Clinical impact of volume of disease and time of metastatic disease presentation on patients receiving enzalutamide or abiraterone acetate plus prednisone as first-line therapy for metastatic castration-resistant prostate cancer. Academic Article uri icon

Overview

abstract

  • BACKGROUND: Metastatic castration-resistant prostate cancer remains a challenging condition to treat. Among the available therapeutic options, the androgen receptor signaling inhibitors abiraterone acetate plus prednisone (AA) and enzalutamide (Enza), are currently the most used first-line therapies in clinical practice. However, validated clinical indicators of prognosis in this setting are still lacking. In this study, we aimed to evaluate a prognostic model based on the time of metastatic disease presentation (after prior local therapy [PLT] or de-novo [DN]) and disease burden (low volume [LV] or high-volume [HV]) at AA/Enza onset for mCRPC patients receiving either AA or Enza as first-line. METHODS: A cohort of consecutive patients who started AA or Enza as first-line treatment for mCRPC between January 1st, 2015, and April 1st, 2019 was identified from the clinical and electronic registries of the 9 American and European participating centers. Patients were classified into 4 cohorts by the time of metastatic disease presentation (PLT or DN) and volume of disease (LV or HV; per the E3805 trial, HV was defined as the presence of visceral metastases and/or at least 4 bone metastases of which at least 1 out the axial/pelvic skeleton) at AA/Enza onset. The endpoint was overall survival defined as the time from AA or Enza initiation, respectively, to death from any cause or censored at the last follow-up visit, whichever occurred first. RESULTS: Of the 417 eligible patients identified, 157 (37.6%) had LV/PLT, 87 (20.9%) LV/DN, 64 (15.3%) HV/PLT, and 109 (26.1%) HV/DN. LV cohorts showed improved median overall survival (59.0 months; 95% CI, 51.0-66.9 months) vs. HV cohorts (27.5 months; 95% CI, 22.8-32.2 months; P = 0.0001), regardless of the time of metastatic presentation. In multivariate analysis, HV cohorts were confirmed associated with worse prognosis compared to those with LV (HV/PLT, HR = 1.87; p = 0.029; HV/DN, HR = 2.19; P = 0.002). CONCLUSION: Our analysis suggests that the volume of disease could be a prognostic factor for patients starting AA or Enza as first-line treatment for metastatic castration-resistant prostate cancer, pending prospective clinical trial validation.

authors

  • Nuzzo, Pier Vitale
  • Pederzoli, Filippo
  • Saieva, Calogero
  • Zanardi, Elisa
  • Fotia, Giuseppe
  • Malgeri, Andrea
  • Rossetti, Sabrina
  • Valenca Bueno, Loana
  • Andrade, Livia Maria Q S
  • Patrikidou, Anna
  • Mestre, Ricardo Pereira
  • Modesti, Mikol
  • Pignata, Sandro
  • Procopio, Giuseppe
  • Fornarini, Giuseppe
  • De Giorgi, Ugo
  • Russo, Antonio
  • Francini, Edoardo

publication date

  • February 3, 2023

Research

keywords

  • Abiraterone Acetate
  • Prostatic Neoplasms, Castration-Resistant

Identity

PubMed Central ID

  • PMC9896712

Scopus Document Identifier

  • 85147458375

Digital Object Identifier (DOI)

  • 10.1200/OP.21.00206

PubMed ID

  • 36737752

Additional Document Info

volume

  • 21

issue

  • 1