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Managing lines of therapy in castration-resistant prostate cancer: real-life snapshot from a multicenter cohort

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Abstract

Purpose

To provide a snapshot of toxicities and oncologic outcomes of Abiraterone (AA) and Enzalutamide (EZ) in a chemo-naïve metastatic castration-resistant prostate cancer (mCPRC) population from a longitudinal real-life multicenter cohort.

Methods

We prospectively collected data on chemo-naïve mCRPC patients treated with AA or EZ. Primary outcomes were PSA response, oncologic outcomes and toxicity profile. The Kaplan–Meier method was used to compare differences in terms of progression-free survival (PFS) between AA vs EZ and high- vs low-volume disease cohorts. Univariable and multivariable Cox regression analyses were performed to identify predictors of PFS. Toxicity, PSA response rates and oncologic outcomes on second line were compared with those observed on first line.

Results

Out of 137 patients, 88 received AA, and 49 EZ. On first line, patients receiving EZ had significantly higher PSA response compared with AA (95.9% vs 67%, p < 0.001), comparable toxicity rate (10.2% vs 16.3%, p = 0.437) and PFS probabilities (p = 0.145). Baseline PSA and high-volume disease were predictors of lower PFS probabilities at univariable analysis (p = 0.027 and p = 0.007, respectively). Overall, 28 patients shifted to a second-line therapy (EZ or radiometabolic therapy). Toxicity and PSA response rates on second line were comparable to those observed on first line (11.1% vs 12.4%, p = 0.77; 73.1% vs 77.4%, p = 0.62, respectively); 2-year PFS, cancer-specific and overall survival probabilities were comparable to those displayed in first-line cohort (12.1% vs 16.2%, p = 0.07; 85.7% vs 86.4%, p = 0.98; 71% vs 80.3%, p = 0.66, respectively).

Conclusions

Toxicity profile, PSA response rate and oncological outcomes were comparable between first-line and second-line courses in patients treated with either AA or EZ for mCRPC. Our findings showed the tolerability and oncological effectiveness, when feasible, of two lines of therapy other than chemotherapy.

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Abbreviations

CRPC:

Castration-resistant prostate cancer

EZ:

Enzalutamide

AA:

Abiraterone acetate

PFS:

Progression-free survival

OS:

Overall survival

HSMPC:

Hormone-sensitive metastatic prostate cancer

AR:

Androgen receptor

mCRPC:

Metastatic castration-resistant prostate cancer

CSS:

Cancer-specific survival

ADT:

Androgen deprivation therapy

AP:

Apalutamide

nmCRPC:

Non-metastatic castration-resistant prostate cancer

FDA:

Food and drug administration

ARTA:

Androgen receptor-targeted agents

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Author information

Authors and Affiliations

  1. Department of Urology, “Regina Elena” National Cancer Institute of Rome, Via Elio Chianesi 53, 00154, Rome, Italy

    Mariaconsiglia Ferriero, Gabriele Tuderti, Umberto Anceschi, Aldo Brassetti, Salvatore Guaglianone, Michele Gallucci & Giuseppe Simone

  2. Department of Urology, “La Sapienza” University of Rome, Viale dell’Università 33, 00185, Rome, Italy

    Riccardo Mastroianni, Costantino Leonardo, Rocco Simone Flammia & Michele Gallucci

  3. Department of Urology, Faculty of Health Sciences, University “La Sapienza”, Sant’Andrea Hospital, Via di Grottarossa, 1035, 00189, Rome, Italy

    Cosimo De Nunzio, Giorgia Tema, Silvana Giacinti & Andrea Tubaro

  4. Department of Urology, S. Pio Da Pietrelcina Hospital, Via S. Camillo de Lellis, 66054, Vasto, Italy

    Luca Cindolo & Luigi Schips

  5. Department of Medical Oncology, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152, Rome, Italy

    Fabio Calabrò

  6. Department of Urology, “G.D’Annunzio” University, Via dei Vestini, 31, 66100, Chieti, Italy

    Jamil Ghahhari

Authors
  1. Mariaconsiglia Ferriero
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  2. Riccardo Mastroianni
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  3. Cosimo De Nunzio
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  4. Luca Cindolo
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  5. Fabio Calabrò
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  6. Giorgia Tema
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  7. Costantino Leonardo
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  9. Gabriele Tuderti
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  10. Umberto Anceschi
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  11. Aldo Brassetti
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  12. Silvana Giacinti
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  13. Salvatore Guaglianone
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  14. Jamil Ghahhari
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  15. Luigi Schips
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  16. Andrea Tubaro
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  17. Michele Gallucci
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  18. Giuseppe Simone
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Contributions

MF: project development, data collection, data analysis, manuscript writing; RM: data collection, data analysis; CN: data collection; LC: data collection, data analysis, manuscript editing; FC: data collection; GT: data collection; CL: data collection; RSF: data collection; GT: data collection; UA: data collection; AB: data collection; SG: data collection; SG: data collection; JG: data collection; LS: data collection; AT: data collection; MG: project development, data analysis; GS: project development, data analysis, manuscript writing, manuscript editing

Corresponding author

Correspondence to Mariaconsiglia Ferriero.

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Ferriero, M., Mastroianni, R., De Nunzio, C. et al. Managing lines of therapy in castration-resistant prostate cancer: real-life snapshot from a multicenter cohort. World J Urol 38, 1757–1764 (2020). https://doi.org/10.1007/s00345-019-02974-6

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  • DOI: https://doi.org/10.1007/s00345-019-02974-6

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