh
- Analysis Group, Inc, 111 Huntington Ave 14th Floor, Boston, MA, 02199, USA
| | - Sameer R Ghate
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
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Caffo O, Frantellizzi V, Monari F, Galli L, Costa RP, Pinto C, Tucci M, Baldari S, Facchini G, Bortolus R, Alongi F, Alongi P, Donner D, Fanti S, Sbrana A, Morabito A, Masini C, Zichi C, Pignata S, Borsatti E, Salgarello M, Spada M, De Giorgi U, Lo Re G, Cortesi E, De Vincentis G. Sequencing Life-Prolonging Agents in Castration-Resistant Prostate Cancer Patients: Comparison of Sequences With and Without 223Ra. Cancer Biother Radiopharm 2021; 36:391-396. [PMID: 33769088 DOI: 10.1089/cbr.2020.4442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The retrospective studies that have so far described the outcomes of the sequential use of life-prolonging agents (LPAs) did not include metastatic castration-resistant prostate cancer (mCRPC) patients who received radium-223 (223Ra) as part of their treatment. Consequently, it is not known whether including 223Ra in the therapeutic sequence has an impact on cumulative survival. The aim of this study was to evaluate this impact by comparing the cumulative overall survival (OS) in two series of mCRPC patients sequentially treated with two or three LPAs after first-line docetaxel (DOC), including 223Ra and not. Materials and Methods: The authors retrospectively reviewed the records of mCRPC patients with bone involvement alone who received two or three LPAs (including 223Ra) after first-line DOC. The control group was a contemporary series of mCRPC patients with bone involvement alone treated with sequences of two or three LPAs other than 223Ra after first-line DOC. Results: Median cumulative OS was 40.6 months in the 223Ra group of 78 patients and 36.2 months in the non-223Ra group of 186 patients (p = 0.08). OS outcomes were significantly influenced by the number of treatment lines, and baseline Eastern Cooperative Oncology Group performance status (PS) and prostate-specific antigen levels. Conclusions: To the best of the authors' knowledge, this is the first study designed to evaluate the impact of introducing 223Ra in the treatment sequences for mCRPC patients, and the results show that its use does not negatively affect cumulative OS.
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Affiliation(s)
- Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Viviana Frantellizzi
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, La Sapienza University, Rome, Italy
| | - Fabio Monari
- Department of Radiotherapy, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Galli
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Carmine Pinto
- Medical Oncology Unit, Clinical Cancer Centre, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marcello Tucci
- Department of Medical Oncology, Cardinal Massaia Hospital, Asti, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Gaetano Facchini
- Department of Medical Oncology, S.M. delle Grazie Hospital, Pozzuoli, Italy
| | - Roberto Bortolus
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy.,University of Brescia, Brescia, Italy
| | | | - Davide Donner
- Department of Nuclear Medicine, Santa Chiara Hospital, Trento, Italy
| | - Stefano Fanti
- Department of Nuclear Medicine Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Sbrana
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Cristina Masini
- Medical Oncology Unit, Clinical Cancer Centre, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Clizia Zichi
- Department of Medical Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Salvatore Pignata
- Department of Biomedical and Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Eugenio Borsatti
- Department of Nuclear Medicine Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Matteo Salgarello
- Department of Nuclear Medicine Oncology IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Massimiliano Spada
- Department of Medical Oncology, Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Giovanni Lo Re
- Department of Medical Oncology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Enrico Cortesi
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, La Sapienza University, Rome, Italy
| | - Giuseppe De Vincentis
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, La Sapienza University, Rome, Italy
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Albers P, Bögemann M, Machtens S, Merseburger AS, Schostak M, Steuber T, Wülfing C, De Santis M. [Changes in the treatment of metastatic prostate cancer-new data and open questions]. Urologe A 2019; 59:307-317. [PMID: 31781782 DOI: 10.1007/s00120-019-01072-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The availability of taxane-based chemotherapy and androgen-receptor-targeted agents (ARTAs) have significantly broadened the therapeutic options for patients with metastatic prostate cancer and may also result in longer patient survival. The therapeutic sequence of ARTAs and taxanes may influence outcome and therefore decisions should be made on an individual basis. This article provides guidance for therapeutic decision-making in daily clinical practice by working out criteria that can be used to support individual therapeutic decisions. The focus is on metastatic castration-naive prostate cancer, oligometastatic disease as well as non-metastatic and metastatic castration-resistant prostate cancer.
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Affiliation(s)
- P Albers
- Klinik für Urologie und Universitätstumorzentrum, Comprehensive Cancer Center, Universitätsklinikum, Medizinische Fakultät Heinrich-Heine-Universität, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - M Bögemann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Münster, Deutschland
| | - S Machtens
- Klinik für Urologie und Kinderurologie, GFO Kliniken Rhein Berg, Betriebsstätte, Marien-Krankenhaus, Bergisch Gladbach, Deutschland
| | - A S Merseburger
- Klinik für Urologie, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - M Schostak
- Klinik für Urologie und Kinderurologie, Universitätsklinik Magdeburg, Magdeburg, Deutschland
| | - T Steuber
- Martini-Klinik, Prostatakrebszentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - C Wülfing
- Abteilung für Urologie, Asklepios Klinik Altona, Hamburg, Deutschland
| | - M De Santis
- Klinik für Urologie, Interdisziplinäre Uro-Onkologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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