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Roy S, Saad F, Malone S, Agarwal N, Mohamad O, Morgan SC, Malone J, Swami U, Jia AY, Gebrael G, Mendiratta P, Brown JR, Rao SK, Sun Y, Wallis CJD, Chi KN, Chowdhury S, Kishan AU, Spratt DE. Effect of Prior Prostate Directed Local Therapy on Response to Apalutamide in Metastatic Hormone Sensitive Prostate Cancer: A Secondary Analysis of the TITAN Study. Eur Urol 2024; 85:398-400. [PMID: 38485300 DOI: 10.1016/j.eururo.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/02/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Soumyajit Roy
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA.
| | - Fred Saad
- Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Shawn Malone
- Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Canada
| | - Neeraj Agarwal
- Department of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Osama Mohamad
- Department of Genitourinary Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Scott C Morgan
- Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Canada
| | - Julia Malone
- Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Canada
| | - Umang Swami
- Department of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Angela Y Jia
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, OH, USA
| | - Georges Gebrael
- Department of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Prateek Mendiratta
- Department of Medical Oncology, University Hospitals, Seidman Cancer Center, Cleveland, OH, USA
| | - Jason R Brown
- Department of Medical Oncology, University Hospitals, Seidman Cancer Center, Cleveland, OH, USA
| | - Santosh K Rao
- Department of Medical Oncology, University Hospitals, Seidman Cancer Center, Cleveland, OH, USA
| | - Yilun Sun
- Case Western Reserve University, Cleveland, OH, USA
| | - Christopher J D Wallis
- Department of Urology, Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Kim N Chi
- BC Cancer, Vancouver Prostate Centre, Vancouver, Canada
| | - Simon Chowdhury
- Guy's and St. Thomas' NHS Foundation Trust and Sarah Cannon Research Institute, London, UK
| | - Amar U Kishan
- Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, OH, USA
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Miyake H, Kakei Y, Nakano Y, Terakawa T, Miyakoda K, Harada K, Fujisawa M. Efficacy and safety of apalutamide in patients with metastatic castration-resistant prostate cancer (GENESIS): protocol for a multicentre, open-label, single-arm clinical trial. BMJ Open 2023; 13:e070173. [PMID: 36990491 PMCID: PMC10069569 DOI: 10.1136/bmjopen-2022-070173] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION This is a multicentre, open-label, single-arm clinical trial to evaluate the efficacy and safety of apalutamide in patients with metastatic castration-resistant prostate cancer. METHODS AND ANALYSIS The trial will be performed at 4 university hospitals and 14 city hospitals in Japan. The target number of patients will be 110. The patients will be orally administered 240 mg apalutamide once daily during the treatment period. The primary outcome is the prostate-specific antigen (PSA) response rate. PSA response is defined as ≥50% decline from baseline at 12 weeks. Secondary outcomes are time to PSA progression, progression-free survival, overall survival, progression-free survival during second therapy, ≥50% decline in PSA from baseline at 24 and 48 weeks, ≥90% decline in PSA from baseline or lower PSA detection sensitivity after the initial dose at 12, 24 and 48 weeks, PSA maximal changes, accumulated PSA response from screening to 24 and 48 weeks, and grade 3 or 4 adverse events according to the Common Terminology Criteria for Adverse Events version 4.0. ETHICS AND DISSEMINATION This study has been approved by the Certified Research Review Board of Kobe University (No. CRB5180009). All participants will be required to provide written informed consent. Findings will be disseminated through scientific and professional conferences and peer-reviewed journal publications. The datasets generated during the study will be available from the corresponding author on reasonable request. TRIAL REGISTRATION NUMBER jRCTs051220077.
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Affiliation(s)
| | - Yasumasa Kakei
- Department of Clinical and Translational Research Center, Kobe University Hospital, Kobe, Japan
- Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yuzo Nakano
- Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoaki Terakawa
- Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keiko Miyakoda
- Department of Clinical and Translational Research Center, Kobe University Hospital, Kobe, Japan
| | - Kenichi Harada
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masato Fujisawa
- Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Fenner A. ARNEO: neoadjuvant degarelix + apalutamide before surgery for high-risk prostate cancer. Nat Rev Urol 2022; 19:634. [PMID: 36195722 DOI: 10.1038/s41585-022-00664-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Saad F, Efstathiou E, Attard G, Flaig TW, Franke F, Goodman OB, Oudard S, Steuber T, Suzuki H, Wu D, Yeruva K, De Porre P, Brookman-May S, Li S, Li J, Thomas S, Bevans KB, Mundle SD, McCarthy SA, Rathkopf DE. Apalutamide plus abiraterone acetate and prednisone versus placebo plus abiraterone and prednisone in metastatic, castration-resistant prostate cancer (ACIS): a randomised, placebo-controlled, double-blind, multinational, phase 3 study. Lancet Oncol 2021; 22:1541-1559. [PMID: 34600602 DOI: 10.1016/s1470-2045(21)00402-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The majority of patients with metastatic castration-resistant prostate cancer (mCRPC) will have disease progression of a uniformly fatal disease. mCRPC is driven by both activated androgen receptors and elevated intratumoural androgens; however, the current standard of care is therapy that targets a single androgen signalling mechanism. We aimed to investigate the combination treatment using apalutamide plus abiraterone acetate, each of which suppresses the androgen signalling axis in a different way, versus standard care in mCRPC. METHODS ACIS was a randomised, placebo-controlled, double-blind, phase 3 study done at 167 hospitals in 17 countries in the USA, Canada, Mexico, Europe, the Asia-Pacific region, Africa, and South America. We included chemotherapy-naive men (aged ≥18 years) with mCRPC who had not been previously treated with androgen biosynthesis signalling inhibitors and were receiving ongoing androgen deprivation therapy, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and a Brief Pain Inventory-Short Form question 3 (ie, worst pain in the past 24 h) score of 3 or lower. Patients were randomly assigned (1:1) via a centralised interactive web response system with a permuted block randomisation scheme (block size 4) to oral apalutamide 240 mg once daily plus oral abiraterone acetate 1000 mg once daily and oral prednisone 5 mg twice daily (apalutamide plus abiraterone-prednisone group) or placebo plus abiraterone acetate and prednisone (abiraterone-prednisone group), in 28-day treatment cycles. Randomisation was stratified by presence or absence of visceral metastases, ECOG performance status, and geographical region. Patients, the investigators, study team, and the sponsor were masked to group assignments. An independent data-monitoring committee continually monitored data to ensure ongoing patient safety, and reviewed efficacy data. The primary endpoint was radiographic progression-free survival assessed in the intention-to-treat population. Safety was reported for all patients who received at least one dose of study drug. This study is completed and no longer recruiting and is registered with ClinicalTrials.gov, number NCT02257736. FINDINGS 982 men were enrolled and randomly assigned from Dec 10, 2014 to Aug 30, 2016 (492 to apalutamide plus abiraterone-prednisone; 490 to abiraterone-prednisone). At the primary analysis (median follow-up 25·7 months [IQR 23·0-28·9]), median radiographic progression-free survival was 22·6 months (95% CI 19·4-27·4) in the apalutamide plus abiraterone-prednisone group versus 16·6 months (13·9-19·3) in the abiraterone-prednisone group (hazard ratio [HR] 0·69, 95% CI 0·58-0·83; p<0·0001). At the updated analysis (final analysis for overall survival; median follow-up 54·8 months [IQR 51·5-58·4]), median radiographic progression-free survival was 24·0 months (95% CI 19·7-27·5) versus 16·6 months (13·9-19·3; HR 0·70, 95% CI 0·60-0·83; p<0·0001). The most common grade 3-4 treatment-emergent adverse event was hypertension (82 [17%] of 490 patients receiving apalutamide plus abiraterone-prednisone and 49 [10%] of 489 receiving abiraterone-prednisone). Serious treatment-emergent adverse events occurred in 195 (40%) patients receiving apalutamide plus abiraterone-prednisone and 181 (37%) patients receiving abiraterone-prednisone. Drug-related treatment-emergent adverse events with fatal outcomes occurred in three (1%) patients in the apalutamide plus abiraterone-prednisone group (2 pulmonary embolism, 1 cardiac failure) and five (1%) patients in the abiraterone-prednisone group (1 cardiac failure and 1 cardiac arrest, 1 mesenteric arterial occlusion, 1 seizure, and 1 sudden death). INTERPRETATION Despite the use of an active and established therapy as the comparator, apalutamide plus abiraterone-prednisone improved radiographic progression-free survival. Additional studies to identify subgroups of patients who might benefit the most from combination therapy are needed to further refine the treatment of mCRPC. FUNDING Janssen Research & Development.
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Affiliation(s)
- Fred Saad
- Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada.
| | | | | | | | - Fabio Franke
- ONCOSITE, Hospital Unimed Noroeste, Ijuí, Brazil
| | - Oscar B Goodman
- Comprehensive Cancer Centers of Nevada, US Oncology Network, Las Vegas, NV, USA
| | - Stéphane Oudard
- Georges Pompidou Hospital, University of Paris, Paris, France
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Daphne Wu
- Janssen Research & Development, Los Angeles, CA, USA
| | - Kesav Yeruva
- Janssen Research & Development, Los Angeles, CA, USA
| | | | - Sabine Brookman-May
- Janssen Research & Development, Los Angeles, CA, USA; Ludwig Maximilians University, Munich, Germany
| | - Susan Li
- Janssen Research & Development, Spring House, PA, USA
| | - Jinhui Li
- Janssen Research & Development, San Diego, CA, USA
| | - Shibu Thomas
- Janssen Research & Development, Spring House, PA, USA
| | | | | | | | - Dana E Rathkopf
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY, USA
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Cheng Q, Chen J, Jia Q, Fang Z, Zhao G. Efficacy and safety of current medications for treating severe and non-severe COVID-19 patients: an updated network meta-analysis of randomized placebo-controlled trials. Aging (Albany NY) 2021; 13:21866-21902. [PMID: 34531332 PMCID: PMC8507270 DOI: 10.18632/aging.203522] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/31/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Many recent studies have investigated the role of drug interventions for coronavirus disease 2019 (COVID-19) infection. However, an important question has been raised about how to select the effective and secure medications for COVID-19 patients. The aim of this analysis was to assess the efficacy and safety of the various medications available for severe and non-severe COVID-19 patients based on randomized placebo-controlled trials (RPCTs). METHODS We did an updated network meta-analysis. We searched the databases from inception until July 31, 2021, with no language restrictions. We included RPCTs comparing 49 medications and placebo in the treatment of severe and non-severe patients (aged 18 years or older) with COVID-19 infection. We extracted data on the trial and patient characteristics, and the following primary outcomes: all-cause mortality, the ratios of virological cure, and treatment-emergent adverse events. Odds ratio (OR) and their 95% confidence interval (CI) were used as effect estimates. RESULTS From 3,869 publications, we included 61 articles related to 73 RPCTs (57 in non-severe COVID-19 patients and 16 in severe COVID-19 patients), comprising 20,680 patients. The mean sample size was 160 (interquartile range 96-393) in this study. The median duration of follow-up drugs intervention was 28 days (interquartile range 21-30). For increase in virological cure, we only found that proxalutamide (OR 9.16, 95% CI 3.15-18.30), ivermectin (OR 6.33, 95% CI 1.22-32.86), and low dosage bamlanivimab (OR 5.29, 95% CI 1.12-24.99) seemed to be associated with non-severe COVID-19 patients when compared with placebo, in which proxalutamide seemed to be better than low dosage bamlanivimab (OR 5.69, 95% CI 2.43-17.65). For decrease in all-cause mortality, we found that proxalutamide (OR 0.13, 95% CI 0.09-0.19), imatinib (OR 0.49, 95% CI 0.25-0.96), and baricitinib (OR 0.58, 95% CI 0.42-0.82) seemed to be associated with non-severe COVID-19 patients; however, we only found that immunoglobulin gamma (OR 0.27, 95% CI 0.08-0.89) was related to severe COVID-19 patients when compared with placebo. For change in treatment-emergent adverse events, we only found that sotrovimab (OR 0.21, 95% CI 0.13-0.34) was associated with non-severe COVID-19 patients; however, we did not find any medications that presented a statistical difference when compared with placebo among severe COVID-19 patients. CONCLUSION We conclude that marked variations exist in the efficacy and safety of medications between severe and non-severe patients with COVID-19. It seems that monoclonal antibodies (e.g., low dosage bamlanivimab, baricitinib, imatinib, and sotrovimab) are a better choice for treating severe or non-severe COVID-19 patients. Clinical decisions to use preferentially medications should carefully consider the risk-benefit profile based on efficacy and safety of all active interventions in patients with COVID-19 at different levels of infection.
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Affiliation(s)
- Qinglin Cheng
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China
- School of Medicine, Hangzhou Normal University, Hangzhou 310021, China
| | - Junfang Chen
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China
| | - Qingjun Jia
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China
| | - Zijian Fang
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China
| | - Gang Zhao
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China
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Graham LS, True LD, Gulati R, Schade GR, Wright J, Grivas P, Yezefski T, Nega K, Alexander K, Hou WM, Yu EY, Montgomery B, Mostaghel EA, Matsumoto AA, Marck B, Sharifi N, Ellis WJ, Reder NP, Lin DW, Nelson PS, Schweizer MT. Targeting backdoor androgen synthesis through AKR1C3 inhibition: A presurgical hormonal ablative neoadjuvant trial in high-risk localized prostate cancer. Prostate 2021; 81:418-426. [PMID: 33755225 PMCID: PMC8044035 DOI: 10.1002/pros.24118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/27/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Localized prostate cancers (PCs) may resist neoadjuvant androgen receptor (AR)-targeted therapies as a result of persistent intraprostatic androgens arising through upregulation of steroidogenic enzymes. Therefore, we sought to evaluate clinical effects of neoadjuvant indomethacin (Indo), which inhibits the steroidogenic enzyme AKR1C3, in addition to combinatorial anti-androgen blockade, in men with high-risk PC undergoing radical prostatectomy (RP). METHODS This was an open label, single-site, Phase II neoadjuvant trial in men with high to very-high-risk PC, as defined by NCCN criteria. Patients received 12 weeks of apalutamide (Apa), abiraterone acetate plus prednisone (AAP), degarelix, and Indo followed by RP. Primary objective was to determine the pathologic complete response (pCR) rate. Secondary objectives included minimal residual disease (MRD) rate, defined as residual cancer burden (RCB) ≤ 0.25cm3 (tumor volume multiplied by tumor cellularity) and elucidation of molecular features of resistance. RESULTS Twenty patients were evaluable for the primary endpoint. Baseline median prostate-specific antigen (PSA) was 10.1 ng/ml, 4 (20%) patients had Gleason grade group (GG) 4 disease and 16 had GG 5 disease. At RP, 1 (5%) patient had pCR and 6 (30%) had MRD. Therapy was well tolerated. Over a median follow-up of 23.8 months, 1 of 7 (14%) men with pathologic response and 6 of 13 (46%) men without pathologic response had a PSA relapse. There was no association between prostate hormone levels or HSD3B1 genotype with pathologic response. CONCLUSIONS In men with high-risk PC, pCR rates remained low even with combinatorial AR-directed therapy, although rates of MRD were higher. Ongoing follow-up is needed to validate clinical outcomes of men who achieve MRD.
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Affiliation(s)
- Laura S Graham
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Lawrence D True
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Roman Gulati
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - George R Schade
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Jonathan Wright
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Todd Yezefski
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Katie Nega
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Katerina Alexander
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Wen-Min Hou
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Evan Y Yu
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Bruce Montgomery
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Geriatric Research Education and Clinical Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Elahe A Mostaghel
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Geriatric Research Education and Clinical Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Alvin A Matsumoto
- Geriatric Research Education and Clinical Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Brett Marck
- Geriatric Research Education and Clinical Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Nima Sharifi
- Genitourinary Malignancies Research Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Nicholas P Reder
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Peter S Nelson
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Michael T Schweizer
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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González Del Alba A, Méndez-Vidal MJ, Vazquez S, Castro E, Climent MA, Gallardo E, Gonzalez-Billalabeitia E, Lorente D, Maroto JP, Arranz JA. SEOM clinical guidelines for the treatment of advanced prostate cancer (2020). Clin Transl Oncol 2021; 23:969-979. [PMID: 33625671 PMCID: PMC8057980 DOI: 10.1007/s12094-021-02561-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/24/2022]
Abstract
The treatment of advanced prostate cancer has evolved due to recent advances in molecular research and new drug development. Dynamic aberrations in the androgen receptor, DNA repair genes, PTEN-PI3K, and other pathways drive the behavior of advanced prostate cancer allowing a better selection of therapies in each patient. Tumor testing for BRCA1 and BRCA2 is recommended for patients with metastatic prostate cancer, also considering a broad panel to guide decisions and genetic counseling. In symptomatic metastatic patients, castration should be stared to palliate symptoms and prolong survival. In high-risk or high-volume metastatic hormone-naïve patients, castration should be combined with docetaxel, abiraterone, enzalutamide or apalutamide. Radiotherapy to the primary tumor combined with systemic therapy is recommended in low-volume mHNPC patients. In patients with non-metastatic castration-resistant tumors, risk stratification can define the frequency of imaging. Adding enzalutamide, darolutamide or apalutamide to these patients prolongs metastasis-free and overall survival, but potential adverse events need to be taken into consideration. The choice of docetaxel, abiraterone or enzalutamide for treating metastatic castration-resistant patients depends on previous therapies, with cabazitaxel being also recommended after docetaxel. Olaparib is recommended in BRCA1/BRCA2 mutated castration-resistant patients after progression on at least one new hormonal therapy. Aggressive variants of prostate cancer respond to platinum-based chemotherapy. To optimize treatment efficiency, oncologists should incorporate all of these advances into an overall therapeutic strategy.
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Affiliation(s)
- A González Del Alba
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Joaquin Rodrigo 2, Majadahonda, 28222, Madrid, Spain.
| | - M J Méndez-Vidal
- Medical Oncology Department, Hospital Universitario Reina Sofía, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain
| | - S Vazquez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - E Castro
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria y Regional de Mälaga, Málaga, Spain
| | - M A Climent
- Medical Oncology Department, Fundación Instituto Valenciano de Oncología, València, Spain
| | - E Gallardo
- Medical Oncology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - E Gonzalez-Billalabeitia
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Instituto Imas12, Madrid, Spain
- Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
| | - D Lorente
- Medical Oncology Department, Hospital Provincial de Castellón, Castellon, Spain
| | - J P Maroto
- Medical Oncology Department, Hospital Universitari Santa Creu i San Pau, Barcelona, Spain
| | - J A Arranz
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Sekino Y, Han X, Babasaki T, Miyamoto S, Kobatake K, Kitano H, Ikeda K, Goto K, Inoue S, Hayashi T, Teishima J, Shiota M, Takeshima Y, Yasui W, Matsubara A. TUBB3 is associated with PTEN, neuroendocrine differentiation, and castration resistance in prostate cancer. Urol Oncol 2021; 39:368.e1-368.e9. [PMID: 33771409 DOI: 10.1016/j.urolonc.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/20/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tubulin-β3 encoded by the Tubulin-β3 (TUBB3) gene is a microtubule protein. Previous studies have shown that TUBB3 expression is upregulated in castration-resistant prostate cancer (CaP) and is involved in taxane resistance. However, the biological mechanism of TUBB3 involvement in the progression to castration-resistant CaP is not fully elucidated. This study aimed to analyze the expression and function of TUBB3 in localized and metastatic CaP. METHODS TUBB3 expression was determined using immunohistochemistry in localized and metastatic CaP. We also investigated the association between TUBB3, phosphatase and tensin homolog (PTEN), and neuroendocrine differentiation and examined the involvement of TUBB3 in new antiandrogen drugs (enzalutamide and apalutamide) resistance in metastatic CaP. RESULTS In 155 cases of localized CaP, immunohistochemistry showed that 5 (3.2%) of the CaP cases were positive for tubulin-β3. Kaplan-Meier analysis showed that high expression of tubulin-β3 was associated with poor prostate-specific antigen recurrence-free survival after radical prostatectomy. In 57 cases of metastatic CaP, immunohistochemistry showed that 14 (25%) cases were positive for tubulin-β3. Tubulin-β3 expression was higher in metastatic CaP than in localized CaP. High tubulin-β3 expression was correlated with negative PTEN expression. TUBB3 expression was increased in neuroendocrine CaP based on several public databases. PTEN knockout decreased the sensitivity to enzalutamide and apalutamide in 22Rv-1 cells. TUBB3 knockdown reversed the sensitivity to enzalutamide and apalutamide in PTEN-CRISPR 22Rv-1 cells. High expression of tubulin-β3 and negative expression of PTEN were significantly associated with poor overall survival in metastatic CaP treated with androgen deprivation therapy. CONCLUSIONS These results suggest that TUBB3 may be a useful predictive biomarker for survival and play an essential role in antiandrogen resistance in CaP.
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Affiliation(s)
- Yohei Sekino
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Xiangrui Han
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takashi Babasaki
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunsuke Miyamoto
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kohei Kobatake
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Kitano
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenichiro Ikeda
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Goto
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Inoue
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Wataru Yasui
- Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Urology, Hiroshima General Hospital, Hatsukaichi, Japan
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10
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Myint ZW, Momo HD, Otto DE, Yan D, Wang P, Kolesar JM. Evaluation of Fall and Fracture Risk Among Men With Prostate Cancer Treated With Androgen Receptor Inhibitors: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2025826. [PMID: 33201234 PMCID: PMC7672516 DOI: 10.1001/jamanetworkopen.2020.25826] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/19/2020] [Indexed: 01/31/2023] Open
Abstract
Importance A high incidence of fall and fracture in a subset of patients treated with androgen receptor inhibitors (ARIs) has been reported, although the relative risk (RR) of fall and fracture for patients who receive ARI treatment is unknown. Objective To evaluate whether treatment with ARIs is associated with an elevated relative risk for fall and fracture in patients with prostate cancer. Data Sources Cochrane, Scopus, and MedlinePlus databases were searched from inception through August 2019. Study Selection Randomized clinical trials comparing patients with prostate cancer treated with any ARI or placebo were included. Data Extraction and Synthesis Two independent reviewers used a standardized data extraction and quality assessment form. A mixed effects model was used to estimate the effects of ARI on relative risk, with included studies treated as random effects and study groups treated as fixed effects in the pooled analysis. Sample size for each study was used to weight the mixed model. Statistical analysis was performed from August to October 2019. Main Outcomes and Measures The primary outcome was RR of fall and fractures for patients receiving ARI treatment. Results Eleven studies met this study's inclusion criteria. The total population was 11 382 men (median [range] age: 72 [43-97] years), with 6536 in the ARI group and 4846 in the control group. Participants in the ARI group could have received enzalutamide, apalutamide, or darolutamide in combination with androgen deprivation therapy or other enzalutamide combinations; patients in the control group could have received placebo, bicalutamide, or abiraterone. The reported incidence of fall was 525 falls (8%) in the ARI group and 221 falls (5%) in the control group. The incidence of fracture was 242 fractures (4%) in the ARI group and 107 fractures (2%) in the control group. Use of an ARI was associated with an increased risk of falls and fractures: all-grade falls (RR, 1.8; 95% CI, 1.42-2.24; P < .001); grade 3 or greater fall (RR, 1.6; 95% CI, 1.27-2.08; P < .001); all-grade fracture (RR, 1.59; 95% CI, 1.35-1.89; P < .001), and likely grade 3 or greater fracture (RR, 1.71; 95% CI, 1.12-2.63; P = .01). Conclusions and Relevance Use of ARI was associated with an increase in falls and fractures in patients with prostate cancer as assessed by a retrospective systematic review and meta-analysis. Further studies are warranted to identify and understand potential mechanisms and develop strategies to decrease falls and fractures associated with ARI use.
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Affiliation(s)
- Zin W. Myint
- Division of Medical Oncology, Department of Internal Medicine, University of Kentucky, Lexington
- Markey Cancer Center, University of Kentucky, Lexington
| | - Harry D. Momo
- Markey Cancer Center, University of Kentucky, Lexington
| | - Danielle E. Otto
- Markey Cancer Center, University of Kentucky, Lexington
- University of Kentucky College of Pharmacy, Lexington
| | - Donglin Yan
- Markey Cancer Center, University of Kentucky, Lexington
| | - Peng Wang
- Division of Medical Oncology, Department of Internal Medicine, University of Kentucky, Lexington
- Markey Cancer Center, University of Kentucky, Lexington
| | - Jill M. Kolesar
- Markey Cancer Center, University of Kentucky, Lexington
- University of Kentucky College of Pharmacy, Lexington
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11
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Swami U, Agarwal N. Improvement in overall survival with Apalutamide, Darolutamide and Enzalutamide in patients with non-metastatic castration-resistant prostate cancer. Cancer Treat Res Commun 2020; 25:100205. [PMID: 32822968 DOI: 10.1016/j.ctarc.2020.100205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/25/2020] [Accepted: 08/10/2020] [Indexed: 06/11/2023]
Abstract
Since 2018, apalutamide, darolutamide, and enzalutamide have been approved for the treatment of men with non-metastatic castration-resistant prostate cancer (M0CRPC). These approvals were based on the results of three separate randomized, placebo-controlled, phase III trials: SPARTAN (apalutamide), ARAMIS (darolutamide) and PROSPER (enzalutamide). These trials included men with M0CRPC and a short PSA doubling time (≤10 months). Results demonstrated a longer metastasis-free survival with these agents when used in conjunction with androgen deprivation therapy (ADT), compared to ADT alone. Updated results of these trials presented in the 2020 annual meeting of American Society of Oncology (ASCO) showed significantly improved overall survival with these agents. Based on these results, apalutamide, darolutamide, and enzalutamide can now be considered the standard of care treatment options for the treatment of men with M0CRPC.
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Affiliation(s)
- Umang Swami
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Neeraj Agarwal
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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12
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Dirix P, Strijbos M, den Mooter TV, Liefhooghe N, Bruwaene SV, Uvin P, Ghysel C, Ost D, Schatteman P, Bral S, Engels B, den Begin RV, Otte FX, Roumeguere T, Palumbo S, Neybuch Y, Fonteyne V, Ost P, Dirix L. Phase II open-label study investigating apalutamide in patients with biochemical progression after radical prostatectomy. Future Oncol 2020; 16:1083-1189. [PMID: 32356465 DOI: 10.2217/fon-2020-0056] [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] [Indexed: 11/21/2022] Open
Abstract
Apalutamide, a competent inhibitor of the androgen receptor, has shown promising clinical efficacy results for patients with advanced prostate cancer. Here, we describe the rationale and design for the SAVE trial, a multi-center, Phase II study, wherein 202 men with biochemical progression after radical prostatectomy are randomly assigned 1:1 to apalutamide plus salvage radiotherapy (SRT) or androgen-deprivation therapy with an luteinizing hormone-releasing hormone agonist or antagonist plus SRT. The primary objective is to compare sexual function between the two treatment arms based on the expanded prostate cancer index-26 sexual domain score at nine months after start of hormonal treatment. The key secondary objectives are to assess quality of life, to evaluate the safety profile and the short-term efficacy of apalutamide in combination with SRT. ClinicalTrials.gov identifier: NCT03899077.
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Affiliation(s)
- Piet Dirix
- Department of Radiation Oncology, Iridium Kankernetwerk, Antwerp, Belgium
| | - Michiel Strijbos
- Department of Medical Oncology, GZA Sint-Augustinus Hospital, Antwerp, Belgium
| | - Tom Van den Mooter
- Department of Medical Oncology, GZA Sint-Augustinus Hospital, Antwerp, Belgium
| | - Nick Liefhooghe
- Department of Radiation Oncology, AZ Groeninge, Kortrijk, Belgium
| | | | - Pieter Uvin
- Department of Urology, AZ Sint-Jan, Bruges, Belgium
| | | | - Dieter Ost
- Department of Urology, AZ Sint-Blasius, Dendermonde, Belgium
| | | | - Samuel Bral
- Department of Radiation Oncology, OLV, Aalst, Belgium
| | - Benedikt Engels
- Department of Radiation Oncology, UZ Brussel, Brussels, Belgium
| | | | | | | | - Samuel Palumbo
- Department of Radiation Oncology, Hôpital Sainte Elisabeth, Namur, Belgium
| | - Yannick Neybuch
- Department of Radiation Oncology, Hôpital Jolimont, La Louvière, Belgium
| | | | - Piet Ost
- Department of Radiation Oncology, UZ Gent, Ghent, Belgium
| | - Luc Dirix
- Department of Medical Oncology, GZA Sint-Augustinus Hospital, Antwerp, Belgium
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13
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Mori K, Mostafaei H, Pradere B, Motlagh RS, Quhal F, Laukhtina E, Schuettfort VM, Abufaraj M, Karakiewicz PI, Kimura T, Egawa S, Shariat SF. Apalutamide, enzalutamide, and darolutamide for non-metastatic castration-resistant prostate cancer: a systematic review and network meta-analysis. Int J Clin Oncol 2020; 25:1892-1900. [PMID: 32924096 PMCID: PMC7572325 DOI: 10.1007/s10147-020-01777-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/16/2020] [Indexed: 12/11/2022]
Abstract
Management of non-metastatic castration-resistant prostate cancer (nmCRPC) has undergone a paradigm shift with next-generation androgen receptor inhibitors. However, direct comparative data are not available to inform treatment decisions and/or guideline recommendations. Therefore, we performed network meta-analysis to indirectly compare the efficacy and safety of currently available treatments. Multiple databases were searched for articles published before June 2020. Studies that compared overall and/or metastasis-free and/or prostate-specific antigen (PSA) progression-free survival (OS/MFS/PSA-PFS) and/or adverse events (AEs) in nmCRPC patients were considered eligible. Three studies (n = 4117) met our eligibility criteria. Formal network meta-analyses were conducted. For MFS, apalutamide, darolutamide, and enzalutamide were significantly more effective than placebo, and apalutamide emerged as the best option (P score: 0.8809). Apalutamide [hazard ratio (HR): 0.85, 95% credible interval (CrI): 0.77-0.94] and enzalutamide (HR: 0.86, 95% CrI: 0.78-0.95) were both significantly more effective than darolutamide. For PSA-PFS, all three agents were statistically superior to placebo, and apalutamide emerged as the likely preferred option (P score: 1.000). Apalutamide (HR: 0.71, 95% CrI: 0.69-0.74) and enzalutamide (HR: 0.76, 95% CrI: 0.74-0.79) were both significantly more effective than darolutamide. For AEs (including all AEs, grade 3 or grade 4 AEs, grade 5 AEs, and discontinuation rates), darolutamide was the likely best option. Apalutamide and enzalutamide appear to be more efficacious agents for therapy of nmCRPC, while darolutamide appears to have the most favorable tolerability profile. These findings may facilitate individualized treatment strategies and inform future direct comparative trials.
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Affiliation(s)
- Keiichiro Mori
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hadi Mostafaei
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Deaprtment of Urology, PRES Centre Val de Loire, CHRU Tours, France, Université François Rabelais de Tours, Tours, France
| | - Reza Sari Motlagh
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Fahad Quhal
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ekaterina Laukhtina
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Victor M Schuettfort
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
- Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan.
- Department of Urology, Weill Cornell Medical College, New York, NY, USA.
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
- European Association of Urology Research Foundation, Arnhem, Netherlands.
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14
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Chowdhury S, Oudard S, Uemura H, Joniau S, Pilon D, Lefebvre P, McQuarrie K, Liu J, Dearden L, Sermon J, Van Sanden S, Diels J, Hadaschik BA. Matching-Adjusted Indirect Comparison of Health-Related Quality of Life and Adverse Events of Apalutamide Versus Enzalutamide in Non-Metastatic Castration-Resistant Prostate Cancer. Adv Ther 2020; 37:512-526. [PMID: 31813087 DOI: 10.1007/s12325-019-01157-4] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The present study aimed to indirectly compare apalutamide and enzalutamide with respect to tolerability and health-related quality of life (HRQoL) among men with non-metastatic castration-resistant prostate cancer (nmCRPC). METHODS Patient-level data from the SPARTAN study [apalutamide + androgen deprivation therapy (ADT) versus placebo + ADT] and aggregate published data from the PROSPER study (enzalutamide + ADT versus placebo + ADT) were used. Anchored matching-adjusted indirect comparison (MAIC) was conducted by weighting patients' baseline characteristics from SPARTAN to match aggregated baseline characteristics in PROSPER. Odds ratios (ORs) of reported adverse events (AEs) and baseline-to-follow-up least squares mean differences in HRQoL [measured with Functional Assessment of Cancer Therapy-Prostate (FACT-P) score] with 95% credible intervals were re-estimated for SPARTAN arms using weighted population and indirectly compared with those in PROSPER through a Bayesian framework. Events of special interest included fatigue, hot flush, nausea, diarrhea, hypertension, falls, dizziness, decreased appetite, arthralgia, asthenia and headache. In addition, any AEs and serious AEs were explored. RESULTS Of 1207 SPARTAN patients, 1171 were matched to 1401 PROSPER patients. Relative to enzalutamide, apalutamide demonstrated better tolerability as evidenced by the highest probability of reduced occurrence of fatigue [p(OR < 1) = 99.5%], hypertension [p(OR < 1) = 99.2%], decreased appetite [p(OR < 1) = 98.3%], fall [p(OR < 1) = 90.3%], headaches [p(OR < 1) = 86.7%], and nausea [p(OR < 1) = 80.0%]. The probabilities of reduced occurrence of any AEs and SAEs with apalutamide versus enzalutamide were 66.9% and 90.9%, respectively. Relative to enzalutamide, apalutamide treatment was associated with a higher probability of a better HRQoL based on the FACT-P total score [p(diff > 0) = 73.1%]. The probability of a better HRQoL with apalutamide versus enzalutamide was highest for the physical [p(diff > 0) = 97.3%] and functional [p(diff > 0) = 86.7%] wellbeing subscales, and the pain-related subscale [p(diff > 0) = 90.1%]. CONCLUSION Anchored MAIC suggests that treatment of men with nmCRPC with apalutamide is associated with a higher probability of better tolerability due to fewer AEs and better HRQoL than enzalutamide.
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Affiliation(s)
- Simon Chowdhury
- Department of Medical Oncology, Guy's, King's, and St. Thomas' Hospital, London, UK.
| | - Stéphane Oudard
- European Georges Pompidou Hospital, Paris Descartes University, Paris, France
| | - Hiroji Uemura
- Yokohama City University Medical Center, Yokohama, Japan
| | | | | | | | | | - Jinan Liu
- Janssen Research & Development, Horsham, PA, USA
| | | | | | | | | | - Boris A Hadaschik
- University of Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
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15
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Thomas C. [Apalutamide for metastatic, castration-sensitive prostate cancer]. Urologe A 2019; 58:1496-1497. [PMID: 31712857 DOI: 10.1007/s00120-019-01071-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C Thomas
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus Dresden, Technischen Universität Dresden, Dresden, Deutschland.
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Abstract
Prostate cancer (PC) is a major health issue in developed countries, with, on the one hand, men suffering from sequelae related to unnecessary treatment of non-lethal PC, and, on the other hand, still dying because of advanced PC that progresses to castration-resistant disease. Systemic treatment is the mainstay of therapy of castration-resistant PC (CRPC). To date, a multitude of systemic agents have been tested and many of these have failed to provide a clinically meaningful benefit in CRPC, while others have been approved by the US Food and Drug Administration and/or the European Medicines Agency, including antiandrogen hormonal drugs (abiraterone, enzalutamide, apalutamide), chemotherapy (docetaxel and cabazitaxel), immunotherapy (Sipuleucel-T), and radiopharmaceutical (Radium-223) agents. In this review, systemic treatments regarded as most likely to have an impact in clinical practice are presented and discussed. In addition to the pivotal clinical studies, selected retrospective and non-randomized clinical trials are also discussed if deemed to have an impact on clinical practice or future research. A comprehensive appraisal of the expanding landscape of systemic therapies for advanced PC is provided from an expert perspective, with a focus on novel classification and diagnostic tools that have been paving the way for the development of precision medicine in PC.
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Affiliation(s)
- Martina Pagliuca
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Carlo Buonerba
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
- Experimental Zoo-prophylactic Institute of Southern Italy, Portici, Italy
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Giuseppe Di Lorenzo
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy.
- Department of Medicine, Università degli Studi del Molise, Campobasso, Italy.
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17
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Ghashghaei M, Kucharczyk M, Elakshar S, Muanza T, Niazi T. Combining prostate cancer radiotherapy with therapies targeting the androgen receptor axis. Curr Oncol 2019; 26:e640-e650. [PMID: 31708657 PMCID: PMC6821115 DOI: 10.3747/co.26.5005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 01/22/2023] Open
Abstract
Background Prostate cancer (pca) is the most common non-dermatologic cancer and the 3rd leading cause of male cancer mortality in Canada. In patients with high-risk localized or recurrent pca, management typically includes the combination of long-term androgen deprivation therapy (adt) and radiotherapy (rt). New androgen-receptor-axis targeted therapies (arats), which await validation, offer an option to intensify therapy. Methods In this narrative review, we report the relevant history that has supported combining adt with rt. The literature in PubMed was searched for studies involving pca and novel arats (abiraterone acetate, enzalutamide, apalutamide, darolutamide) published between 1995 and 2019. Literature discussing clinical trials in which those modalities were combined was extracted and synthesized into a combined molecular and clinical discussion. Potential treatment intensification mechanisms and rationales are explored. Results Early results from three phase i/ii trials demonstrated that concurrent abiraterone acetate, adt, and rt is safe, improves the extent of chemical castration, and is associated with limited treatment failures. A single in vitro study implies synergy for radiosensitization beyond that facilitated by conventional adt. Studies investigating the combination of other arats with rt are under way, including multiple phase iii trials, but short-term results are not yet available.
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Affiliation(s)
- M Ghashghaei
- Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
- Division of Experimental Medicine, McGill University, Montreal, QC
| | - M Kucharczyk
- Department of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - S Elakshar
- Department of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - T Muanza
- Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
- Division of Experimental Medicine, McGill University, Montreal, QC
- Department of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - T Niazi
- Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
- Department of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
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18
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Abstract
Novel androgen deprivation agents delay metastasis in non-metastatic, castration-resistant, prostate cancer (nmCRPC). The recent regulatory guidance: considerations for metastasis-free survival endpoint in clinical trials, opens new opportunities in cell biology, medicinal chemistry and advanced imaging. Past failures are the likely result of equating tumour shrinkage to efficacy, rather than inhibition of tumour spread. In the future, the selection of anti-metastasis drug candidates will probably be based on anti-migratory rather than anti-proliferative potential. Oligometastatic cancer coupled with advanced imaging can serve as a clinical proof-of-concept model.
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Affiliation(s)
| | - Daniel Rosel
- Department of Cell Biology, Faculty of Science and BIOCEV, Charles University, Prague, Czech Republic
| | - Jan Brábek
- Department of Cell Biology, Faculty of Science and BIOCEV, Charles University, Prague, Czech Republic.
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19
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Nieto-Gómez P, Ubago-Pérez R, Cabeza-Barrera J. Efficacy of enzalutamide and apalutamide in the treatment of non-metastasic castration-resistant prostate cancer: Indirect comparison. Actas Urol Esp 2019; 43:355-363. [PMID: 31133348 DOI: 10.1016/j.acuro.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/22/2019] [Accepted: 03/19/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To perform an adjusted indirect comparison of the efficacy of enzalutamide and apalutamide in patients with non-metastatic castration-resistant prostate cancer (nmCRPC) with a high risk of progression to metastatic disease. MATERIAL AND METHODS After carrying out a literature search, we performed an adjusted indirect comparison (Bucher et al.) of the relative efficacy of enzalutamide and apalutamide in patients with nmCRPC with a high risk of progression to metastatic disease. The outcomes included were metastasis-free survival (MFS) and PSA response rate (PSARR). RESULTS There were no statistically significant differences between enzalutamide and apalutamide regarding the analysed outcomes. For the comparison enzalutamide+ADT vs. apalutamide+ADT: MFS a HR (95% CI)=1,036 (0.781-1.373) was obtained. For PSARR, a RR (95% CI)=0.81 (0.339-1.938) was obtained. CONCLUSIONS The adjusted indirect comparison performed in this study shows that there are no statistically significant differences in terms of efficacy regarding MFS and PSARR between enzalutamide+ADT and apalutamide+ADT in patients with nmCRPC with a high risk of progression to metastatic disease. However, in order to confirm these results, an independent trial with direct comparison between both drugs would be required.
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Affiliation(s)
- P Nieto-Gómez
- Unidad de Gestión Clínica de Farmacia Hospitalaria, Hospital Universitario San Cecilio, Granada, España.
| | - R Ubago-Pérez
- Unidad de Gestión Clínica de Farmacia Hospitalaria, Hospital Universitario San Cecilio, Granada, España
| | - J Cabeza-Barrera
- Unidad de Gestión Clínica de Farmacia Hospitalaria, Hospital Universitario San Cecilio, Granada, España
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Chi KN, Agarwal N, Bjartell A, Chung BH, Pereira de Santana Gomes AJ, Given R, Juárez Soto Á, Merseburger AS, Özgüroğlu M, Uemura H, Ye D, Deprince K, Naini V, Li J, Cheng S, Yu MK, Zhang K, Larsen JS, McCarthy S, Chowdhury S. Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med 2019; 381:13-24. [PMID: 31150574 DOI: 10.1056/nejmoa1903307] [Citation(s) in RCA: 738] [Impact Index Per Article: 147.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Apalutamide is an inhibitor of the ligand-binding domain of the androgen receptor. Whether the addition of apalutamide to androgen-deprivation therapy (ADT) would prolong radiographic progression-free survival and overall survival as compared with placebo plus ADT among patients with metastatic, castration-sensitive prostate cancer has not been determined. METHODS In this double-blind, phase 3 trial, we randomly assigned patients with metastatic, castration-sensitive prostate cancer to receive apalutamide (240 mg per day) or placebo, added to ADT. Previous treatment for localized disease and previous docetaxel therapy were allowed. The primary end points were radiographic progression-free survival and overall survival. RESULTS A total of 525 patients were assigned to receive apalutamide plus ADT and 527 to receive placebo plus ADT. The median age was 68 years. A total of 16.4% of the patients had undergone prostatectomy or received radiotherapy for localized disease, and 10.7% had received previous docetaxel therapy; 62.7% had high-volume disease, and 37.3% had low-volume disease. At the first interim analysis, with a median of 22.7 months of follow-up, the percentage of patients with radiographic progression-free survival at 24 months was 68.2% in the apalutamide group and 47.5% in the placebo group (hazard ratio for radiographic progression or death, 0.48; 95% confidence interval [CI], 0.39 to 0.60; P<0.001). Overall survival at 24 months was also greater with apalutamide than with placebo (82.4% in the apalutamide group vs. 73.5% in the placebo group; hazard ratio for death, 0.67; 95% CI, 0.51 to 0.89; P = 0.005). The frequency of grade 3 or 4 adverse events was 42.2% in the apalutamide group and 40.8% in the placebo group; rash was more common in the apalutamide group. CONCLUSIONS In this trial involving patients with metastatic, castration-sensitive prostate cancer, overall survival and radiographic progression-free survival were significantly longer with the addition of apalutamide to ADT than with placebo plus ADT, and the side-effect profile did not differ substantially between the two groups. (Funded by Janssen Research and Development; TITAN ClinicalTrials.gov number, NCT02489318.).
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Affiliation(s)
- Kim N Chi
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Neeraj Agarwal
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Anders Bjartell
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Byung Ha Chung
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Andrea J Pereira de Santana Gomes
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Robert Given
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Álvaro Juárez Soto
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Axel S Merseburger
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Mustafa Özgüroğlu
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Hirotsugu Uemura
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Dingwei Ye
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Kris Deprince
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Vahid Naini
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Jinhui Li
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Shinta Cheng
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Margaret K Yu
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Ke Zhang
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Julie S Larsen
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Sharon McCarthy
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
| | - Simon Chowdhury
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz, Spain (A.J.S.); University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (A.S.M.); Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey (M.O.); Kindai University Hospital Faculty of Medicine, Osaka, Japan (H.U.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Janssen Research and Development, Beerse, Belgium (K.D.); Janssen Research and Development, San Diego (V.N., J.L., K.Z.), and Janssen Research and Development, Los Angeles (M.K.Y., J.S.L.) - both in California; Janssen Research and Development, Raritan, NJ (S. Cheng, S.M.); and Guy's, King's, and St. Thomas' Hospitals and the Sarah Cannon Research Institute, London (S. Chowdhury)
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21
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Moul JW. How I do it: Apalutamide use in non-metastatic castrate resistant prostate cancer. Can J Urol 2019; 26:9782-9786. [PMID: 31180310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Urologists have been using oral nonsteroidal antiandrogens (AA) for 30 years as a component of combined androgen blockade. In February 2018, a new third generation AA, apalutamide, became available for the first time for non-metastatic (M0) castrate resistant prostate cancer (CRPC). Apalutamide was found to delay the presence of metastases (metastases free survival-MFS) by approximately 2 years versus placebo in M0 CRPC. While overall survival benefit has yet to be established, the MFS benefit is clinically meaningful and urology practices should be equipped to manage patients using this new oral agent. Since the majority of patients remain under urologic care when this disease stage develops and because the drug is straightforward to administer, urology practices are ideal to identify and treat. The objective of this brief article is to discuss the typical patient profile for use of apalutamide and to review the pros and cons of use and common side effects and management.
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Affiliation(s)
- Judd W Moul
- Division of Urology, Department of Surgery and Duke Cancer Institute, Durham, North Carolina, USA
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22
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Werutsky G, Maluf FC, Cronemberger EH, Carrera Souza V, dos Santos Martins SP, Peixoto F, Smaletz O, Schutz F, Herchenhorn D, Santos T, Mavignier Carcano F, Queiroz Muniz D, Nunes Filho PRS, Zaffaroni F, Barrios C, Fay A. The LACOG-0415 phase II trial: abiraterone acetate and ADT versus apalutamide versus abiraterone acetate and apalutamide in patients with advanced prostate cancer with non-castration testosterone levels. BMC Cancer 2019; 19:487. [PMID: 31122212 PMCID: PMC6533731 DOI: 10.1186/s12885-019-5709-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 05/14/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Testosterone suppression is the standard treatment for advanced prostate cancer, and it is associated with side-effects that impair patients' quality of life, like sexual dysfunction, osteoporosis, weight gain, and increased cardiovascular risk. We hypothesized that abiraterone acetate with prednisone (AAP) and apalutamide, alone or in combination, can be an effective hormonal therapy also possibly decreasing castration-associated side effects. METHODS Phase II, open-label, randomized, efficacy trial of abiraterone acetate plus prednisone (AAP) and Androgen Deprivation Therapy (ADT) versus apalutamide versus the combination of AAP (without ADT) and apalutamide. Key eligibility criteria are confirmed prostate adenocarcinoma; biochemical relapse after definitive treatment (PSA ≥ 4 ng/ml and doubling time less than 10 months, or PSA ≥ 20 ng/ml); newly diagnosed locally advanced or metastatic prostate cancer; asymptomatic to moderately symptomatic regarding bone symptoms. Patients with other histology besides adenocarcinoma or previous use of hormonal therapy or chemotherapy were excluded. DISCUSSION There is an urgent need to study and validate regimens such as new hormonal agents that may add benefit to castration with an acceptable safety profile. We aim to evaluate if apalutamide in monotherapy or in combination with AAP is an effective and safety hormonal treatment that can spare patients of androgen deprivation therapy. TRIAL REGISTRATION This trial was registered in ClinicalTrials.gov on October 16, 2017, under Identifier: NCT02867020.
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Affiliation(s)
- Gustavo Werutsky
- Latin American Cooperative Oncology Group, Ipiranga Avenue 6681, 99A, Room, Porto Alegre, 806 Brazil
| | | | | | | | | | - Fábio Peixoto
- Americas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - Oren Smaletz
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Fábio Schutz
- Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Paulo R. S. Nunes Filho
- Latin American Cooperative Oncology Group, Ipiranga Avenue 6681, 99A, Room, Porto Alegre, 806 Brazil
| | - Facundo Zaffaroni
- Latin American Cooperative Oncology Group, Ipiranga Avenue 6681, 99A, Room, Porto Alegre, 806 Brazil
| | - Carlos Barrios
- Latin American Cooperative Oncology Group, Ipiranga Avenue 6681, 99A, Room, Porto Alegre, 806 Brazil
| | - André Fay
- PUCRS School of Medicine, Porto Alegre, Brazil
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23
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Parikh NR, Huiza C, Patel JS, Tsai S, Kalpage N, Thein M, Pitcher S, Lee SP, Inouye WS, Jordan ML, Sanati H, Jafari L, Bennett CJ, Gin GE, Kishan AU, Reiter RE, Lewis M, Sadeghi A, Aronson WJ, Garraway IP, Rettig MB, Nickols NG. Systemic and tumor-directed therapy for oligometastatic prostate cancer: study protocol for a phase II trial for veterans with de novo oligometastatic disease. BMC Cancer 2019; 19:291. [PMID: 30935383 PMCID: PMC6444674 DOI: 10.1186/s12885-019-5496-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/20/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The treatment paradigm for metastatic hormone-sensitive prostate cancer (mHSPC) patients is evolving. PET/CT now offers improved sensitivity and accuracy in staging. Recent randomized trial data supports escalated hormone therapy, local primary tumor therapy, and metastasis-directed therapy. The impact of combining such therapies into a multimodal approach is unknown. This Phase II single-arm clinical trial sponsored and funded by Veterans Affairs combines local, metastasis-directed, and systemic therapies to durably render patients free of detectable disease off active therapy. METHODS Patients with newly-diagnosed M1a/b prostate cancer (PSMA PET/CT staging is permitted) and 1-5 radiographically visible metastases (excluding pelvic lymph nodes) are undergoing local treatment with radical prostatectomy, limited duration systemic therapy for a total of six months (leuprolide, abiraterone acetate with prednisone, and apalutamide), metastasis-directed stereotactic body radiotherapy (SBRT), and post-operative fractionated radiotherapy if pT ≥ 3a, N1, or positive margins are present. The primary endpoint is the percent of patients achieving a serum PSA of < 0.05 ng/mL six months after recovery of serum testosterone ≥150 ng/dL. Secondary endpoints include time to biochemical progression, time to radiographic progression, time to initiation of alternative antineoplastic therapy, prostate cancer specific survival, health related quality-of-life, safety and tolerability. DISCUSSION To our knowledge, this is the first trial that tests a comprehensive systemic and tumor directed therapeutic strategy for patients with newly diagnosed oligometastatic prostate cancer. This trial, and others like it, represent the critical first step towards curative intent therapy for a patient population where palliation has been the norm. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03298087 (registration date: September 29, 2017).
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Affiliation(s)
- Neil R. Parikh
- Department of Radiation Oncology, UCLA, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095-6951 USA
| | - Claudia Huiza
- Department of Radiation Oncology, UCLA, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095-6951 USA
- VA Greater Los Angeles Healthcare System, Internal Medicine Service, Hematology/Oncology Section, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
| | - Jill S. Patel
- Department of Urology, UCLA, 27-139 Center for Health Sciences, Los Angeles, CA 90095 USA
| | - Sonny Tsai
- VA Greater Los Angeles Healthcare System, Internal Medicine Service, Hematology/Oncology Section, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
| | - Nathisha Kalpage
- VA Greater Los Angeles Healthcare System, Internal Medicine Service, Hematology/Oncology Section, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
- Department of Urology, UCLA, 27-139 Center for Health Sciences, Los Angeles, CA 90095 USA
| | - May Thein
- VA Long Beach Healthcare System, Radiation Oncology Service, 5901 East 7th Street, Long Beach, CA 90822 USA
| | - Sage Pitcher
- Department of Urology, UCLA, 27-139 Center for Health Sciences, Los Angeles, CA 90095 USA
| | - Steve P. Lee
- VA Long Beach Healthcare System, Radiation Oncology Service, 5901 East 7th Street, Long Beach, CA 90822 USA
- Department of Radiation Oncology, UCI, 101 The City Drive, Bldg. 23, Orange, CA 92868-3298 USA
| | - Warren S. Inouye
- VA Long Beach Healthcare System, Radiation Oncology Service, 5901 East 7th Street, Long Beach, CA 90822 USA
- Department of Radiation Oncology, UCI, 101 The City Drive, Bldg. 23, Orange, CA 92868-3298 USA
| | - Mark L. Jordan
- Department of Urology, UCI, 333 City Blvd W #2100, Orange, CA 92868 USA
- VA Long Beach Healthcare System, Urology Service, 5901 East 7th Street, Long Beach, CA 90822 USA
| | - Homayoon Sanati
- VA Long Beach Healthcare System, Internal Medicine Service, Hematology/Oncology Section, 5901 East 7th Street, Long Beach, CA 90822 USA
| | - Lida Jafari
- Department of Urology, UCLA, 27-139 Center for Health Sciences, Los Angeles, CA 90095 USA
- VA Greater Los Angeles Healthcare System, Imaging Service, Nuclear Medicine Section, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
| | - Carol J. Bennett
- Department of Urology, UCLA, 27-139 Center for Health Sciences, Los Angeles, CA 90095 USA
- VA Greater Los Angeles Healthcare System, Urology Service, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
| | - Greg E. Gin
- Department of Urology, UCI, 333 City Blvd W #2100, Orange, CA 92868 USA
- VA Long Beach Healthcare System, Urology Service, 5901 East 7th Street, Long Beach, CA 90822 USA
| | - Amar U. Kishan
- Department of Radiation Oncology, UCLA, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095-6951 USA
| | - Robert E. Reiter
- Department of Urology, UCLA, 27-139 Center for Health Sciences, Los Angeles, CA 90095 USA
| | - Michael Lewis
- VA Greater Los Angeles Healthcare System, Pathology Service, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
| | - Ahmad Sadeghi
- VA Greater Los Angeles Healthcare System, Radiation Oncology Service, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
| | - William J. Aronson
- Department of Urology, UCLA, 27-139 Center for Health Sciences, Los Angeles, CA 90095 USA
- VA Long Beach Healthcare System, Internal Medicine Service, Hematology/Oncology Section, 5901 East 7th Street, Long Beach, CA 90822 USA
| | - Isla P. Garraway
- Department of Urology, UCLA, 27-139 Center for Health Sciences, Los Angeles, CA 90095 USA
- VA Long Beach Healthcare System, Internal Medicine Service, Hematology/Oncology Section, 5901 East 7th Street, Long Beach, CA 90822 USA
| | - Matthew B. Rettig
- VA Greater Los Angeles Healthcare System, Internal Medicine Service, Hematology/Oncology Section, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
- Department of Urology, UCLA, 27-139 Center for Health Sciences, Los Angeles, CA 90095 USA
| | - Nicholas G. Nickols
- Department of Radiation Oncology, UCLA, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095-6951 USA
- Department of Urology, UCLA, 27-139 Center for Health Sciences, Los Angeles, CA 90095 USA
- VA Greater Los Angeles Healthcare System, Radiation Oncology Service, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
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24
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Küronya Z, Biró K, Maráz A, Géczi L. [The modern treatment of metastatic castration-resistant prostate cancer]. Magy Onkol 2019; 63:41-50. [PMID: 30889620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 06/09/2023]
Abstract
The basic therapy of metastatic prostate carcinoma is androgen deprivation therapy. Unfortunately, almost all patients develop resistance to treatment that leads to castration-resistant prostate cancer. From 2010, 6 new active substances were registered for the treatment of metastatic castration-resistant prostate cancer, which dramatically improved the overall survival of patients. Two of these are treatments for the androgenic axis, the other drugs or therapeutic methods are immunotherapy, chemotherapy, isotope treatment and RANK-ligand inhibition. The year 2018 was a major success in the treatment of nonmetastatic castration-resistant prostate carcinoma, with the FDA authorizing both apalutamide and enzalutamide at this stage. The aim of this review is to present the standard of care of metastatic castration-resistant prostate cancer by disease stage, and to introduce the emerging treatment modalities presently assessed in clinical trials and discuss the open questions.
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Affiliation(s)
- Zsófia Küronya
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Krisztina Biró
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary
| | - Lajos Géczi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
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Abstract
High-risk nonmetastatic castration-resistant prostate cancer is a lethal disease that previously lacked clear treatment options. Progression to bone metastases is associated with significant morbidity and high cost. Apalutamide, an androgen receptor inhibitor, has substantial clinical response in nonmetastatic castration-resistant prostate cancer. Apalutamide + androgen deprivation therapy is well tolerated and improves metastasis-free survival, progression-free survival and time to symptomatic progression, and is associated with a favorable trend of improved overall survival. Future research is needed to elucidate mechanisms of resistance to treatment with androgen signaling inhibitors.
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Affiliation(s)
- Hala T Borno
- Division of Hematology/Oncology, Department of Medicine, University of California at San Francisco, CA 94158, USA
- Helen Diller Family Comprehensive Cancer Center, Department of Medicine, University of California at San Francisco, CA 94158, USA
| | - Eric J Small
- Division of Hematology/Oncology, Department of Medicine, University of California at San Francisco, CA 94158, USA
- Helen Diller Family Comprehensive Cancer Center, Department of Medicine, University of California at San Francisco, CA 94158, USA
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26
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Schmid MC, Khan SQ, Kaneda MM, Pathria P, Shepard R, Louis TL, Anand S, Woo G, Leem C, Faridi MH, Geraghty T, Rajagopalan A, Gupta S, Ahmed M, Vazquez-Padron RI, Cheresh DA, Gupta V, Varner JA. Integrin CD11b activation drives anti-tumor innate immunity. Nat Commun 2018; 9:5379. [PMID: 30568188 PMCID: PMC6300665 DOI: 10.1038/s41467-018-07387-4] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023] Open
Abstract
Myeloid cells are recruited to damaged tissues where they can resolve infections and tumor growth or stimulate wound healing and tumor progression. Recruitment of these cells is regulated by integrins, a family of adhesion receptors that includes integrin CD11b. Here we report that, unexpectedly, integrin CD11b does not regulate myeloid cell recruitment to tumors but instead controls myeloid cell polarization and tumor growth. CD11b activation promotes pro-inflammatory macrophage polarization by stimulating expression of microRNA Let7a. In contrast, inhibition of CD11b prevents Let7a expression and induces cMyc expression, leading to immune suppressive macrophage polarization, vascular maturation, and accelerated tumor growth. Pharmacological activation of CD11b with a small molecule agonist, Leukadherin 1 (LA1), promotes pro-inflammatory macrophage polarization and suppresses tumor growth in animal models of murine and human cancer. These studies identify CD11b as negative regulator of immune suppression and a target for cancer immune therapy.
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Affiliation(s)
- Michael C Schmid
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Samia Q Khan
- Drug Discovery Center, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Megan M Kaneda
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Paulina Pathria
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Ryan Shepard
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Tiani L Louis
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Sudarshan Anand
- Department of Pathology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Gyunghwi Woo
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Chris Leem
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - M Hafeez Faridi
- Drug Discovery Center, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Terese Geraghty
- Drug Discovery Center, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Anugraha Rajagopalan
- Drug Discovery Center, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Seema Gupta
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Mansoor Ahmed
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Roberto I Vazquez-Padron
- Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, 33136, USA
| | - David A Cheresh
- Department of Pathology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Vineet Gupta
- Drug Discovery Center, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, 60612, USA.
| | - Judith A Varner
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, 92093, USA.
- Department of Pathology, University of California, San Diego, La Jolla, CA, 92093, USA.
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27
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Apalutamide (Erleada) for prostate cancer. Med Lett Drugs Ther 2018; 60:e124-5. [PMID: 30036351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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28
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Affiliation(s)
- Julia A Beaver
- From the Office of Hematology and Oncology Products, Center for Drug Evaluation and Research (J.A.B.), and the Oncology Center of Excellence (P.G.K., R.P.), U.S. Food and Drug Administration, Silver Spring, MD; and the Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, Washington, DC (J.A.B.)
| | - Paul G Kluetz
- From the Office of Hematology and Oncology Products, Center for Drug Evaluation and Research (J.A.B.), and the Oncology Center of Excellence (P.G.K., R.P.), U.S. Food and Drug Administration, Silver Spring, MD; and the Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, Washington, DC (J.A.B.)
| | - Richard Pazdur
- From the Office of Hematology and Oncology Products, Center for Drug Evaluation and Research (J.A.B.), and the Oncology Center of Excellence (P.G.K., R.P.), U.S. Food and Drug Administration, Silver Spring, MD; and the Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, Washington, DC (J.A.B.)
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29
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Nevedomskaya E, Baumgart SJ, Haendler B. Recent Advances in Prostate Cancer Treatment and Drug Discovery. Int J Mol Sci 2018; 19:ijms19051359. [PMID: 29734647 PMCID: PMC5983695 DOI: 10.3390/ijms19051359] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [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] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 02/08/2023] Open
Abstract
Novel drugs, drug sequences and combinations have improved the outcome of prostate cancer in recent years. The latest approvals include abiraterone acetate, enzalutamide and apalutamide which target androgen receptor (AR) signaling, radium-223 dichloride for reduction of bone metastases, sipuleucel-T immunotherapy and taxane-based chemotherapy. Adding abiraterone acetate to androgen deprivation therapy (ADT) in order to achieve complete androgen blockade has proven highly beneficial for treatment of locally advanced prostate cancer and metastatic hormone-sensitive prostate cancer (mHSPC). Also, ADT together with docetaxel treatment showed significant benefit in mHSPC. Ongoing clinical trials for different subgroups of prostate cancer patients include the evaluation of the second-generation AR antagonists enzalutamide, apalutamide and darolutamide, of inhibitors of the phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K) pathway, of inhibitors of DNA damage response, of targeted alpha therapy and of prostate-specific membrane antigen (PSMA) targeting approaches. Advanced clinical studies with immune checkpoint inhibitors have shown limited benefits in prostate cancer and more trials are needed to demonstrate efficacy. The identification of improved, personalized treatments will be much supported by the major progress recently made in the molecular characterization of early- and late-stage prostate cancer using “omics” technologies. This has already led to novel classifications of prostate tumors based on gene expression profiles and mutation status, and should greatly help in the choice of novel targeted therapies best tailored to the needs of patients.
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Affiliation(s)
- Ekaterina Nevedomskaya
- Therapeutic Research Groups, Research & Development, Pharmaceuticals, Bayer AG, Müllerstr. 178, 13353 Berlin, Germany.
| | - Simon J Baumgart
- Therapeutic Research Groups, Research & Development, Pharmaceuticals, Bayer AG, Müllerstr. 178, 13353 Berlin, Germany.
| | - Bernard Haendler
- Therapeutic Research Groups, Research & Development, Pharmaceuticals, Bayer AG, Müllerstr. 178, 13353 Berlin, Germany.
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30
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Smith MR, Saad F, Chowdhury S, Oudard S, Hadaschik BA, Graff JN, Olmos D, Mainwaring PN, Lee JY, Uemura H, Lopez-Gitlitz A, Trudel GC, Espina BM, Shu Y, Park YC, Rackoff WR, Yu MK, Small EJ. Apalutamide Treatment and Metastasis-free Survival in Prostate Cancer. N Engl J Med 2018; 378:1408-1418. [PMID: 29420164 DOI: 10.1056/nejmoa1715546] [Citation(s) in RCA: 793] [Impact Index Per Article: 132.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Apalutamide, a competitive inhibitor of the androgen receptor, is under development for the treatment of prostate cancer. We evaluated the efficacy of apalutamide in men with nonmetastatic castration-resistant prostate cancer who were at high risk for the development of metastasis. METHODS We conducted a double-blind, placebo-controlled, phase 3 trial involving men with nonmetastatic castration-resistant prostate cancer and a prostate-specific antigen doubling time of 10 months or less. Patients were randomly assigned, in a 2:1 ratio, to receive apalutamide (240 mg per day) or placebo. All the patients continued to receive androgen-deprivation therapy. The primary end point was metastasis-free survival, which was defined as the time from randomization to the first detection of distant metastasis on imaging or death. RESULTS A total of 1207 men underwent randomization (806 to the apalutamide group and 401 to the placebo group). In the planned primary analysis, which was performed after 378 events had occurred, median metastasis-free survival was 40.5 months in the apalutamide group as compared with 16.2 months in the placebo group (hazard ratio for metastasis or death, 0.28; 95% confidence interval [CI], 0.23 to 0.35; P<0.001). Time to symptomatic progression was significantly longer with apalutamide than with placebo (hazard ratio, 0.45; 95% CI, 0.32 to 0.63; P<0.001). The rate of adverse events leading to discontinuation of the trial regimen was 10.6% in the apalutamide group and 7.0% in the placebo group. The following adverse events occurred at a higher rate with apalutamide than with placebo: rash (23.8% vs. 5.5%), hypothyroidism (8.1% vs. 2.0%), and fracture (11.7% vs. 6.5%). CONCLUSIONS Among men with nonmetastatic castration-resistant prostate cancer, metastasis-free survival and time to symptomatic progression were significantly longer with apalutamide than with placebo. (Funded by Janssen Research and Development; SPARTAN ClinicalTrials.gov number, NCT01946204 .).
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Affiliation(s)
- Matthew R Smith
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Fred Saad
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Simon Chowdhury
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Stéphane Oudard
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Boris A Hadaschik
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Julie N Graff
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - David Olmos
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Paul N Mainwaring
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Ji Youl Lee
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Hiroji Uemura
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Angela Lopez-Gitlitz
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Géralyn C Trudel
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Byron M Espina
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Youyi Shu
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Youn C Park
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Wayne R Rackoff
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Margaret K Yu
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
| | - Eric J Small
- From the Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (M.R.S.); Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (F.S.); Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London (S.C.); Georges Pompidou Hospital, Paris (S.O.); University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany (B.A.H.); Veterans Affairs Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health and Science University, Portland (J.N.G.); Spanish National Cancer Research Center, Madrid, and Hospitales Universitarios Virgen de la Victoria y Regional, Institute of Biomedical Research in Malaga, Malaga - both in Spain (D.O.); Centre for Personalised Nanomedicine, University of Queensland, Brisbane, Australia (P.N.M.); St. Mary's Hospital of Catholic University, Seoul, South Korea (J.Y.L.); Yokohama City University Medical Center, Yokohama, Japan (H.U.); Janssen Research and Development, Los Angeles (A.L.-G., G.C.T., B.M.E., Y.S., Y.C.P., W.R.R., M.K.Y.); and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco (E.J.S.)
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Gourd E. Apalutamide shows efficacy in prostate cancer. Lancet Oncol 2018; 19:e149. [PMID: 29456088 DOI: 10.1016/s1470-2045(18)30156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Smith MR, Antonarakis ES, Ryan CJ, Berry WR, Shore ND, Liu G, Alumkal JJ, Higano CS, Chow Maneval E, Bandekar R, de Boer CJ, Yu MK, Rathkopf DE. Phase 2 Study of the Safety and Antitumor Activity of Apalutamide (ARN-509), a Potent Androgen Receptor Antagonist, in the High-risk Nonmetastatic Castration-resistant Prostate Cancer Cohort. Eur Urol 2016; 70:963-970. [PMID: 27160947 PMCID: PMC5568792 DOI: 10.1016/j.eururo.2016.04.023] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/21/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Apalutamide is a potent androgen receptor (AR) antagonist that targets the AR ligand-binding domain and prevents AR nuclear translocation, DNA binding, and transcription of AR gene targets. OBJECTIVE To evaluate the activity and safety of apalutamide in patients with high-risk nonmetastatic castration-resistant prostate cancer (nmCRPC). DESIGN, SETTING, AND PARTICIPANTS We conducted a multicenter phase 2 study of nmCRPC patients with a high risk for progression (prostate-specific antigen [PSA] ≥8 ng/ml or PSA doubling time [PSA DT] ≤10 mo). INTERVENTION Patients received 240mg/d apalutamide while continuing on androgen-deprivation therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary end point was 12-wk PSA response (Prostate Cancer Working Group 2 criteria). Secondary end points included safety, time to PSA progression (TTPP), and metastasis-free survival (MFS). RESULTS AND LIMITATIONS A total of 51 patients were enrolled; four patients with metastatic disease were excluded from the efficacy analysis. Patient characteristics included median age, 71 yr; Eastern Cooperative Oncology Group performance status 0 (76%); Gleason score ≤7 (57%); median PSA 10.7 ng/ml; and PSA DT ≤10 mo (45%). At median follow-up of 28.0 mo, 18 patients (35%) remained in the study. Overall, 89% of patients had ≥50% PSA decline at 12 wk. Median TTPP was 24.0 mo (95% confidence interval [CI], 16.3 mo-not reached [NR]); median MFS was NR (95% CI, 33.4 mo-NR). Most of the patients discontinued study treatment (n=33) due to disease progression (n=11 [22%]) or adverse events (AEs) (n=9 [18%]). The most common AE was fatigue (any grade, n=31 [61%]) although grade ≥3 fatigue was uncommon (n=2 [4%]). These represent the first apalutamide nmCRPC patient clinical data. CONCLUSIONS In high-risk nmCRPC patients, apalutamide was safe with robust activity based on durable PSA responses and disease control. PATIENT SUMMARY Antitumor activity and the safety of apalutamide in patients with nonmetastatic castration-resistant prostate cancer support continued development in this setting. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01171898.
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Affiliation(s)
- Matthew R Smith
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA.
| | - Emmanuel S Antonarakis
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Charles J Ryan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | | | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Glenn Liu
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Joshi J Alumkal
- Oregon Health & Science University, Knight Cancer Institute, Portland, OR, USA
| | - Celestia S Higano
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | - Margaret K Yu
- Janssen Research & Development, Los Angeles, CA, USA
| | - Dana E Rathkopf
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
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Abstract
Recently, the standard of care for metastatic Castration Resistant Prostate Cancer (mCRPC) has changed considerably. Persistent androgen receptor (AR) signaling has been identified as a target for novel therapies and reengages the fact that AR continues to be the primary target responsible for metastatic prostate cancer. Androgen receptor gene amplification and over expression have been found to result in a higher concentration of androgen receptors on tumor cells, making them extremely sensitive to low levels of circulating androgens. Additionally, prostate cancer cells are able to maintain dihydrotestosterone (DHT) concentration in excess of serum concentrations to support tumor growth. For many years ketoconazole was the only CYP17 inhibitor that was used to treat mCRPC. However, significant toxicities limit its use. Newly approved chemotherapeutic agents such as Abiraterone (an oral selective inhibitor of CYP17A), which blocks androgen biosynthesis both within and outside the prostate cancer cells), and enzalutamide (blocks AR signaling) have improved overall survival. There are also ongoing phase III trials for Orteronel (TAK- 700), ARN- 509 and Galeterone (TOK-001), which targets androgen signaling. In this review, we will present the rationale for the newly approved hormonal treatments, their indications and complications, and we will discuss ongoing trials that are being done to improve the efficacy of the approved agents. Finally, we will talk about the potential upcoming hormonal treatments for mCRPC.
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Affiliation(s)
- Eva Gupta
- Mayo Clinic, 4500 San Pablo Rd S, Jacksonville 32224, FL, USA
| | | | - Winston Tan
- Mayo Clinic, 4500 San Pablo Rd S, Jacksonville 32224, FL, USA
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Abstract
Persistent androgen receptor (AR) signaling despite low levels of serum androgens has been identified as a critical target for drug discovery in castration-resistant prostate cancer (CRPC). As proof of principle that the AR remains relevant in CRPC, 2 AR-targeted agents recently approved by the Food and Drug Administration-abiraterone and enzalutamide-have increased overall survival for patients with CRPC in the setting of prior chemotherapy. This review focuses on the AR and 2 direct antagonists, enzalutamide and ARN-509. These next-generation AR antagonists offer great promise for patients with advanced disease. Relative to conventional antiandrogens such as bicalutamide, they bind to the receptor with higher affinity, prevent nuclear translocation and DNA binding, and induce apoptosis without agonist activity in preclinical models. The success of these AR-targeted agents in the clinic has changed the landscape of therapy for patients with CRPC, and further therapeutic options building on this platform are currently in development.
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Affiliation(s)
- Dana Rathkopf
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Howard I. Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Muller AJ, DuHadaway JB, Donover PS, Sutanto-Ward E, Prendergast GC. Inhibition of indoleamine 2,3-dioxygenase, an immunoregulatory target of the cancer suppression gene Bin1, potentiates cancer chemotherapy. Nat Med 2005; 11:312-9. [PMID: 15711557 DOI: 10.1038/nm1196] [Citation(s) in RCA: 820] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Accepted: 01/05/2005] [Indexed: 02/06/2023]
Abstract
Immune escape is a crucial feature of cancer progression about which little is known. Elevation of the immunomodulatory enzyme indoleamine 2,3-dioxygenase (IDO) in tumor cells can facilitate immune escape. Not known is how IDO becomes elevated or whether IDO inhibitors will be useful for cancer treatment. Here we show that IDO is under genetic control of Bin1, which is attenuated in many human malignancies. Mouse knockout studies indicate that Bin1 loss elevates the STAT1- and NF-kappaB-dependent expression of IDO, driving escape of oncogenically transformed cells from T cell-dependent antitumor immunity. In MMTV-Neu mice, an established breast cancer model, we show that small-molecule inhibitors of IDO cooperate with cytotoxic agents to elicit regression of established tumors refractory to single-agent therapy. Our findings suggest that Bin1 loss promotes immune escape in cancer by deregulating IDO and that IDO inhibitors may improve responses to cancer chemotherapy.
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Affiliation(s)
- Alexander J Muller
- Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, Pennsylvania 19096, USA
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Cereghino JJ, Brock JT, Van Meter JC, Penry JK, Smith LD, Fisher P, Ellenberg J. Evaluation of albutoin as an antiepileptic drug. Clin Pharmacol Ther 1974; 15:406-16. [PMID: 4206927 DOI: 10.1002/cpt1974154406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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