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

  • Mariaconsiglia FerrieroEmail author
  • Riccardo Mastroianni
  • Cosimo De Nunzio
  • Luca Cindolo
  • Fabio Calabrò
  • Giorgia Tema
  • Costantino Leonardo
  • Rocco Simone Flammia
  • Gabriele Tuderti
  • Umberto Anceschi
  • Aldo Brassetti
  • Silvana Giacinti
  • Salvatore Guaglianone
  • Jamil Ghahhari
  • Luigi Schips
  • Andrea Tubaro
  • Michele Gallucci
  • Giuseppe Simone
Original Article

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.

keywords

Castration-resistant prostate cancer Metastatic disease Systemic therapy High volume disease Androgen receptor targeted agent 

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

Notes

Authors’ contribution

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

Compliance with ethical standards

Informed consent

All patients have signed the informed consent for data collection and follow-up.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Mariaconsiglia Ferriero
    • 1
    Email author
  • Riccardo Mastroianni
    • 2
  • Cosimo De Nunzio
    • 3
  • Luca Cindolo
    • 4
  • Fabio Calabrò
    • 5
  • Giorgia Tema
    • 3
  • Costantino Leonardo
    • 2
  • Rocco Simone Flammia
    • 2
  • Gabriele Tuderti
    • 1
  • Umberto Anceschi
    • 1
  • Aldo Brassetti
    • 1
  • Silvana Giacinti
    • 3
  • Salvatore Guaglianone
    • 1
  • Jamil Ghahhari
    • 6
  • Luigi Schips
    • 4
  • Andrea Tubaro
    • 3
  • Michele Gallucci
    • 1
    • 2
  • Giuseppe Simone
    • 1
  1. 1.Department of Urology“Regina Elena” National Cancer Institute of RomeRomeItaly
  2. 2.Department of Urology“La Sapienza” University of RomeRomeItaly
  3. 3.Department of Urology, Faculty of Health SciencesUniversity “La Sapienza”, Sant’Andrea HospitalRomeItaly
  4. 4.Department of UrologyS. Pio Da Pietrelcina HospitalVastoItaly
  5. 5.Department of Medical OncologySan Camillo-Forlanini HospitalRomeItaly
  6. 6.Department of Urology“G.D’Annunzio” UniversityChietiItaly

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