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Hunnisett A, Victor D. Non-metastatic castration-resistant prostate cancer: the evolving treatment landscape and role of nurse specialists. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S4-S13. [PMID: 35648671 DOI: 10.12968/bjon.2022.31.10.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Prostate cancer is the most common type of cancer in men in the UK. Within 2 years of diagnosis, one-third of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) will develop metastatic disease, which is associated with significantly greater morbidity and mortality compared to disease without metastases. The approval of second-generation androgen receptor inhibitors such as darolutamide has transformed the nmCRPC treatment landscape because they lead to prolonged metastasis-free survival and better maintenance of quality of life compared with placebo. Early identification of patients with nmCRPC who are suitable for treatment is imperative because most of these patients are asymptomatic. Clinical nurse specialists (CNSs) play a critical, supportive role in the management of disease and treatment follow-up. This product-focused article discusses the use of darolutamide in nmCRPC and the vital role that CNSs play in the management and care of patients with prostate cancer.
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Affiliation(s)
- Andrew Hunnisett
- Macmillan Clinical Nurse Specialist, Lancashire Teaching Hospitals NHS Foundation Trust
| | - Debbie Victor
- Uro-Oncology Cancer Nurse Specialist, Royal Cornwall Hospitals NHS Trust
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2
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Alcaraz Asensio A, Alvarez Ossorio JL, Cozar Olmo JM, Chantada Abal V, Juarez Soto A, Linares Espinos E, Moreno Jimenez J, Muñoz Rodriguez J, Perez Fentes D, Plata Bello A, Rodrigo Aliaga M, Unda Urzaiz M, Vilaseca A. Non-metastatic castration-resistant prostate cancer: management recommendations. Actas Urol Esp 2022; 46:193-213. [PMID: 35305957 DOI: 10.1016/j.acuroe.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE Survival and quality of life (QoL) of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) deteriorate significantly when they develop metastases. New generation antiandrogens (apalutamide, enzalutamide and darolutamide) can prolong metastasis-free survival (MFS) and overall survival (OS) in these patients, maintaining their QoL. MATERIAL AND METHODS After the performance of a systematic review of the literature, a scientific committee reached a consensus on simple and practical recommendations to consolidate and improve the management of patients with nmCRPC in urology consultations. RESULTS Recommendations are made on the frequency of PSA determination and imaging tests in patients with nmCRPC. The importance of co-morbidities in patients with nmCRPC is also highlighted, and recommendations are also made on functional and QoL assessment that can be carried out during urology consultations. The efficacy, safety, and effects on QoL of new generation antiandrogens are reviewed. CONCLUSIONS To evaluate treatment of patients with nmCRPC, it is necessary to consider co-morbidities and QoL, in addition to age. New generation antiandrogens are a safe and effective treatment option for patients with nmCRPC. The recommendations of this review can be helpful in optimizing the management of nmCRPC patients in urology consultations.
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Affiliation(s)
- A Alcaraz Asensio
- Servicio de Urología, Hospital Clinic de Barcelona, Barcelona, Spain.
| | | | - J M Cozar Olmo
- Servicio de Urología, Hospital Virgen de Las Nieves, Granada, Spain
| | - V Chantada Abal
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - A Juarez Soto
- Servicio de Urología, Hospital de Jerez, Jerez de la Frontera, Jerez, Spain
| | | | - J Moreno Jimenez
- Servicio de Urología, Complejo Hospitalario de Jaén, Jaén, Spain
| | - J Muñoz Rodriguez
- Servicio de Urología, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - D Perez Fentes
- Servicio de Urología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - A Plata Bello
- Servicio de Urología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - M Rodrigo Aliaga
- Servicio de Urología, Hospital General Universitario Castellón, Castellón, Spain
| | - M Unda Urzaiz
- Servicio de Urología, Hospital Universitario de Basurto, Bilbao, Spain
| | - A Vilaseca
- Servicio de Urología, Hospital Clinic de Barcelona, Barcelona, Spain
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Alcaraz Asensio A, Alvarez Ossorio J, Cozar Olmo J, Chantada Abal V, Juarez Soto A, Linares Espinos E, Moreno Jimenez J, Muñoz Rodriguez J, Perez Fentes D, Plata Bello A, Rodrigo Aliaga M, Unda Urzaiz M, Vilaseca A. Cáncer de próstata resistente a la castración no metastásico: recomendaciones de manejo. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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4
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Rizzo A, Oderda M, Mollica V, Merler S, Morelli F, Fragomeno B, Taveri E, Sorgentoni G, Santoni M, Massari F. A meta-analysis on overall survival and safety outcomes in patients with nonmetastatic castration-resistant prostate cancer treated with novel hormonal agents. Anticancer Drugs 2022; 33:e43-e51. [PMID: 34387593 DOI: 10.1097/cad.0000000000001168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several novel androgen receptor (AR)-inhibitors have been introduced for nonmetastatic castration-resistant prostate cancer (nmCRPC) treatment, with the improvement of survival outcomes which need to be balanced against the risk of adverse events. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating enzalutamide, apalutamide and darolutamide in nmCRPC patients, to assess overall survival (OS), incidence and risk of adverse drug events, adverse-events-related death and adverse-events-related treatment discontinuation. We selected three RCTs (SPARTAN, PROSPER and ARAMIS). New hormonal agents administration resulted in better OS, despite the increased risk of several any grade and grade 3-4 adverse events. In the decision-making process, careful evaluation of expected adverse events, patients' comorbidities and maintenance of quality of life are mandatory.
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Affiliation(s)
- Alessandro Rizzo
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Marco Oderda
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin
| | - Veronica Mollica
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Sara Merler
- U.O.C. Oncology, Azienda Ospedaliera Universitaria Integrata, University and Hospital Trust of Verona, Verona
| | - Franco Morelli
- Medical Oncology Department, Casa Sollievo Della Sofferenza Hospital, IRCCS, San Giovanni Rotondo
| | - Benedetta Fragomeno
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Elena Taveri
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | | | | | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
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Tombal B, Stenzl A, Cella D, Loriot Y, Armstrong AJ, Fizazi K, Beer T, Sternberg CN, Hussain M, Ivanescu C, Ganguli A, Ramaswamy K, Saad F. The Impact of Enzalutamide on the Prostate Cancer Patient Experience: A Summary Review of Health-Related Quality of Life across Pivotal Clinical Trials. Cancers (Basel) 2021; 13:cancers13235872. [PMID: 34884981 PMCID: PMC8657254 DOI: 10.3390/cancers13235872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Patients with prostate cancer often experience pain, fatigue and other negative symptoms that can lead to poorer quality of life. Enzalutamide is a prostate cancer therapy that is effective across the disease continuum from early-state cancer patients through to patients with metastatic castration-resistant disease. In this study, we evaluated how enzalutamide impacts patients’ quality of life. We found that patients with early disease maintained low pain levels and symptom-related burden when treated with enzalutamide or with a control treatment, and that patients with advanced disease who received enzalutamide experienced mitigated negative impacts compared to controls. Furthermore, it took longer for patients treated with enzalutamide to report experiencing a reduction in quality of life, and this was most pronounced for patients with advanced cancer. Enzalutamide can be tolerated by patients with early or advanced prostate cancer and delays both disease progression and the associated deterioration of quality of life. Abstract This review examines the impact of treatment with enzalutamide on health-related quality of life (HRQoL) in prostate cancer patients across the disease continuum based on pivotal clinical trials. We assessed the effect of enzalutamide on pain, symptom burden and overall HRQoL from randomized controlled trials. Patient experience was evaluated in men with metastatic hormone-sensitive prostate cancer (mHSPC), non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-resistant prostate cancer (mCRPC) (pre-chemotherapy and post-chemotherapy). Patients across the disease continuum reported a generally positive status at baseline, with relatively low levels of pain and impairment due to cancer-related symptoms and high HRQoL. For patients with earlier-state prostate cancer, pain and symptom-related burden were low at study entry and remained so, regardless of whether patients received enzalutamide or control treatment. Patients with more advanced disease reported mitigation in pain and symptom burden while receiving treatment with enzalutamide. Enzalutamide was observed to slow deterioration of overall HRQoL most for patients with nmCRPC or mCRPC (statistical significance for between-group difference in median time to deterioration: mHSPC (confirmed) p = 0.2998; nmCRPC (confirmed) p = 0.0044; mCRPC (unconfirmed) p < 0.0001). Across the prostate cancer continuum, enzalutamide is well-tolerated and delays the negative impact that disease progression has on quality of life.
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Affiliation(s)
- Bertrand Tombal
- Cliniques Universitaires Saint Luc, Avenue Hippocrate, 10, B-1200 Bruxelles, Belgium;
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany;
| | - David Cella
- Feinberg School of Medicine, Northwestern University, 633 Clark Street, Evanston, IL 60208, USA;
| | - Yohann Loriot
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif CEDEX, 94805 Paris, France; (Y.L.); (K.F.)
| | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate & Urologic Cancers, Duke University, 905 La Salle Street, GSRB1 Room 3006, Durham, NC 27710, USA;
| | - Karim Fizazi
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif CEDEX, 94805 Paris, France; (Y.L.); (K.F.)
| | - Tomasz Beer
- Oregon Health & Science University Center for Health & Healing, 3485 S. Bond Avenue, Building 2, Portland, OR 97239, USA;
| | - Cora N. Sternberg
- Division of Hematology and Oncology, Englander Institute for Precision Medicine, Weill Cornell Medicine, Belfer Research Building, 413 East 69th Street, Room 1412, New York, NY 10021, USA;
| | - Maha Hussain
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, 303 East Superior Street, Suite 3-107, Chicago, IL 60611, USA;
| | - Cristina Ivanescu
- IQVIA, Diana Building, Office 314, Herikerbergweg 181, Zuidoost, 1101 CN Amsterdam, The Netherlands;
| | - Arijit Ganguli
- Astellas Pharma Global Development, Inc., 1 Astellas Way, Northbrook, IL 60062, USA
- Correspondence: ; Tel.: +1-224-205-5080
| | - Krishnan Ramaswamy
- Pfizer Oncology, 235 East 42nd Street, Mailstop 219/06/32, New York, NY 10017, USA;
| | - Fred Saad
- University of Montréal Hospital Center (CHUM), Montréal Cancer Institute, University of Montréal, Pavillon R, 900, Rue St-Denis, Porte R10-464, Montréal, QC H2X 0A9, Canada;
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Management of Patients with Nonmetastatic Castration-Resistant Prostate Cancer: Recommendations of a Multidisciplinary Panel of Experts from South America. Prostate Cancer 2021. [DOI: 10.1155/2021/3334333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Most prostate cancer patients who undergo androgen-deprivation therapy or orchiectomy will eventually develop castration-resistant prostate cancer (CRPC), often preceded by a nonmetastatic CRPC state known as M0CRPC. The recent development of second-generation antiandrogens provides clinicians with efficacious and safe treatments for M0CRPC. However, the complexity of these patients, who typically have to deal with underlying comorbidities and polypharmacy, often challenges therapeutic decisions in this setting. The recent development of novel imaging techniques also provides clinicians with tools for detecting metastases with high sensitivity and specificity. However, the lack of evidence on the early detection of metastases and the corresponding impact on therapeutic decisions makes these techniques a double-edged sword that must be managed appropriately. Here, we present the expert view of the rapidly evolving concept of M0CRPC and provide recommendations for the identification of these patients, the appropriate use of the emerging imaging modalities, and patients’ management, particularly considering their clinical complexity and the recent development of next-generation antiandrogens.
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Health-related Quality of Life at the SPARTAN Final Analysis of Apalutamide for Nonmetastatic Castration-resistant Prostate Cancer Patients Receiving Androgen Deprivation Therapy. Eur Urol Focus 2021; 8:958-967. [PMID: 34479838 DOI: 10.1016/j.euf.2021.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/14/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND In SPARTAN, apalutamide improved metastasis-free and overall survival for patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) with a prostate-specific antigen doubling time of ≤10 mo. OBJECTIVE We evaluated health-related quality of life (HRQoL) at the final analysis of the SPARTAN study. INTERVENTION Patients received apalutamide (240 mg/d) or placebo in 28-d cycles. All patients continued androgen deprivation therapy (ADT). DESIGN, SETTING, AND PARTICIPANTS A total of 1207 patients with nmCRPC were randomized 2:1 to apalutamide or placebo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS HRQoL was assessed using Functional Assessment of Cancer Therapy-Prostate (FACT-P) and EQ-5D-3L questionnaires at day 1 of cycle 1 (predose/baseline), cycles 2-6, every two cycles during cycles 7-13, every four cycles thereafter, at the end of treatment, and every 4 mo after progression to 1 yr. Results are presented using descriptive statistics. A mixed model for repeated measures was fitted to estimate the mean scores at each scheduled visit during treatment. RESULTS At final analysis, with 52 mo follow-up for survival, the median treatment duration was 32.9 mo for apalutamide and 11.5 mo for placebo. Patients had good baseline HRQoL. At each scheduled collection during treatment, >90% per group completed the questionnaires. The change in FACT-P total score from baseline to cycles 21 and 25 significantly favored apalutamide over placebo (p = 0.0138 and 0.0009, respectively). The apalutamide group generally maintained favorable FACT-P (total and subscales) and EQ-5D-3L scores, while placebo scores tended to decline over time (starting in cycles 11-13 and pronounced by cycles 21-25). Notably, patient-reported fatigue did not worsen with apalutamide. Most patients reported being "not at all bothered" by side effects, and bother did not increase over time with apalutamide or placebo. Patients receiving apalutamide had minimal change in side-effect bother following symptomatic adverse events. CONCLUSIONS Final analysis of SPARTAN confirms that HRQoL is preserved in patients with nmCRPC receiving apalutamide plus ADT, but declines in patients receiving placebo plus ADT after approximately 1 yr. PATIENT SUMMARY Responses from patients with prostate cancer who were included in the SPARTAN study indicated that treatment with apalutamide, even after the most extensive follow-up time possible, did not reduce their quality of life. These results, along with improved survival and longer time to the development of metastases (reported separately), confirm the benefits of apalutamide for patients with nonmetastatic castration-resistant prostate cancer.
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8
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Health-related Quality of Life in Patients with Advanced Prostate Cancer: A Systematic Review. Eur Urol Focus 2021; 7:742-751. [DOI: 10.1016/j.euf.2020.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/31/2020] [Indexed: 11/24/2022]
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9
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Olivier KM, Floyd R, Smith MR, Shore ND, Sutton J. New treatments for patients with non‐metastatic castration‐resistant prostate cancer: A nursing perspective. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2021. [DOI: 10.1111/ijun.12263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kara M. Olivier
- Massachusetts General Hospital Cancer Center Boston Massachusetts USA
| | - Rebecca Floyd
- Carolina Urologic Research Center Myrtle Beach South Carolina USA
| | - Matthew R. Smith
- Massachusetts General Hospital Cancer Center Boston Massachusetts USA
| | - Neal D. Shore
- Carolina Urologic Research Center Myrtle Beach South Carolina USA
| | - Jennifer Sutton
- Carolina Urologic Research Center Myrtle Beach South Carolina USA
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Chung DY, Ha JS, Cho KS. Novel Treatment Strategy Using Second-Generation Androgen Receptor Inhibitors for Non-Metastatic Castration-Resistant Prostate Cancer. Biomedicines 2021; 9:biomedicines9060661. [PMID: 34207755 PMCID: PMC8229358 DOI: 10.3390/biomedicines9060661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022] Open
Abstract
Non-metastatic castration-resistant prostate cancer (nmCRPC) is defined by a progressively rising prostate-specific antigen level, despite a castrate level of testosterone, in the absence of obvious radiologic evidence of metastatic disease on conventional imaging modalities. As a significant proportion of patients with nmCRPC develop metastatic diseases, the therapeutic goals of physicians for these patients are to delay metastasis development, preserve quality of life, and increase overall survival (OS). Since 2018, the treatment of nmCRPC has changed dramatically with the introduction of second-generation androgen receptor inhibitors, such as enzalutamide (ENZA), apalutamide (APA), and darolutamide (DARO). These drugs demonstrated substantial improvements in metastasis-free survival (MFS) and OS in phase III randomized clinical trials. In addition, these drugs have an excellent safety profile, preserve quality of life, and can delay disease-related symptoms. A recently published indirect meta-analysis reported that APA and ENZA showed better findings in MFS and that DARO had relatively fewer adverse effects. However, in the absence of a direct comparison, careful interpretation is required. Thus, APA, ENZA, and DARO should be considered the new standard drugs for treating nmCRPC.
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Affiliation(s)
- Doo Yong Chung
- Department of Urology, Inha University School of Medicine, Incheon 22212, Korea;
| | - Jee Soo Ha
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
- Correspondence: ; Tel.: +82-2-2019-3471
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Palmieri VE, Roviello G, D'Angelo A, Casadei C, De Giorgi U, Giorgione R. Darolutamide in hormone-sensitive and castration-resistant prostate cancer. Expert Rev Clin Pharmacol 2021; 14:535-544. [PMID: 33685318 DOI: 10.1080/17512433.2021.1901580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Important changes in the treatment of prostate cancer have taken place in recent years. Non-metastatic castration-resistant prostate cancer (nmCRPC) has been clinically delineated. In this setting, three drugs have been approved in high-risk disease: apalutamide, enzalutamide and darolutamide.Areas covered:This manuscript aims to profile darolutamide, its clinical development, pharmacologic properties, efficacy and safety. We presented the results of published clinical studies, but we also investigated ongoing ones.Expert opinion: An indirect comparison with the other two aforementioned drugs emerged. While the clinical efficacy is comparable, the toxicity profile is different for darolutamide, resulting in greater tolerance. We must wait for the results of the trials that study darolutamide in hormone-sensitive disease, both in the metastatic phase and in the localized phase. Clinical experience will also be important to determine ever more personalized treatments for patients.
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Affiliation(s)
| | - Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Alberto D'Angelo
- Department of Biology and Biochemistry, University of Bath, Bath UK
| | - Chiara Casadei
- IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Roberta Giorgione
- School of Human Health Sciences, University of Florence, Florence, Italy
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12
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Feng Z, Graff JN. Next-Generation Androgen Receptor-Signaling Inhibitors for Prostate Cancer: Considerations for Older Patients. Drugs Aging 2021; 38:111-123. [DOI: 10.1007/s40266-020-00809-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 12/22/2022]
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13
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Saad F, Bögemann M, Suzuki K, Shore N. Treatment of nonmetastatic castration-resistant prostate cancer: focus on second-generation androgen receptor inhibitors. Prostate Cancer Prostatic Dis 2021; 24:323-334. [PMID: 33558665 PMCID: PMC8134049 DOI: 10.1038/s41391-020-00310-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nonmetastatic castration-resistant prostate cancer (nmCRPC) is defined as a rising prostate-specific antigen concentration, despite castrate levels of testosterone with ongoing androgen-deprivation therapy or orchiectomy, and no detectable metastases by conventional imaging. Patients with nmCRPC progress to metastatic disease and are at risk of developing cancer-related symptoms and morbidity, eventually dying of their disease. While patients with nmCRPC are generally asymptomatic from their disease, they are often older and have chronic comorbidities that require long-term concomitant medication. Therefore, careful consideration of the benefit-risk profile of potential treatments is required. METHODS In this review, we will discuss the rationale for early treatment of patients with nmCRPC to delay metastatic progression and prolong survival, as well as the factors influencing this treatment decision. We will focus on oral pharmacotherapy with the second-generation androgen receptor inhibitors, apalutamide, enzalutamide, and darolutamide, and the importance of balancing the clinical benefit they offer with potential adverse events and the consequential impact on quality of life, physical capacity, and cognitive function. RESULTS AND CONCLUSIONS While the definition of nmCRPC is well established, the advent of next-generation imaging techniques capable of detecting hitherto undetectable oligometastatic disease in patients with nmCRPC has fostered debate on the criteria that inform the management of these patients. However, despite these developments, published consensus statements have maintained that the absence of metastases on conventional imaging suffices to guide such therapeutic decisions. In addition, the prolonged metastasis-free survival and recently reported positive overall survival outcomes of the three second-generation androgen receptor inhibitors have provided further evidence for the early use of these agents in patients with nmCRPC in order to delay metastases and prolong survival. Here, we discuss the benefit-risk profiles of apalutamide, enzalutamide, and darolutamide based on the data available from their pivotal clinical trials in patients with nmCRPC.
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Affiliation(s)
- Fred Saad
- Department of Urology, Centre Hospitalier de l'Université de Montreal (CHUM), Montreal Cancer Institute/CRCHUM, Montreal, QC, Canada.
| | - Martin Bögemann
- Department of Urology, Münster University Medical Center, Münster, Germany
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Neal Shore
- Carolina Urologic Research Center, Atlantic Urology Clinics, Myrtle Beach, SC, USA
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Roumiguié M, Paoletti X, Neuzillet Y, Mathieu R, Vincendeau S, Kleinclauss F, Mejean A, Guy L, Timsit MO, Lebret T. Apalutamide, darolutamide and enzalutamide in nonmetastatic castration-resistant prostate cancer: a meta-analysis. Future Oncol 2021; 17:1811-1823. [PMID: 33543650 DOI: 10.2217/fon-2020-1104] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: Comparison of the efficacy/safety/health-related quality of life of apalutamide, enzalutamide and darolutamide in Phase III clinical trials involving patients with nonmetastatic castration-resistant prostate cancer was performed. Materials & methods: Relevant studies were identified by searching PubMed as well as conference abstracts reporting updated overall survival. Three pivotal trials were identified, SPARTAN (apalutamide), PROSPER (enzalutamide) and ARAMIS (darolutamide), and form the basis of this analysis. Results: All three drugs significantly prolonged metastasis-free survival, prostate-specific antigen response and overall survival versus placebo, and were generally well tolerated. Conclusion: Drug selection will likely be influenced by tolerability/safety and other factors, such as the propensity for drug-drug interactions and the presence of comorbidities, that affect the risk-benefit balance in individual patients.
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Affiliation(s)
- Mathieu Roumiguié
- Department of Urology, CHU-Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Xavier Paoletti
- Department of Public health, University of Versailles, Saint-Quentin, France.,Institut Curie, INSERM U900, Biostatistics for Personalized Medicine, Saint-Cloud, France
| | - Yann Neuzillet
- Department of Urology, Hôpital Foch, University of Paris-Saclay, Versailles Saint-Quentin-en-Yvelines, Suresnes, France
| | - Romain Mathieu
- Department of Urology, Univ rennes, CHU Rennes, Inserm, EHESP, Irset - UMR_S 1085, F 35000 Rennes, France
| | - Sebastien Vincendeau
- Department of Urology, Centre Hospitalier Privé Saint Grégoire, Saint-Grégoire, France
| | - François Kleinclauss
- Department of Urology, Andrology & Kidney Transplantation, University of Franche-Comté, Besançon, France
| | - Arnaud Mejean
- Department of Urology, Hôpital Europeen Georges-Pompidou (HEGP), AP-HP, Paris, France
| | - Laurent Guy
- Department of Urology, CHU Clermont-Ferrand, UMR1240 INSERM, Université Clermont-Auvergne, Clermont Ferrand, France
| | - Marc Olivier Timsit
- Department of Urology, Hôpital Europeen Georges-Pompidou (HEGP), AP-HP, INSERM, PARCC, Paris, France
| | - Thierry Lebret
- Department of Urology, Hôpital Foch, University of Paris-Saclay, Versailles Saint-Quentin-en-Yvelines, Suresnes, France
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Uemura H, Matsushima H, Kobayashi K, Mizusawa H, Nishimatsu H, Fizazi K, Smith M, Shore N, Tammela T, Tabata KI, Matsubara N, Iinuma M, Uemura H, Oya M, Momma T, Kawakita M, Fukasawa S, Kobayashi T, Kuss I, Le Berre MA, Snapir A, Sarapohja T, Suzuki K. Efficacy and safety of darolutamide in Japanese patients with nonmetastatic castration-resistant prostate cancer: a sub-group analysis of the phase III ARAMIS trial. Int J Clin Oncol 2020; 26:578-590. [PMID: 33226524 PMCID: PMC7895789 DOI: 10.1007/s10147-020-01824-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
Background Darolutamide, an oral androgen receptor inhibitor, has been approved for treating nonmetastatic castration-resistant prostate cancer (nmCRPC), based on significant improvements in metastasis-free survival (MFS) in the ARAMIS clinical trial. Efficacy and safety of darolutamide in Japanese patients are reported here. Methods In this randomized, double-blind, placebo-controlled phase III trial, 1509 patients with nmCRPC and prostate-specific antigen (PSA) doubling time ≤ 10 months were randomized 2:1 to darolutamide 600 mg twice daily or matched placebo while continuing androgen deprivation therapy. The primary endpoint was MFS. Results In Japan, 95 patients were enrolled and randomized to darolutamide (n = 62) or placebo (n = 33). At the primary analysis (cut-off date: September 3, 2018), after 20 primary end-point events had occurred, median MFS was not reached with darolutamide vs. 18.2 months with placebo (HR 0.28, 95% CI 0.11–0.70). Median OS was not reached due to limited numbers of events in both groups but favored darolutamide in the Japanese subgroup. Time to pain progression, time to PSA progression, and PSA response also favored darolutamide. Among Japanese patients randomized to darolutamide vs. placebo, incidences of treatment-emergent adverse events (TEAEs) were 85.5 vs. 63.6%, and incidences of treatment discontinuation due to TEAEs were 8.1 vs. 6.1%. Conclusions Efficacy outcomes favored darolutamide in Japanese patients with nmCRPC, supporting the clinical benefit of darolutamide in this patient population. Darolutamide was well tolerated; however, due to the small sample size, it is impossible to conclude with certainty whether differences in the safety profile exist between Japanese and overall ARAMIS populations. Electronic supplementary material The online version of this article (10.1007/s10147-020-01824-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Hisashi Matsushima
- Department of Urology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, 164-8541, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, 238-8558, Japan
| | - Hiroya Mizusawa
- Department of Urology, National Hospital Organization, Shinshu Ueda Medical Center, 1-27-21 Midorigaoka, Ueda, 386-8610, Japan
| | - Hiroaki Nishimatsu
- Department of Urology, The Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, 130-8587, Japan
| | - Karim Fizazi
- Institut Gustave Roussy, 39 Rue Camille Desmoulins, 94805, Villejuif Cedex, France
| | - Matthew Smith
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, 02114, USA
| | - Neal Shore
- Carolina Urologic Research Center, 823 82nd Parkway, Myrtle Beach, SC, 29572, USA
| | - Teuvo Tammela
- Tampere University Hospital, Urologian poliklinikka, PL 2000, Teiskontie 35, 33521, Tampere, Finland
| | - Ken-Ichi Tabata
- Department of Urology, Kitasato University Hospital, 1-15-1 Kitazato Minami-ku, Sagamihara, 252-0375, Japan
| | - Nobuaki Matsubara
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Masahiro Iinuma
- Department of Urology, National Hospital Organization, Mito Medical Center, 280 Sakuranosato Ibarakimachi, Higashiibaraki, 311-3193, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University, 377-2, Onohigashi, Osakasayama, 589-8511, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University, 35 Shinano-machi, Shinjuku-ku, 160-8582, Japan
| | - Tetsuo Momma
- Department of Urology, National Hospital Organization, Saitama National Hospital, 2-1 Suwa, Wako, 351-0102, Japan
| | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi Chuo-ku, Kobe, 650-0047, Japan
| | - Satoshi Fukasawa
- Division of Urology, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan
| | - Tadahiro Kobayashi
- Department of Urology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui, 910-8526, Japan
| | - Iris Kuss
- Clinical Statistics, Bayer AG, Building P300, B342, 13342, Berlin, Germany
| | | | - Amir Snapir
- Orion Corporation Orion Pharma, Orionintie 1, P.O. Box 65, FI-02101, Espoo, Finland.,PCI Biotech, Ullernchausseen 64, 0379, Oslo, Norway
| | - Toni Sarapohja
- Orion Corporation Orion Pharma, Orionintie 1, P.O. Box 65, FI-02101, Espoo, Finland
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University, 3-39-15 Showa-machi, Maebashi, 371-8511, Japan
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