1
|
Calleris G, Filleron T, Kesch C, Roubaud G, Pradère B, Cabarrou B, Malavaud B, Roupret M, Mourey L, Ploussard G. Surgery with or Without Darolutamide in High-risk and/or Locally Advanced Prostate Cancer: The SUGAR (CCAFU-PR2) Phase 2 Trial Rationale and Protocol. Eur Urol Oncol 2024; 7:494-500. [PMID: 37806843 DOI: 10.1016/j.euo.2023.09.020] [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: 09/08/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND High-risk prostate cancer (PCa) patients frequently experience recurrence and progression after radical prostatectomy (RP). Neoadjuvant androgen deprivation therapy (ADT) has not demonstrated a clear oncological benefit and is not currently recommended. OBJECTIVE The SUGAR trial is the first phase 2, randomised, controlled, multicentre, noncommercial, open-label study investigating single-agent perioperative darolutamide compared with the standard of care (ie, upfront RP, without neoadjuvant ADT). DESIGN, SETTING, AND PARTICIPANTS SUGAR aims to randomise 240 men affected by nonmetastatic PCa, with the major eligibility criteria being International Society of Urological Pathology grade group ≥4, seminal vesicle invasion at magnetic resonance imaging and/or clinically node-positive disease. Patients in the experimental arm will undergo neoadjuvant darolutamide monotherapy, RP, and adjuvant darolutamide, completing 9 mo of treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint is noncurable recurrence-free survival, an innovative and clinically meaningful measure; the secondary endpoints encompass safety; recurrence-free, metastasis-free, and overall survival; pathological response; and quality of life. A predictive biomarker analysis will also be performed. RESULTS AND LIMITATIONS Initial data suggest that intensified neoadjuvant treatment with androgen receptor signalling inhibitors (ARSIs) is associated with a sustained pathological response and may improve outcomes, via tumour downstaging and micrometastasis eradication. ARSI monotherapy could further enhance tolerability. CONCLUSIONS SUGAR will provide efficacy and safety information on perioperative darolutamide monotherapy compared with upfront RP, in a contemporary high-risk PCa population undergoing surgery. PATIENT SUMMARY The on-going SUGAR clinical trial evaluates 9 mo of darolutamide treatment in addition to radical prostatectomy, in men affected by prostate cancer with specific high-risk characteristics. It investigates whether this hormonal treatment can lower the rates of noncurable recurrences, maintaining a favourable tolerability profile.
Collapse
Affiliation(s)
- Giorgio Calleris
- Department of Urology UROSUD, La Croix du Sud Hospital, Toulouse, France; Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Thomas Filleron
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Claudia Kesch
- Department of Urology UROSUD, La Croix du Sud Hospital, Toulouse, France; Department of Urology and West German Cancer Center, University Hospital Essen, Essen, Germany
| | | | - Benjamin Pradère
- Department of Urology UROSUD, La Croix du Sud Hospital, Toulouse, France
| | - Bastien Cabarrou
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Bernard Malavaud
- Surgery Department, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Morgan Roupret
- GRC 5 Predictive Onco-Urology Research Group and Urology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Loic Mourey
- Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Guillaume Ploussard
- Department of Urology UROSUD, La Croix du Sud Hospital, Toulouse, France; Surgery Department, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France.
| |
Collapse
|
2
|
Correa R, Vidal N, Quesada-García A, Marcos R, Muñoz Del Toro J, Muñoz-Rodríguez J. Management of patients with localized prostate cancer and biochemical recurrence in Spain: A medical survey. Actas Urol Esp 2024; 48:218-227. [PMID: 37574011 DOI: 10.1016/j.acuroe.2023.08.002] [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: 04/18/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION The management of patients with prostate cancer (PCa) is established in clinical practice guidelines, which are based on randomized studies according to the level of evidence. In Spain, the degree of compliance with these guidelines in clinical practice is unknown. OBJECTIVES To describe the profiles of PCa patients at the time of diagnosis and the management of patients with localized PCa and those with BCR in Spain. MATERIALS & METHODS A medical survey was conducted in specialized care (85 urologists [UROs], 64 radiation oncologists [ROs], and 21 medical oncologists [MOs]). Three questionnaires were developed for this study with 22 (UROs and ROs) or 21 questions (MOs). RESULTS The annual incidence of PCa was 24,057 in participating hospitals (N = 131). The extrapolated annual incidence in Spain is 40,531 cases. The estimated prevalence of PCa in Spain is 221,689. Of note, 79% and 80% of patients seen by UROs and ROs, respectively had localized PCa at diagnosis. Biopsy was the most used diagnostic test among the three specialties, followed by abdominopelvic computer tomography. More than 90% of patients with BCR underwent standard tests. Next generation imaging tests and PET-choline/PSMA are still used residually. Most patients with localized PCa are currently treated with either surgery or radiotherapy, while for BCR patients, UROs and ROs prefer radiotherapy and MOs androgen deprivation therapy alone or in combination. CONCLUSION This study describes patient profiles at the time of diagnosis and provides an overview of the current therapeutic management of localized PCa and BCR in clinical practice in Spain.
Collapse
Affiliation(s)
- R Correa
- Servicio de Oncología Radioterápica, Hospital Clínico Universitario Virgen de la Victoria Campus Universitario de Teatinos, Málaga, Spain
| | - N Vidal
- Servicio de Oncología Médica, Hospital Clínico San Carlos, Madrid, Spain
| | - A Quesada-García
- Medical Affairs Department, Janssen; Paseo de las Doce Estrellas 5-7, 28042, Madrid, Spain.
| | - R Marcos
- Business Intelligence Department, Janssen; Paseo de las Doce Estrellas 5-7, 28042, Madrid, Spain.
| | - J Muñoz Del Toro
- Medical & Regulatory Affairs Department, Janssen; Lagoas Park, Edificio 9, 2740-262 Porto Salvo, Portugal.
| | - J Muñoz-Rodríguez
- Servicio de Urología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| |
Collapse
|
3
|
Baboudjian M, Touzani A, Martini A, Diamand R, Roche JB, Lacetera V, Beauval JB, Gondran-Tellier B, Roumeguère T, Simone G, Windisch O, Benamran D, Fourcade A, Fiard G, VAN DEN Bergh RC, Peltier A, Ploussard G. Oncological outcomes of radical prostatectomy in very high-risk patients according to STAMPEDE criteria: does local treatment alone still have a place in the era of intensified systemic therapies? Minerva Urol Nephrol 2023; 75:124-126. [PMID: 36282548 DOI: 10.23736/s2724-6051.22.05121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- Michael Baboudjian
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France - .,Department of Urology, North Hospital, Aix-Marseille University, Marseille, France - .,APHM, Marseille, France - .,Department of Urology, La Conception Hospital, Aix-Marseille University, Marseille, France - .,Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain -
| | - Alae Touzani
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | - Alberto Martini
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute, University of Brussels, Brussels, Belgium
| | - Jean B Roche
- Department of Urology, Clinique Saint-Augustin, Bordeaux, France
| | - Vito Lacetera
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Pesaro-Urbino, Italy
| | - Jean B Beauval
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | - Bastien Gondran-Tellier
- Department of Urology, North Hospital, Aix-Marseille University, Marseille, France.,Department of Urology, La Conception Hospital, Aix-Marseille University, Marseille, France
| | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute, University of Brussels, Brussels, Belgium
| | - Guiseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Olivier Windisch
- Division of Urology, University Hospital of Geneva, Geneva, Switzerland
| | - Daniel Benamran
- Department of Urology, Brest University Hospital Center, Hôpital Cavale Blanche, Brest, France
| | - Alexandre Fourcade
- Department of Urology, Brest University Hospital Center, Hôpital Cavale Blanche, Brest, France
| | - Gaelle Fiard
- Department of Urology, CNRS, TIMC, Grenoble INP, Grenoble Alpes University Hospital, Université Grenoble Alpes, Grenoble, France
| | | | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute, University of Brussels, Brussels, Belgium
| | | |
Collapse
|
4
|
Intensification of Systemic Therapy in Addition to Definitive Local Treatment in Nonmetastatic Unfavourable Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol 2022; 82:82-96. [DOI: 10.1016/j.eururo.2022.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/22/2022] [Accepted: 03/24/2022] [Indexed: 11/21/2022]
|
5
|
Maluf FC, Schutz FA, Cronemberger EH, Luz MDA, Martins SPS, Muniz DQB, Bastos DA, Cárcano FM, Smaletz O, Soares A, Peixoto FA, Gomes AJ, Cruz FM, Franke FA, Herchenhorn D, Dos Santos TM, Fabricio VDC, Gidekel R, Werutsky G, de Jesus RG, Souza VC, Fay AP. A phase 2 randomized clinical trial of abiraterone plus ADT, apalutamide, or abiraterone and apalutamide in patients with advanced prostate cancer with non-castrate testosterone levels (LACOG 0415). Eur J Cancer 2021; 158:63-71. [PMID: 34655838 DOI: 10.1016/j.ejca.2021.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/28/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) combined with apalutamide, abiraterone acetate plus prednisone, enzalutamide, or docetaxel are the standard treatments for advanced castration-sensitive prostate cancer (CSPC). We investigated ADT-free alternatives for advanced CSPC. PATIENTS AND METHODS LACOG 0415 is a phase 2, open-label, non-comparative, randomized trial. Patients with advanced CSPC were randomized (1:1:1) to receive goserelin plus abiraterone acetate and prednisone (ADT plus AAP arm), apalutamide (APA arm), or apalutamide plus abiraterone acetate and prednisone (APA plus AAP arm). The primary endpoint was the proportion of patients with PSA of ≤0.2 ng/mL at week 25 in the modified intention-to-treat population. Safety analyses were performed in all patients with at least one dose of the study drug. RESULTS Of 128 randomized patients, 120 patients were evaluable for PSA response at week 25; 17.2% had a high-risk biochemical recurrence, 8.6% had locally advanced disease, and 74.2% had distant metastases. At week 25, PSA of ≤0.2 ng/mL was observed in 75.6% (95%CI 59.7%-87.6%), 60.0% (95%CI 43.3%-75.1%), and 79.5% (95%CI 63.5%-90.7%) of patients in ADT plus AAP, APA, and APA plus AAP arms, respectively. PSA decline of ≥80% was observed in 100%, 90.0%, and 97.4%, respectively. Grade 3-4 AEs were observed in 31.0%, 21.4% and 36.4%, respectively. Testosterone levels increased significantly in the APA arm and decreased significantly in ADT plus AAP and APA plus AAP arms. CONCLUSIONS ADT-free alternatives provide a high PSA response in advanced CSPC, although the APA arm did not reach the expected rate of PSA of ≤0.2 ng/mL at week 25. These results warrant further investigation of ADT-free treatments as alternatives in advanced CSPC. SOURCE STUDY REGISTRATION ClinicalTrials.govNCT02867020.
Collapse
Affiliation(s)
- Fernando C Maluf
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil; Beneficência Portuguesa de São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | - Fabio A Schutz
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil; Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Eduardo H Cronemberger
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil
| | | | | | - David Q B Muniz
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Diogo A Bastos
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | | | - Oren Smaletz
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andrey Soares
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil; Centro Paulista de Oncologia - Oncoclinicas, São Paulo, Brazil
| | - Fábio A Peixoto
- Instituto COI de Educação, Pesquisa e Gestão em Saúde, Rio de Janeiro, Brazil
| | | | - Felipe M Cruz
- IBCC Oncologia - Centro Universitário São Camilo, São Paulo, Brazil
| | | | - Daniel Herchenhorn
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil; Oncologia D'OR/Instituto D'OR de Ensino e Pesquisa, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Vinicius C Souza
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil; Oncologia D'OR, Salvador, Brazil
| | - André P Fay
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil; PUCRS School of Medicine, Porto Alegre, Brazil; Grupo Oncoclínicas, Porto Alegre, Brazil
| |
Collapse
|
6
|
Abstract
High-risk prostate cancer is a heterogeneous disease that lacks clear consensus on its ideal management. Historically, non-surgical treatment was the preferred strategy, and several studies demonstrated improved survival among men with high-risk disease managed with the combination of radiotherapy and androgen deprivation therapy (ADT) compared with ADT alone. However, practice trends in the past 10-15 years have shown increased use of radical prostatectomy with pelvic lymph node dissection for primary management of high-risk, localized disease. Radical prostatectomy, as a primary monotherapy, offers the potential benefits of avoiding ADT, reducing rates of symptomatic local recurrence, enabling full pathological tumour staging and potentially reducing late adverse effects such as secondary malignancy compared with radiation therapy. Retrospective studies have reported wide variability in short-term (pathological) and long-term (oncological) outcomes of radical prostatectomy. Surgical monotherapy continues to be appropriate for selected patients, whereas in others the best treatment strategy probably involves a multimodal approach. Appropriate risk stratification utilizing clinical, pathological and potentially also genomic risk data is imperative in the initial management of men with prostate cancer. However, data from ongoing and planned prospective trials are needed to identify the optimal management strategy for men with high-risk, localized prostate cancer.
Collapse
|