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Chakrani Z, Mellgard G, Saffran N, McCroskery S, Taylor N, Patel M, Liaw B, Galsky M, Oh WK, Tsao CK, Patel VG. Risk Factors for Early Treatment Discontinuation Due to Toxicity Among Patients With Metastatic Castration-resistant Prostate Cancer Receiving Androgen Receptor-targeted Therapy. Am J Clin Oncol 2024; 47:271-278. [PMID: 38344754 DOI: 10.1097/coc.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
OBJECTIVES Androgen receptor-targeted therapies (ARTs) improve survival outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC); however, a significant portion of patients discontinue treatment for various reasons including treatment-related toxicity. We aim to describe reasons for ART treatment discontinuation and identify predictors associated with increased risk of treatment discontinuation due to toxicity. METHODS We performed a single-institution retrospective review of patients with mCRPC receiving ART between 2010 and 2021. Our primary aim was to identify risk factors for treatment discontinuation due to toxicity. Our secondary aim was to describe ART discontinuation patterns among patients with mCRPC. RESULTS One hundred thirty-three patients with mCRPC started and discontinued ARTs. Fourteen patients (10.5%) discontinued treatment due to toxicity. Common reasons for treatment discontinuation include Prostate Specific Antigen test progression, radiographic progression, toxicity, and death. Significant predictors of treatment discontinuation due to toxicity on bivariate analysis and multivariate analysis included patient-reported falls (odds ratio [OR]: 7.67, CI: [1.31-40.42]; P =0.016), rash (OR: 13.4, CI: [1.35-134.81]; P =0.026), and weakness (OR: 4.16, CI: [1.15-15.0]; P =0.019). CONCLUSIONS Our work presents the first description of ART treatment discontinuation and its causes in the real-world setting, as well as patient-reported side effects. Most patients with mCRPC discontinued treatment due to the progression of disease and a minority of patients discontinued secondary to treatment toxicity. Initial multivariable analysis suggests that patient-reported weakness, falls, and rash were associated with a higher likelihood of treatment discontinuation due to toxicity. Early monitoring of this population can prolong the duration of treatment and prevent unnecessary treatment burden.
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Affiliation(s)
- Zakaria Chakrani
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
| | - George Mellgard
- Department of Medicine, NewYork Presbyterian - Columbia University Irving Medical Center
| | - Nathaniel Saffran
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
| | - Stephen McCroskery
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
| | - Nicole Taylor
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
| | - Mann Patel
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Center, New York, NY
| | - Bobby Liaw
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
| | - Matthew Galsky
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
- Department of Medical Education, Rutgers New Jersey Medical School, Newark, NJ
| | - William K Oh
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
- Department of Medical Education, Rutgers New Jersey Medical School, Newark, NJ
- Prostate Cancer Foundation, Santa Monica, CA
| | - Che-Kai Tsao
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
- Prostate Cancer Foundation, Santa Monica, CA
| | - Vaibhav G Patel
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
- Arvinas Inc., New Haven, CT
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Liatsou I, Assefa B, Liyanage W, Surasinghe S, Nováková Z, Bařinka C, Gabrielson K, Raman V, Artemov D, Hapuarachchige S. Development and therapeutic evaluation of 5D3(CC-MLN8237) 3.2 antibody-theranostic conjugates for PSMA-positive prostate cancer therapy. Front Pharmacol 2024; 15:1385598. [PMID: 38751786 PMCID: PMC11094276 DOI: 10.3389/fphar.2024.1385598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Prostate cancer (PC) is an aggressive cancer that can progress rapidly and eventually become castrate-resistant prostate cancer (CRPC). Stage IV metastatic castrate-resistant prostate cancer (mCRPC) is an incurable late-stage cancer type with a low 5-year overall survival rate. Targeted therapeutics such as antibody-drug conjugates (ADCs) based on high-affinity monoclonal antibodies and potent drugs conjugated via smart linkers are being developed for PC management. Conjugating further with in vitro or in vivo imaging agents, ADCs can be used as antibody-theranostic conjugates (ATCs) for diagnostic and image-guided drug delivery. In this study, we have developed a novel ATC for PSMA (+) PC therapy utilizing (a) anti-PSMA 5D3 mAb, (b) Aurora A kinase inhibitor, MLN8237, and (c) for the first time using tetrazine (Tz) and trans-cyclooctene (TCO) click chemistry-based conjugation linker (CC linker) in ADC development. The resulting 5D3(CC-MLN8237)3.2 was labeled with suitable fluorophores for in vitro and in vivo imaging. The products were characterized by SDS-PAGE, MALDI-TOF, and DLS and evaluated in vitro by optical imaging, flow cytometry, and WST-8 assay for cytotoxicity in PSMA (+/-) cells. Therapeutic efficacy was determined in human PC xenograft mouse models following a designed treatment schedule. After the treatment study animals were euthanized, and toxicological studies, complete blood count (CBC), blood clinical chemistry analysis, and H&E staining of vital organs were conducted to determine side effects and systemic toxicities. The IC50 values of 5D3(CC-MLN8237)3.2-AF488 in PSMA (+) PC3-PIP and PMSA (-) PC3-Flu cells are 8.17 nM and 161.9 nM, respectively. Pure MLN8237 shows 736.9 nM and 873.4 nM IC50 values for PC3-PIP and PC3-Flu cells, respectively. In vivo study in human xenograft mouse models confirmed high therapeutic efficacy of 5D3(CC-MLN8237)3.2-CF750 with significant control of PSMA (+) tumor growth with minimal systemic toxicity in the treated group compared to PSMA (-) treated and untreated groups. Approximately 70% of PSMA (+) PC3-PIP tumors did not exceed the threshold of the tumor size in the surrogate Kaplan-Meyer analysis. The novel ATC successfully controlled the growth of PSMA (+) tumors in preclinical settings with minimal systemic toxicities. The therapeutic efficacy and favorable safety profile of novel 5D3(CC-MLN8237)3.2 ATC demonstrates their potential use as a theranostic against aggressive PC.
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Affiliation(s)
- Ioanna Liatsou
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Betelhem Assefa
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Wathsala Liyanage
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sharmane Surasinghe
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States
| | - Zora Nováková
- Laboratory of Structural Biology, Institute of Biotechnology of the Czech Academy of Sciences, Vestec, Czechia
| | - Cyril Bařinka
- Laboratory of Structural Biology, Institute of Biotechnology of the Czech Academy of Sciences, Vestec, Czechia
| | - Kathleen Gabrielson
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Venu Raman
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dmitri Artemov
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sudath Hapuarachchige
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Jeong CW, Han JH, Kwon DD, Joung JY, Kim CS, Ahn H, Hong JH, Kim TH, Chung BH, Jeon SS, Kang M, Hong SK, Jung TY, Park SW, Yun SJ, Lee JY, Lee SH, Kang SH, Kwak C. Oncological Outcomes in Men with Metastatic Castration-Resistant Prostate Cancer Treated with Enzalutamide with versus without Confirmatory Bone Scan. Cancer Res Treat 2024; 56:634-641. [PMID: 38062708 PMCID: PMC11016638 DOI: 10.4143/crt.2023.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/03/2023] [Indexed: 04/13/2024] Open
Abstract
PURPOSE In men with metastatic castration-resistant prostate cancer (mCRPC), new bone lesions are sometimes not properly categorized through a confirmatory bone scan, and clinical significance of the test itself remains unclear. This study aimed to demonstrate the performance rate of confirmatory bone scans in a real-world setting and their prognostic impact in enzalutamide-treated mCRPC. MATERIALS AND METHODS Patients who received oral enzalutamide for mCRPC during 2014-2017 at 14 tertiary centers in Korea were included. Patients lacking imaging assessment data or insufficient drug exposure were excluded. The primary outcome was overall survival (OS). Secondary outcomes included performance rate of confirmatory bone scans in a real-world setting. Kaplan-Meier analysis and multivariate Cox regression analysis were performed. RESULTS Overall, 520 patients with mCRPC were enrolled (240 [26.2%] chemotherapy-naïve and 280 [53.2%] after chemotherapy). Among 352 responders, 92 patients (26.1%) showed new bone lesions in their early bone scan. Confirmatory bone scan was performed in 41 patients (44.6%), and it was associated with prolonged OS in the entire population (median, 30.9 vs. 19.7 months; p < 0.001), as well as in the chemotherapy-naïve (median, 47.2 vs. 20.5 months; p=0.011) and post-chemotherapy sub-groups (median, 25.5 vs. 18.0 months; p=0.006). Multivariate Cox regression showed that confirmatory bone scan performance was an independent prognostic factor for OS (hazard ratio 0.35, 95% confidence interval, 0.18 to 0.69; p=0.002). CONCLUSION Confirmatory bone scan performance was associated with prolonged OS. Thus, the premature discontinuation of enzalutamide without confirmatory bone scans should be discouraged.
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Affiliation(s)
- Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jang Hee Han
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jae Young Joung
- Center for Prostate Cancer, National Cancer Center, Goyang, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Hwan Kim
- Department of Urology, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae Young Jung
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Sung Woo Park
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seok Joong Yun
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ji Yeol Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hwan Lee
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Luca T, Malfa GA, Siracusa L, La Mantia A, Bianchi S, Napoli E, Puleo S, Sergi A, Acquaviva R, Castorina S. Redox State Modulatory Activity and Cytotoxicity of Olea europaea L. (Oleaceae) Leaves Extract Enriched in Polyphenols Using Macroporous Resin. Antioxidants (Basel) 2024; 13:73. [PMID: 38247497 PMCID: PMC10812475 DOI: 10.3390/antiox13010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/23/2024] Open
Abstract
The food products derived from Olea europaea are a fundamental part of the Mediterranean diet, and their health-promoting effects are well known. In this study, we analyzed the phytochemical characteristics, the redox state modulatory activity, and the cytotoxic effect of an olive leaf aqueous extract enriched by macroporous resin on different tumor and normal cell lines (LNCaP, PC3, HFF-1). HPLC-DAD analysis, the Folin-Ciocalteu and aluminum chloride methods confirmed the qualitatively and quantitatively high content of phenolic compounds (130.02 ± 2.3 mg GAE/g extract), and a DPPH assay (IC50 = 100.00 ± 1.8 μg/mL), the related antioxidant activity. The biological investigation showed a significant cytotoxic effect, highlighted by an MTT test and the evident cellular morphological changes, on two prostate cancer cell lines. Remarkably, the extract was practically non-toxic on HFF-1 at the concentrations (100, 150, 300 µg/mL) and exposure times tested. Hence, the results are selective for tumor cells. The underlying cytotoxicity was associated with the decrease in ROS production (55% PC3, 42% LNCaP) and the increase in RSH levels (>50% PC3) and an LDH release assay (50% PC3, 40% LNCaP, established necrosis as the main cell death mechanism.
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Affiliation(s)
- Tonia Luca
- Department of Medical, Surgical Sciences and Advanced Technology, University of Catania, Via Santa Sofia, 95123 Catania, Italy; (T.L.); (S.C.)
| | - Giuseppe Antonio Malfa
- Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; (A.L.M.); (S.B.); (A.S.); (R.A.)
- Research Centre on Nutraceuticals and Health Products (CERNUT), University of Catania, Viale A. Doria 6, 95125 Catania, Italy
| | - Laura Siracusa
- Institute of Biomolecular Chemistry, Italian National Research Council ICB-CNR, Via Paolo Gaifami 18, 95126 Catania, Italy; (L.S.); (E.N.)
| | - Alfonsina La Mantia
- Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; (A.L.M.); (S.B.); (A.S.); (R.A.)
| | - Simone Bianchi
- Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; (A.L.M.); (S.B.); (A.S.); (R.A.)
- Research Centre on Nutraceuticals and Health Products (CERNUT), University of Catania, Viale A. Doria 6, 95125 Catania, Italy
| | - Edoardo Napoli
- Institute of Biomolecular Chemistry, Italian National Research Council ICB-CNR, Via Paolo Gaifami 18, 95126 Catania, Italy; (L.S.); (E.N.)
| | - Stefano Puleo
- Mediterranean Foundation “GB Morgagni”, 95125 Catania, Italy;
| | - Angelo Sergi
- Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; (A.L.M.); (S.B.); (A.S.); (R.A.)
| | - Rosaria Acquaviva
- Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; (A.L.M.); (S.B.); (A.S.); (R.A.)
- Research Centre on Nutraceuticals and Health Products (CERNUT), University of Catania, Viale A. Doria 6, 95125 Catania, Italy
| | - Sergio Castorina
- Department of Medical, Surgical Sciences and Advanced Technology, University of Catania, Via Santa Sofia, 95123 Catania, Italy; (T.L.); (S.C.)
- Mediterranean Foundation “GB Morgagni”, 95125 Catania, Italy;
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Freedland SJ, Hong A, El-Chaar N, Murty S, Ramaswamy K, Coutinho AD, Nimke D, Morgans AK. Prostate-specific antigen response and clinical progression-free survival in Black and White men with chemotherapy-naïve metastatic castration-resistant prostate cancer treated with enzalutamide in a real-world setting. Prostate Cancer Prostatic Dis 2023; 26:523-530. [PMID: 36517634 PMCID: PMC10449620 DOI: 10.1038/s41391-022-00622-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the United States, Black men have a higher incidence of prostate cancer (PC)-related mortality than men of other races. Several real-world studies in advanced PC suggest, however, that Black men respond better to novel hormonal therapies than White men. Data on treatment responses to enzalutamide by race are limited. We assessed real-world prostate-specific antigen (PSA) response and clinical progression-free survival (cPFS) of Black vs. White men with chemotherapy-naïve PC treated with enzalutamide. METHODS This retrospective cohort study included patients with PC who initiated enzalutamide treatment from 2014 to 2018 in the IntrinsiQ Specialty Solutions™ database, a collection of electronic medical records from community urology practices. Index date was the date of the first prescription for enzalutamide, used as a proxy for metastatic castration-resistant PC (mCRPC). Patients who had undergone chemotherapy and/or abiraterone therapy were excluded. Kaplan-Meier and Cox models adjusted for baseline characteristics were used to estimate PSA response and cPFS by race. RESULTS The study included 214 Black and 1332 White men with chemotherapy-naïve PC presumed to have mCRPC based on the enzalutamide indication during the study period. Black men were younger and had higher baseline median PSA levels than White men. Enzalutamide therapy duration, follow-up time, and number of post-index PSA tests were similar between races. In multivariable analyses, the risk of patients achieving a ≥ 50% PSA decline was similar, whereas a numerically higher trend of ≥90% PSA decline was observed in Black men (HR 1.23; 95% CI 0.93-1.62 [P = 0.14]). In the multivariable analysis, Black men had significantly better cPFS (HR 0.82; 95% CI 0.68-0.98 [P = 0.03]). CONCLUSIONS Black and White men with presumed chemotherapy-naïve mCRPC had similar PSA responses when treated with enzalutamide, but Black men had better cPFS than White men. Further research is warranted to validate these findings.
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Affiliation(s)
- Stephen J Freedland
- Center for Integrated Research in Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Durham VA Health Care System, Durham, NC, USA.
| | - Agnes Hong
- Astellas Pharma Inc., Northbrook, IL, USA
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Higano CS, George DJ, Shore ND, Sartor O, Miller K, Conti PS, Sternberg CN, Saad F, Sade JP, Bellmunt J, Smith MR, Chandrawansa K, Sandström P, Verholen F, Tombal B. Clinical outcomes and treatment patterns in REASSURE: planned interim analysis of a real-world observational study of radium-223 in metastatic castration-resistant prostate cancer. EClinicalMedicine 2023; 60:101993. [PMID: 37251627 PMCID: PMC10209672 DOI: 10.1016/j.eclinm.2023.101993] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
Background Radium-223, a targeted alpha therapy, is approved to treat bone-dominant metastatic castration-resistant prostate cancer (mCRPC), based on significantly prolonged overall survival versus placebo and a favourable safety profile in the phase 3 ALSYMPCA study. ALSYMPCA was conducted when few other treatment options were available, and prospectively collected data are limited on the use of radium-223 in the current mCRPC treatment landscape. We sought to understand long-term safety and treatment patterns in men who received radium-223 in real-world clinical practice. Methods REASSURE (NCT02141438) is a global, prospective, observational study of radium-223 in men with mCRPC. Primary outcomes are adverse events (AEs), including treatment-emergent serious AEs (SAEs) and drug-related AEs during and ≤30 days after radium-223 completion, grade 3/4 haematological toxicities ≤6 months after last radium-223 dose, drug-related SAEs after radium-223 therapy completion, and second primary malignancies. Findings Data collection commenced on Aug 20, 2014, and the data cutoff date for this prespecified interim analysis was Mar 20, 2019 (median follow-up 11.5 months [interquartile range 6.0-18.6]), 1465 patients were evaluable. For second primary malignancies, 1470 patients were evaluable, 21 (1%) of whom had a total of 23 events. During radium-223 therapy, 311 (21%) of 1465 patients had treatment-emergent SAEs, and 510 (35%) had drug-related AEs. In the 6 months after completion of radium-223 therapy, 214 (15%) patients had grade 3/4 haematological toxicities. Eighty patients (5%) had post-treatment drug-related SAEs. Median overall survival was 15.6 months (95% confidence interval 14.6-16.5) from radium-223 initiation. Patient-reported pain scores declined or stabilised. Seventy (5%) patients had fractures. Interpretation REASSURE offers insight into radium-223 use in global real-world clinical practice with currently available therapies. At this interim analysis, with a median follow-up of almost 1 year, 1% of patients had second primary malignancies, and safety and overall survival findings were consistent with clinical trial experience. Final analysis of REASSURE is due in 2024. Funding Bayer HealthCare.
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Affiliation(s)
- Celestia S. Higano
- Departments of Medicine and Urology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel J. George
- Departments of Medicine and Surgery, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Neal D. Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Oliver Sartor
- Departments of Medicine and Urology, Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kurt Miller
- Department of Urology, Charité University Hospital, Berlin, Germany
| | - Peter S. Conti
- Molecular Imaging Center, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Cora N. Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Department of Medicine, Meyer Cancer Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Fred Saad
- Department of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Juan Pablo Sade
- Department of Clinical Oncology, Alexander Fleming Institute, Buenos Aires, Argentina
| | - Joaquim Bellmunt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew R. Smith
- Genitourinary Oncology Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | | | | | - Bertrand Tombal
- Division of Urology, IREC, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
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Habuchi T. Re: Continuous Enzalutamide After Progression of Metastatic Castration-resistant Prostate Cancer Treated with Docetaxel (PRESIDE): An International, Randomised, Phase 3b Study. Eur Urol 2023:S0302-2838(23)02630-1. [PMID: 36870797 DOI: 10.1016/j.eururo.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
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Kim VS, Yang H, Timilshina N, Breunis H, Emmenegger U, Gregg R, Hansen AR, Tomlinson G, Alibhai SMH. The role of frailty in modifying physical function and quality of life over time in older men with metastatic castration-resistant prostate cancer. J Geriatr Oncol 2023; 14:101417. [PMID: 36682218 DOI: 10.1016/j.jgo.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION As treatment options for metastatic castration-resistant prostate cancer (mCRPC) expand and its patient population ages, consideration of frailty is increasingly relevant. Using a novel frailty index (FI) and two common frailty screening tools, we examined quality of life (QoL) and physical function (PF) in frail versus non-frail men receiving treatment for mCRPC. MATERIALS AND METHODS Men aged 65+ starting docetaxel chemotherapy, abiraterone, or enzalutamide for mCRPC were enrolled in a multicenter prospective cohort study. QoL, fatigue, pain, and mood were measured with the Functional Assessment of Cancer Therapy-General scale, the Edmonton Symptom Assessment System tiredness and pain subscales, and the Patient Health Questionnaire-9. PF was evaluated with grip strength, four-meter gait speed, five times Sit-to-Stand Test, and instrumental activities of daily living. Frailty was determined using the Vulnerable Elders Survey (VES-13), the Geriatric 8 (G8), and an FI constructed from 36 variables spanning laboratory abnormalities, geriatric syndromes, functional status, social support, as well as emotional, cognitive, and physical deficits. We categorized patients as non-frail (FI ≤ 0.2, VES < 3, G8 > 14), pre-frail (FI > 0.20, ≤0.35), or frail (FI > 0.35, VES ≥ 3, G8 ≤ 14); assessed correlation between the three tools; and performed linear mixed-effects regression analyses to examine longitudinal differences in outcomes (0, 3, 6 months) by frailty status. A sensitivity analysis with worst-case imputation was conducted to explore attrition. RESULTS We enrolled 175 men (mean age 74.9 years) starting docetaxel (n = 71), abiraterone (n = 37), or enzalutamide (n = 67). Our FI demonstrated moderate correlation with the VES-13 (r = 0.607, p < 0.001) and the G8 (r = -0.520, p < 0.001). Baseline FI score was associated with worse QoL (p < 0.001), fatigue (p < 0.001), pain (p < 0.001), mood (p < 0.001), PF (p < 0.001), and higher attrition (p < 0.01). Over time, most outcomes remained stable, although pain improved, on average, regardless of frailty status (p = 0.007), while fatigue (p = 0.045) and mood (p = 0.015) improved in frail patients alone. DISCUSSION Among older men receiving care for mCRPC, frailty may be associated with worse baseline QoL and PF, but over time, frail patients may experience largely similar trends in QoL and PF as their non-frail counterparts. Further study with larger sample size and longer follow-up may help elucidate how best to incorporate frailty into treatment decision-making for mCRPC.
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Affiliation(s)
- Valerie S Kim
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Helen Yang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Urban Emmenegger
- Department of Medicine, University of Toronto, Toronto, Canada; Division of Medical Oncology, Odette Cancer Centre, Toronto, Canada
| | - Richard Gregg
- Division of Medical Oncology, Queen's University, Kingston, Canada
| | - Aaron R Hansen
- Department of Medicine, University of Toronto, Toronto, Canada; Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
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9
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Fontes MS, Schutz FA, de Almeida Luz M, Bomfim G, Saturnino LTM, Goncalves SC, Soler R. Treatment Patterns Among Patients With Advanced Prostate Cancer in Brazil: An Analysis of a Private Healthcare System Database. World J Oncol 2022; 13:350-358. [PMID: 36660210 PMCID: PMC9822688 DOI: 10.14740/wjon1476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/01/2022] [Indexed: 12/26/2022] Open
Abstract
Background With the ongoing expansion of life-prolonging therapies approved to treat advanced prostate cancer, there is currently an unmet need to better understand real-world treatment patterns and identify optimal treatment sequencing for men with metastatic castration-resistant prostate cancer (mCRPC). Methods In this retrospective, observational cohort analysis, patients with confirmed mCRPC were identified in the Auditron claims database and used to describe mCRPC treatment patterns and trends in the Brazilian private healthcare system from 2014 to 2019. Demographics and clinical characteristics, prostate cancer stage at diagnosis, and type and number of treatment lines were evaluated. The primary endpoint was identification of the drugs used in first-line therapies in mCRPC, and the secondary endpoint included a description of sequential lines of therapy (second and third lines) in mCRPC. Results A total of 168 electronic patient records were reviewed. Docetaxel was the most frequently used first-line treatment (35.7%), followed by abiraterone (33.3%) and enzalutamide (13.1%). Docetaxel, abiraterone, and enzalutamide also accounted for 34.6%, 28.0%, and 15.0%, respectively, of second-line therapies. In third-line therapies, cabazitaxel (26.1%), enzalutamide (23.9%), docetaxel (15.2%), and abiraterone (15.2%) were most commonly prescribed. Irrespective of stage at diagnosis, treatment patterns were similar once the disease progressed to the metastatic castration-resistance stage. Conclusions Docetaxel was the most frequently utilized therapy for mCRPC treatment, followed by abiraterone and enzalutamide. Although the current analyses provide real-world insights into treatment patterns for patients with mCRPC in Brazil, additional real-world data are needed to further validate and expand on these findings.
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Affiliation(s)
| | - Fabio A. Schutz
- Medical Oncology, Beneficencia Portuguesa de Sao Paulo, Sao Paulo 01323-001, Brazil
| | | | - Giovanni Bomfim
- Medical Affairs, Astellas Pharma Brazil, Sao Paulo - SP 04583-110, Brazil
| | | | | | - Roberto Soler
- Medical Affairs, Astellas Pharma Brazil, Sao Paulo - SP 04583-110, Brazil,Corresponding Author: Roberto Soler, Medical Affairs, Astellas Pharma Brazil, Sao Paulo - SP 04583-110, Brazil.
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10
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Castellón EA, Indo S, Contreras HR. Cancer Stemness/Epithelial-Mesenchymal Transition Axis Influences Metastasis and Castration Resistance in Prostate Cancer: Potential Therapeutic Target. Int J Mol Sci 2022; 23:ijms232314917. [PMID: 36499245 PMCID: PMC9736174 DOI: 10.3390/ijms232314917] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
Abstract
Prostate cancer (PCa) is a leading cause of cancer death in men, worldwide. Mortality is highly related to metastasis and hormone resistance, but the molecular underlying mechanisms are poorly understood. We have studied the presence and role of cancer stem cells (CSCs) and the Epithelial-Mesenchymal transition (EMT) in PCa, using both in vitro and in vivo models, thereby providing evidence that the stemness-mesenchymal axis seems to be a critical process related to relapse, metastasis and resistance. These are complex and related processes that involve a cooperative action of different cancer cell subpopulations, in which CSCs and mesenchymal cancer cells (MCCs) would be responsible for invading, colonizing pre-metastatic niches, initiating metastasis and an evading treatments response. Manipulating the stemness-EMT axis genes on the androgen receptor (AR) may shed some light on the effect of this axis on metastasis and castration resistance in PCa. It is suggested that the EMT gene SNAI2/Slug up regulates the stemness gene Sox2, and vice versa, inducing AR expression, promoting metastasis and castration resistance. This approach will provide new sight about the role of the stemness-mesenchymal axis in the metastasis and resistance mechanisms in PCa and their potential control, contributing to develop new therapeutic strategies for patients with metastatic and castration-resistant PCa.
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Affiliation(s)
- Enrique A. Castellón
- Correspondence: (E.A.C.); (H.R.C.); Tel.: +56-229-786-863 (E.A.C.); +56-229-786-862 (H.R.C.)
| | | | - Héctor R. Contreras
- Correspondence: (E.A.C.); (H.R.C.); Tel.: +56-229-786-863 (E.A.C.); +56-229-786-862 (H.R.C.)
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11
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Padmakar Darne C, Velaparthi U, Saulnier M, Frennesson D, Liu P, Huang A, Tokarski J, Fura A, Spires T, Newitt J, Spires VM, Obermeier MT, Elzinga PA, Gottardis MM, Jayaraman L, Vite GD, Balog A. The Discovery of BMS-737 as a Potent, CYP17 Lyase-Selective Inhibitor for the Treatment of Castration-Resistant Prostate Cancer. Bioorg Med Chem Lett 2022; 75:128951. [PMID: 36031020 DOI: 10.1016/j.bmcl.2022.128951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/14/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022]
Abstract
We report herein, the discovery of BMS-737 (compound 33) as a potent, non-steroidal, reversible small molecule inhibitor demonstrating 11-fold selectivity for CYP17 lyase over CYP17 hydroxylase, as well as a clean xenobiotic CYP profile for the treatment of castration-resistant prostate cancer (CRPC). Extensive SAR studies on the initial lead 1 at three different regions of the molecule resulted in the identification of BMS-737, which demonstrated a robust 83% lowering of testosterone without any significant perturbation of the mineralocorticoid and glucocorticoid levels in cynomologous monkeys in a 1-day PK/PD study.
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Affiliation(s)
| | - Upender Velaparthi
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States.
| | - Mark Saulnier
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - David Frennesson
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Peiying Liu
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Audris Huang
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - John Tokarski
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Aberra Fura
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Thomas Spires
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - John Newitt
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Vanessa M Spires
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Mary T Obermeier
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Paul A Elzinga
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Marco M Gottardis
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Lata Jayaraman
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Gregory D Vite
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Aaron Balog
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
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Eke I, Aryankalayil MJ, Bylicky MA, Sandfort V, Vanpouille-Box C, Nandagopal S, Graves EE, Giaccia AJ, Coleman CN. Long-term expression changes of immune-related genes in prostate cancer after radiotherapy. Cancer Immunol Immunother 2022; 71:839-850. [PMID: 34435232 PMCID: PMC8873240 DOI: 10.1007/s00262-021-03036-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/16/2021] [Indexed: 01/14/2023]
Abstract
The expression of immune-related genes in cancer cells can alter the anti-tumor immune response and thereby impact patient outcomes. Radiotherapy has been shown to modulate immune-related genes dependent on the fractionation regimen. To identify long-term changes in gene expression after irradiation, PC3 (p53 deleted) and LNCaP (p53 wildtype) prostate cancer cells were irradiated with either a single dose (SD, 10 Gy) or a fractionated regimen (MF) of 10 fractions (1 Gy per fraction). Whole human genome arrays were used to determine gene expression at 24 h and 2 months after irradiation. Immune pathway activation was analyzed with Ingenuity Pathway Analysis software. Additionally, 3D colony formation assays and T-cell cytotoxicity assays were performed. LNCaP had a higher basal expression of immunogenic genes and was more efficiently killed by cytotoxic T-cells compared to PC3. In both cell lines, MF irradiation resulted in an increase in multiple immune-related genes immediately after irradiation, while at 2 months, SD irradiation had a more pronounced effect on radiation-induced gene expression. Both immunogenic and immunosuppressive genes were upregulated in the long term in PC3 cells by a 10 Gy SD irradiation but not in LNCaP. T-cell-mediated cytotoxicity was significantly increased in 10 Gy SD PC3 cells compared to the unirradiated control and could be further enhanced by treatment with immune checkpoint inhibitors. Irradiation impacts the expression of immune-related genes in cancer cells in a fractionation-dependent manner. Understanding and targeting these changes may be a promising strategy for primary prostate cancer and recurrent tumors.
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Affiliation(s)
- Iris Eke
- Department of Radiation Oncology, Center for Clinical Sciences Research (CCSR), Stanford University School of Medicine, 269 Campus Dr., Room 1260, Stanford, CA, 94305, USA.
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Molykutty J Aryankalayil
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Michelle A Bylicky
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Veit Sandfort
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | | | - Saravanan Nandagopal
- Department of Radiation Oncology, Center for Clinical Sciences Research (CCSR), Stanford University School of Medicine, 269 Campus Dr., Room 1260, Stanford, CA, 94305, USA
| | - Edward E Graves
- Department of Radiation Oncology, Center for Clinical Sciences Research (CCSR), Stanford University School of Medicine, 269 Campus Dr., Room 1260, Stanford, CA, 94305, USA
| | - Amato J Giaccia
- Department of Radiation Oncology, Center for Clinical Sciences Research (CCSR), Stanford University School of Medicine, 269 Campus Dr., Room 1260, Stanford, CA, 94305, USA
- Oxford Institute of Radiation Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, OX37DQ, UK
| | - C Norman Coleman
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA
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13
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Shore ND, Laliberté F, Ionescu-Ittu R, Yang L, Mahendran M, Lejeune D, Yu LH, Burgents J, Duh MS, Ghate SR. Real-World Treatment Patterns and Overall Survival of Patients with Metastatic Castration-Resistant Prostate Cancer in the US Prior to PARP Inhibitors. Adv Ther 2021; 38:4520-4540. [PMID: 34282527 PMCID: PMC8342357 DOI: 10.1007/s12325-021-01823-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/08/2021] [Indexed: 12/19/2022]
Abstract
Introduction Therapeutic options for metastatic castration-resistant prostate cancer (mCRPC) patients are continuously advancing. We described mCRPC treatment patterns in the US from 2013 to 2019. Methods Patients with a confirmed mCRPC diagnosis and adenocarcinoma histology were included in the US Flatiron Health Electronic Health Record-derived de-identified database. Treatment patterns [including treatment per lines of therapies (LOTs), LOT sequences, and time on treatment] and overall survival (OS) have been described in mCRPC settings. Results Of 5213 patients (mean age: 72.6 years), 4374 (83.9%) were treated with ≥ 1 LOT post-mCRPC diagnosis (among those with ≥ 1 LOT, 55.3%, 29.5%, 14.7%, and 6.7% had ≥ 2, 3, 4, and 5 LOTs, respectively). In first line (1L), the main treatment class was next-generation hormonal agents (NHA; 62.5% of patients with ≥ 1 LOT), while the shortest and longest time on 1L were observed for chemotherapy (median 2.8 months) and NHA (median 5.1 months), respectively. The most common LOT sequences were NHA → NHA (29.4% of patients with ≥ 2 LOTs) and NHA → NHA → chemotherapy (16.7% of patients with ≥ 3 LOTs). In Kaplan–Meier analyses, the median OS was 19.4, 14.6, and 11.1 months post-1L, 2L, and 3L start, respectively. Patients who moved rapidly through LOTs had an increased risk of death. Conclusions NHA were widely used as 1L therapy in mCRPC patients from 2013 to 2019, but time on 1L NHA treatment was on average < 6 months. While NHA → NHA was the most observed 1L → 2L LOT sequence, a plethora of other LOT sequences were observed. OS was poor, highlighting an unmet need for life-prolonging treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01823-6.
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Affiliation(s)
- Neal D Shore
- Carolina Urologic Research Center, 823 82nd Pkwy Suite b, Myrtle Beach, SC, 29572, USA
| | - François Laliberté
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Raluca Ionescu-Ittu
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC, H3B 0G7, Canada.
| | - Lingfeng Yang
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | - Malena Mahendran
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Dominique Lejeune
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Louise H Yu
- Analysis Group, Inc, 111 Huntington Ave 14th Floor, Boston, MA, 02199, USA
| | - Joseph Burgents
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | - Mei Sheng Duh
- Analysis Group, Inc, 111 Huntington Ave 14th Floor, Boston, MA, 02199, USA
| | - Sameer R Ghate
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
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14
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Shore ND, Ionescu-Ittu R, Laliberté F, Yang L, Lejeune D, Yu L, Duh MS, Mahendran M, Kim J, Ghate SR. Beyond Frontline Therapy with Abiraterone and Enzalutamide in Metastatic Castration-Resistant Prostate Cancer: A Real-World US Study. Clin Genitourin Cancer 2021; 19:480-490. [PMID: 34373223 DOI: 10.1016/j.clgc.2021.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/27/2021] [Accepted: 07/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Real-world evidence suggest that next generation hormonal agents (NHAs) abiraterone and enzalutamide were preferred as first-line (1L) therapies for metastatic castration-resistant prostate cancer (mCRPC) in the United States (US) pre-2020, with chemotherapies, particularly docetaxel, being preferred in subsequent lines (2L+). This real-world study described patient characteristics, treatment patterns, time on treatment (ToT) and overall survival (OS) among patients with mCRPC treated with 2L and 3L docetaxel post-NHAs in the mCRPC setting. METHODS Adults with confirmed adenocarcinoma mCRPC diagnosis and ≥1 month of follow-up post-diagnosis were selected from a US electronic health record-derived oncology de-identified database (01/2013-03/2019). Based on the observed line of therapy sequences post-mCRPC diagnosis, patients who received NHA therapy in 1L and docetaxel therapy in 2L were included in the 2L docetaxel cohort, and patients who received NHA therapy in both 1L and 2L and docetaxel therapy in 3L were included in the 3L docetaxel cohort. ToT and OS were evaluated using Kaplan-Meier analysis. RESULTS Among 5,213 patients with mCRPC, 278 and 166 were included in the 2L and the 3L docetaxel cohorts, respectively (median age: 73 years for both cohorts). ADT was the most used class of medication pre-mCRPC (>75%). For the 2L cohort, the most common sequence post-mCRPC was 1L abiraterone → 2L docetaxel (52.5%), while the median ToT and OS post-2L start were 4.1 and 10.5 months, respectively; for the 3L cohort, the most common sequence post-mCRPC was 1L abiraterone → 2L enzalutamide → 3L docetaxel (67.5%), while the median ToT and OS post-3L start were 3.8 and 8.7 months, respectively. CONCLUSIONS This real-world study provides novel data on patients treated with docetaxel post-NHAs in a mCRPC setting and highlights the critical unmet need for developing more effective treatment options in this population.
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Affiliation(s)
- Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach.
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15
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Pereira-Salgado A, Kwan EM, Tran B, Gibbs P, De Bono J, IJzerman M. Systematic Review of Efficacy and Health Economic Implications of Real-world Treatment Sequencing in Prostate Cancer: Where Do the Newer Agents Enzalutamide and Abiraterone Fit in? Eur Urol Focus 2021; 7:752-763. [DOI: 10.1016/j.euf.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/11/2020] [Accepted: 03/04/2020] [Indexed: 11/30/2022]
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16
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Kobayashi K, Okuno N, Arai G, Nakatsu H, Maniwa A, Kamiya N, Satoh T, Kikukawa H, Nasu Y, Uemura H, Nakashima T, Mikami K, Iinuma M, Tanabe K, Furukawa J, Kobayashi H. Efficacy and safety of abiraterone acetate plus prednisolone in patients with early metastatic castration-resistant prostate cancer who failed first-line androgen-deprivation therapy: a single-arm, phase 4 study. Jpn J Clin Oncol 2021; 51:544-551. [PMID: 33324967 PMCID: PMC8012350 DOI: 10.1093/jjco/hyaa225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022] Open
Abstract
Aim The aim was to evaluate the efficacy and safety of abiraterone acetate plus prednisolone in patients with chemotherapy-naïve early metastatic castration-resistant prostate cancer who failed first-line androgen deprivation therapy. Methods Patients with early metastatic castration-resistant prostate cancer with confirmed prostate-specific antigen progression within 1-year or prostate-specific antigen progression without having normal prostate-specific antigen level (<4.0 ng/mL) during first-line androgen deprivation therapy were enrolled and administered abiraterone acetate (1000 mg) plus prednisolone (10 mg). A minimum of 48 patients were required according to Simon’s minimax design. The primary endpoint was prostate-specific antigen response rate (≥50% prostate-specific antigen decline by 12 weeks), secondary endpoints included prostate-specific antigen progression-free survival and overall survival. Safety parameters were also assessed. Results For efficacy, 49/50 patients were evaluable. Median age was 73 (range: 55–86) years. The median duration of initial androgen deprivation therapy was 32.4 (range: 13.4–84.1) weeks and 48 patients experienced prostate-specific antigen progression within 1-year after initiation of androgen deprivation therapy. prostate-specific antigen response rate was 55.1% (95% confidence interval: 40.2%–69.3%), median prostate-specific antigen–progression-free survival was 24.1 weeks, and median overall survival was 102.9 weeks (95% confidence interval: 64.86 not estimable [NE]). Most common adverse event was nasopharyngitis (15/50 patients, 30.0%). The most common ≥grade 3 adverse event was alanine aminotransferase increased (6/50 patients, 12.0%). Conclusions Abiraterone acetate plus prednisolone demonstrated a high prostate-specific antigen response rate of 55.1%, suggesting tumor growth still depends on androgen synthesis in patients with early metastatic castration-resistant prostate cancer. However, prostate-specific antigen–progression-free survival was shorter than that reported in previous studies. Considering the benefit–risk profile, abiraterone acetate plus prednisolone would be a beneficial treatment option for patients with chemotherapy-naive metastatic prostate cancer who show early castration resistance.
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Affiliation(s)
- K Kobayashi
- Department of Urology, Federation of National Public Service Personnel Mutual Aid Associations Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - N Okuno
- Department of Urology, Independent Administrative Institution National Hospital Organization Sagamihara Hospital, Kanagawa, Japan
| | - G Arai
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - H Nakatsu
- Department of Urology, Asahi General Hospital, Chiba, Japan
| | - A Maniwa
- Department of Urology, Independent Administrative Institution National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan
| | - N Kamiya
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | - T Satoh
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - H Kikukawa
- Department of Urology, Independent Administrative Institution National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Y Nasu
- Department of Urology, Japan Organization of Occupational Health and Safety Okayama Rosai Hospital, Okayama, Japan
| | - H Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Kanagawa, Japan
| | - T Nakashima
- Department of Urology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - K Mikami
- Department of Urology, Chibaken Saiseikai Narashino Hospital, Chiba, Japan
| | - M Iinuma
- Department of Urology, Independent Administrative Institution National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - K Tanabe
- Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - J Furukawa
- Department of Urology, National University Corporation Kobe University Hospital, Hyogo, Japan
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Petrylak DP, Vaishampayan UN, Patel KR, Higano CS, Albany C, Dawson NA, Mehlhaff BA, Quinn DI, Nordquist LT, Wagner VJ, Siegel J, Trandafir L, Sartor O. A randomized phase IIa study of quantified bone scan response in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with radium-223 dichloride alone or in combination with abiraterone acetate/prednisone or enzalutamide. ESMO Open 2021; 6:100082. [PMID: 33744812 PMCID: PMC7985394 DOI: 10.1016/j.esmoop.2021.100082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/04/2021] [Accepted: 01/23/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In metastatic castration-resistant prostate cancer (mCRPC), assessing treatment response and bone lesions with technetium-99m is limited by image resolution and subjectivity. We evaluated bone scan lesion area (BSLA), a quantitative imaging assessment of response in patients with mCRPC receiving radium-223 alone or in combination with androgen receptor pathway inhibitors (abiraterone/prednisone or enzalutamide). PATIENTS AND METHODS This randomized, non-comparative phase IIa three-arm trial (NCT02034552) evaluated technetium-99m-based BSLA response rate (RR), safety, radiologic progression-free survival (rPFS), and time to first symptomatic skeletal event (SSE) in men with mCRPC and bone metastases receiving radium-223 with/without abiraterone/prednisone or enzalutamide. The primary endpoint was week 24 BSLA RR. RESULTS Overall, 63 patients received treatment (abiraterone/prednisone combination, n = 22; enzalutamide combination, n = 22; radium-223 monotherapy, n = 19). Median treatment duration (first to last dose of any study treatment) was 12 months (abiraterone/prednisone combination), 10 months (enzalutamide combination), and 3 months (radium-223 monotherapy). Week 24 BSLA RR was 58% [80% confidence interval (CI) 41% to 74%; one-sided P < 0.0001; 11/19 patients] with abiraterone/prednisone combination, 50% (32% to 68%; one-sided P < 0.0001; 8/16 patients) with enzalutamide combination, and 22% (10% to 40%; one-sided P = 0.0109; 4/18 patients) with radium-223 monotherapy. Median rPFS was not evaluable for combination arms and 4 months (80% CI 4 to 12) for monotherapy. SSEs were reported in 32% of patients; median time to first SSE was not estimable. Fatigue and back pain were the most commonly reported treatment-emergent adverse events (TEAEs); more patients receiving combination therapy than monotherapy had TEAEs. Fractures were reported in 18% receiving abiraterone/prednisone, 32% receiving enzalutamide, and 11% receiving radium-223 monotherapy. Fracture rates were lower in patients taking bone health agents versus not taking bone health agents at baseline. CONCLUSIONS Technetium-99m imaging BSLA may offer objective, quantifiable assessment of isotope uptake changes, and potentially treatment response, in patients with mCRPC and bone metastases treated with radium-223 alone or in combination with abiraterone/prednisone or enzalutamide. In this largely treatment-naive population, BSLA RR was numerically lower with radium-223 monotherapy versus combination therapy, indicating a limited role as first-line treatment. Use of radium-223 should follow evidence-based treatment guidelines and the licensed indication.
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Affiliation(s)
- D P Petrylak
- Department of Urology, Yale School of Medicine, New Haven, USA.
| | - U N Vaishampayan
- Division of Solid Tumor Oncology, Karmanos Cancer Institute, Detroit, USA
| | - K R Patel
- Arizona Institute of Urology, Tucson, USA
| | | | - C Albany
- Indiana University Health Melvin and Bren Simon Cancer Center, Indianapolis, USA
| | - N A Dawson
- Georgetown Lombardi Comprehensive Cancer Center, Washington, USA
| | | | - D I Quinn
- Department of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, USA
| | - L T Nordquist
- Department of Medical Oncology, Genitourinary Research Network, Omaha, USA
| | - V J Wagner
- Bayer Consumer Care AG, Basel, Switzerland
| | - J Siegel
- Oncology Clinical Statistics, Bayer HealthCare Pharmaceuticals Inc., Whippany, USA
| | | | - O Sartor
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, USA
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18
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Elmore LW, Greer SF, Daniels EC, Saxe CC, Melner MH, Krawiec GM, Cance WG, Phelps WC. Blueprint for cancer research: Critical gaps and opportunities. CA Cancer J Clin 2021; 71:107-139. [PMID: 33326126 DOI: 10.3322/caac.21652] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 12/12/2022] Open
Abstract
We are experiencing a revolution in cancer. Advances in screening, targeted and immune therapies, big data, computational methodologies, and significant new knowledge of cancer biology are transforming the ways in which we prevent, detect, diagnose, treat, and survive cancer. These advances are enabling durable progress in the goal to achieve personalized cancer care. Despite these gains, more work is needed to develop better tools and strategies to limit cancer as a major health concern. One persistent gap is the inconsistent coordination among researchers and caregivers to implement evidence-based programs that rely on a fuller understanding of the molecular, cellular, and systems biology mechanisms underpinning different types of cancer. Here, the authors integrate conversations with over 90 leading cancer experts to highlight current challenges, encourage a robust and diverse national research portfolio, and capture timely opportunities to advance evidence-based approaches for all patients with cancer and for all communities.
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Affiliation(s)
- Lynne W Elmore
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Susanna F Greer
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Elvan C Daniels
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Charles C Saxe
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Michael H Melner
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Ginger M Krawiec
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - William G Cance
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - William C Phelps
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
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19
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Ahmed ME, Joshi VB, Badawy M, Pagliaro LC, Karnes RJ, Lowe V, Thorpe MP, Kwon ED, Kendi AT. Radium-223 in the Third-Line Setting in Metastatic Castration-Resistant Prostate Cancer: Impact of Concomitant Use of Enzalutamide on Overall Survival (OS) and Predictors of Improved OS. Clin Genitourin Cancer 2021; 19:223-229. [PMID: 33632570 DOI: 10.1016/j.clgc.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/22/2020] [Accepted: 12/26/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Radium-223 (Ra-223) has been recommended for bone-dominant metastatic castration-resistant prostate cancer (mCRPC). Second-generation hormone therapy in combination with Ra-223 in mCRPC has been utilized, yet its benefit has not been well elucidated. We investigated the potential survival benefit of concomitant enzalutamide with Ra-223 in the third-line setting and predictors of improved overall survival (OS). PATIENTS AND METHODS We retrospectively identified 51 patients with bone-dominant mCRPC that were treated with Ra-223 in the postchemotherapy and post-hormone therapy setting, either alone (group A; n = 32) or with concomitant enzalutamide (group B; n = 19). The primary endpoint was to study the OS difference between groups A and B. The secondary endpoint was to identify predictors of improved OS with Ra-223 in the third-line setting. RESULTS Mean age was 70.9 years, median baseline prostatic-specific antigen (PSA) was 23.1 ng/mL, alkaline phosphatase was 91 IU/L, and hemoglobin was 12.5 g/dL. There was no difference in median OS between groups A and B, at 20.4 versus 17.5 months, respectively (P = .5186). In univariate and multivariate analyses, only pre-Ra-223 PSA < 30 ng/mL and Eastern Cooperative Oncology Group performance status < 2 were associated with improved OS. CONCLUSION In our study cohort, concomitant use of enzalutamide with Ra-223 in the mCRPC setting was not associated with improved OS. Only pretreatment PSA < 30 ng/mL and pretreatment Eastern Cooperative Oncology Group performance status < 2 were associated with improved OS. Further prospective studies are warranted.
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Affiliation(s)
| | | | - Mohamed Badawy
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN
| | - Lance C Pagliaro
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Val Lowe
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN
| | - Matthew P Thorpe
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - A Tuba Kendi
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN
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20
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España S, Ochoa de Olza M, Sala N, Piulats JM, Ferrandiz U, Etxaniz O, Heras L, Buisan O, Pardo JC, Suarez JF, Barretina P, Comet J, Garcia Del Muro X, Sumoy L, Font A. PSA Kinetics as Prognostic Markers of Overall Survival in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Abiraterone Acetate. Cancer Manag Res 2020; 12:10251-10260. [PMID: 33116879 PMCID: PMC7584507 DOI: 10.2147/cmar.s270392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background Abiraterone acetate (AA) is widely used in the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC). However, a significant percentage of patients will still progress, highlighting the need to identify patients more likely to benefit from AA. Parameters linked to prostate-specific antigen (PSA) kinetics are promising prognostic markers. We have examined clinical and PSA-related factors potentially associated with overall survival (OS) in patients treated with AA. Methods Between 2011 and 2014, 104 patients with mCRPC treated with AA after progression to docetaxel at centers of the Catalan Institute of Oncology were included in this retrospective study. Patients were assessed monthly. Baseline characteristics and variables related to PSA kinetics were included in univariate and multivariate analyses of OS. Results Median OS was 16.4 months (range 12.4-20.6) for all patients. The univariate analysis identified the following baseline characteristics as significantly associated with OS: ECOG PS, location of metastases, time between starting androgen deprivation therapy and starting AA, time between stopping docetaxel treatment and starting AA, neutrophil-lymphocyte ratio (NLR), alkaline phosphatase levels, and PSA levels. Factors related to PSA kinetics associated with longer OS were PSA response >50%, early PSA response (>30% decline at four weeks), PSA decline >50% at week 12, PSA nadir <2.4ng/mL, time to PSA nadir >140 days, the combination of PSA nadir and time to PSA nadir, and low end-of-treatment PSA levels. The multivariate analysis identified ECOG PS (HR 37.46; p<0.001), NLR (HR 3.7; p<0.001), early PSA response (HR 1.22; p=0.002), and time to PSA nadir (HR 0.39; p=0.002) as independent prognostic markers. Conclusion Our results indicate an association between PSA kinetics, especially early PSA response, and outcome to AA after progression to docetaxel. Taken together with other factors, lack of an early PSA response could identify patients who are unlikely to benefit from AA and who could be closely monitored with a view to offering alternative therapies.
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Affiliation(s)
- Sofia España
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Maria Ochoa de Olza
- Catalan Institute of Oncology, Medical Oncology Department, Bellvitge University Hospital, Hospitalet De Llobregat, Spain
| | - Nuria Sala
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Josep Trueta, Girona, Spain
| | - Josep Maria Piulats
- Catalan Institute of Oncology, Medical Oncology Department, Bellvitge University Hospital, Hospitalet De Llobregat, Spain
| | - Ulises Ferrandiz
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Olatz Etxaniz
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Lucia Heras
- Catalan Institute of Oncology, Medical Oncology Department, Bellvitge University Hospital, Hospitalet De Llobregat, Spain.,Medical Oncology Department, Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Oscar Buisan
- Urology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Juan Carlos Pardo
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Jose F Suarez
- Urology Department, Bellvitge University Hospital, Hospitalet de LLobregat, Spain
| | - Pilar Barretina
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Josep Trueta, Girona, Spain
| | - Josep Comet
- Urology Department, University Hospital Josep Trueta, Girona, Spain
| | - Xavier Garcia Del Muro
- Catalan Institute of Oncology, Medical Oncology Department, Bellvitge University Hospital, Hospitalet De Llobregat, Spain
| | - Lauro Sumoy
- High Content Genomics & Bioinformatics Unit, Germans Trias I Pujol Research Institute (IGTP), Program of Predictive and Personalized Medicine of Cancer (PMPPC), Campus Can Ruti, Badalona, Spain
| | - Albert Font
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
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21
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George DJ, Sartor O, Miller K, Saad F, Tombal B, Kalinovský J, Jiao X, Tangirala K, Sternberg CN, Higano CS. Treatment Patterns and Outcomes in Patients With Metastatic Castration-resistant Prostate Cancer in a Real-world Clinical Practice Setting in the United States. Clin Genitourin Cancer 2020; 18:284-294. [DOI: 10.1016/j.clgc.2019.12.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
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Moussa M, Papatsoris A, Abou Chakra M, Sryropoulou D, Dellis A. Pharmacotherapeutic strategies for castrate-resistant prostate cancer. Expert Opin Pharmacother 2020; 21:1431-1448. [PMID: 32469248 DOI: 10.1080/14656566.2020.1767069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Metastatic castration-resistant prostate cancer (CRPC) is a potentially symptomatic disease with an eventual lethal outcome. Novel pharmaceutical agents are continuously studied with encouraging results in CRPC. AREAS COVERED In this perspective, the authors present established and promising pharmacotherapeutic strategies for the management of CRPC; both with and without metastases. Apart from the different treatment strategies, the authors present the relevant sequence of treatment through disease progression. EXPERT OPINION Usually, docetaxel should be considered the first line treatment in mCRPC. Abiraterone acetate (AA) plus prednisone or enzalutamide (ENZ) could be alternative treatments in chemotherapy naïve patients. Sipuleucel-T has been approved for the treatment of asymptomatic or minimally symptomatic mCRPC. Ra-223 has been approved for patients with mCRPC with symptomatic bone metastases (not visceral metastases). Cabazitaxel has been approved as the second line treatment to docetaxel in mCRPC. No differences in the overall survival has been observed between sequences starting with docetaxel versus AA/ENZ. Between AA-to-ENZ and ENZ-to-AA sequence, the AA-to-ENZ sequence appeared to be more favorable than the ENZ-to-AA regarding progression-free survival but not overall survival. Carbazitaxel seemed to retain its activity regardless of the treatment sequence. Of note, ENZ and apalutamide have been approved in non-metastatic CRPC.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University , Beirut, Lebanon
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens , Athens, Greece
| | - Mohamed Abou Chakra
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University , Beirut, Lebanon
| | | | - Athanasios Dellis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens , Athens, Greece.,Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens , Athens
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23
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Concurrent or layered treatment with radium-223 and enzalutamide or abiraterone/prednisone: real-world clinical outcomes in patients with metastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis 2020; 23:680-688. [PMID: 32404868 PMCID: PMC7655504 DOI: 10.1038/s41391-020-0236-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/09/2020] [Accepted: 04/23/2020] [Indexed: 11/08/2022]
Abstract
Background In this study, we evaluated real-world data on radium-223 plus abiraterone/prednisone or enzalutamide. Previously, the ERA 223 trial (NCT02043678) demonstrated increased fracture risk with concurrent treatment with radium-223 and abiraterone plus prednisone/prednisolone in patients with metastatic castration-resistant prostate cancer (mCRPC). Methods We used the Flatiron Health database to perform a retrospective study of patients with mCRPC treated with radium-223. Treatment with radium-223 plus abiraterone/prednisone or enzalutamide was defined as concurrent if both drugs started within 30 days of one another, or layered when the second drug started ≥30 days after the first. The index date was defined as the day of the first radium-223 dose. Outcome measures included symptomatic skeletal events (SSEs), overall survival (OS), and patterns of treatments received. Results Of the 625 patients treated with radium-223, 22% received it together with abiraterone/prednisone and 27% with enzalutamide. When these agents were combined, they were often initiated in a layered fashion (73% layered, 23% concurrent). Prior or concomitant bone health agents (BHAs) were received by 67% and 55% of patients, respectively. Median follow-up was 9 months. Overall, incidence rates for SSEs and pathologic fractures were 0.35 and 0.11 patients per person-year, respectively. Median OS from mCRPC diagnosis was 28.1 months. Conclusions In this real-world setting, combination treatments with radium-223 and abiraterone/prednisone or enzalutamide were common. These agents were more commonly given in a layered than a concurrent fashion. Incidence rates for SSEs were reduced when BHAs were used; however, BHAs were underutilized.
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24
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Nieder C, Dalhaug A, Haukland E. Is there a seasonal variation of survival after systemic chemotherapy for metastatic castration-resistant prostate cancer in a rural part of North Norway? Int J Circumpolar Health 2020; 79:1742520. [PMID: 32191614 PMCID: PMC7144237 DOI: 10.1080/22423982.2020.1742520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The winter darkness or polar night induces endocrine and metabolic mechanisms, which might reduce the efficacy of cancer treatment and thus contribute to shorter survival. Moreover, season-and weather-related treatment delays and irregularities might also cause reduced efficacy of anti-cancer drugs. Therefore, this study evaluated the prognostic impact of timing of chemotherapy (start during winter darkness or outside of this season), in terms of overall survival, in patients with metastatic castration-resistant prostate cancer (MCRPC) who received oncology care at the Nordland hospital Bodø. The study included 111 patients treated with first-line docetaxel chemotherapy for MCRPC. Twenty patients (18%) started their treatment during winter darkness (arbitrarily defined as ±4 weeks around 21 December). In unadjusted univariate analysis, survival was shorter in this group (median 10.2 vs. 18.9 months, p = 0.055). However, not all baseline parameters were equally distributed between the two groups. In multivariable-adjusted Cox regression analysis accounting for several confounding variables, only one factor was statistically significant: pre-chemotherapy serum lactate dehydrogenase level (a surrogate marker of disease burden). Thus, the present results suggest that seasonal variation is not a major contributor to the diverging survival outcomes observed after docetaxel chemotherapy.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT- the Arctic University of Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT- the Arctic University of Norway, Tromsø, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT- the Arctic University of Norway, Tromsø, Norway
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25
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Lorente D, Castro E, Lozano R, Puente J, Romero-Laorden N, Rodríguez-Vida A, Lainez N, Villatoro R, Llácer C, Cattrini C, Hernández A, Domenech M, Zambrana F, Almagro E, Luque R, Martinez E, López-Campos F, Gonzalez B, Méndez-Vidal MJ, Medina A, Piulats JM, Olmos D. Association Between Second Progression-free Survival (PFS2) and Overall Survival in Metastatic Castration-resistant Prostate Cancer. Eur Urol 2020; 77:763-766. [PMID: 32143923 DOI: 10.1016/j.eururo.2020.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/19/2020] [Indexed: 11/25/2022]
Affiliation(s)
- David Lorente
- Servicio de Oncología Médica, Hospital Provincial de Castellón, Castellón de la Plana, Spain; Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre, Madrid, Spain.
| | - Elena Castro
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre, Madrid, Spain; Genitourinary Cancer Translational Research Group, The Institute of Biomedical Research in Málaga, Málaga, Spain; IBIMA, UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain
| | - Rebeca Lozano
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre, Madrid, Spain; Genitourinary Cancer Translational Research Group, The Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Javier Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Nuria Romero-Laorden
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre, Madrid, Spain; Hospital Universitario La Princesa, Madrid, Spain
| | | | - Nuria Lainez
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Casilda Llácer
- Genitourinary Cancer Translational Research Group, The Institute of Biomedical Research in Málaga, Málaga, Spain; IBIMA, UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain
| | - Carlo Cattrini
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre, Madrid, Spain; Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | | | | | | | | | - Raquel Luque
- Complejo Hospitalario Universitario de Granada, Granada, Spain
| | | | - Fernando López-Campos
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre, Madrid, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Ana Medina
- Centro Oncológico de Galicia, A Coruña, Spain
| | | | - David Olmos
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre, Madrid, Spain; Genitourinary Cancer Translational Research Group, The Institute of Biomedical Research in Málaga, Málaga, Spain
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26
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Nieder C, Dalhaug A, Haukland E. Feasibility and efficacy of sequential systemic therapy for metastatic castration-resistant prostate cancer in a rural health care setting. Scand J Urol 2020; 54:110-114. [PMID: 32091322 DOI: 10.1080/21681805.2020.1730435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: The aim of this study was to evaluate the feasibility and efficacy, in terms of overall survival, of sequential systemic therapy in patients with metastatic castration-resistant prostate cancer (MCRPC) who lived in Nordland County, Norway, a large region with a challenging geography, yet only one department of oncology located in the main city, Bodø.Patients and methods: Overall 77 patients who had received at least 2 lines of treatment were included in this retrospective study.Results: Management included docetaxel in 69 patients (90%), often prescribed in first line. Only 12 patients (16%) started their treatment with a sequence of two endocrine drugs (enzalutamide or abiraterone acetate). Thirty-two patients (42%) were not eligible for treatment beyond second line, while 31 (40%) received 3 lines, and 14 (18%) more than 3 lines (for example cabazitaxel or Ra-223). Distance to the department of oncology did not predict for treatment with more than 2 lines. Only two factors were statistically significant: age <75 years and not initiating treatment with two lines of endocrine drugs. Survival increased with increasing number of lines of treatment. None of the five individual drugs available to these patients was significantly associated with survival.Conclusions: There was no indication toward under-treatment with systemic therapy among patients from the distant regions. Sequential treatment was feasible and survival increased with each additional line.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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Belderbos BPS, de Wit R, Lolkema MPJ, Mathijssen RHJ, van Soest RJ. Novel treatment options in the management of metastatic castration-naïve prostate cancer; which treatment modality to choose? Ann Oncol 2019; 30:1591-1600. [PMID: 31340031 DOI: 10.1093/annonc/mdz210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Androgen-deprivation therapy (ADT) has been the mainstay of treatment of metastatic prostate cancer since the first report of its hormonal dependence in the 1940s. Since 2015, the addition of docetaxel and the addition of abiraterone to ADT have conferred substantial overall survival benefit in men with metastatic castration-naïve prostate cancer (mCNPC). The shift of these treatment options for metastatic prostate cancer from the castration-resistant setting to the castration-naïve setting has led to new challenges in the management of this disease. It remains to be determined which patients may benefit most from either early concomitant docetaxel or from abiraterone with ADT, since biomarkers for early therapy response and risk stratification are currently lacking. Therefore, the ability to personalize medicine is hampered. Furthermore, the earlier detection of metastatic prostate cancer by using new imaging modalities makes the application of clinical trial results in daily practice increasingly challenging. Recently, both local radiotherapy to the primary tumor combined with ADT and abiraterone combined with ADT showed a survival benefit in low-volume disease patients. The latest data also demonstrated a survival benefit with the addition of apalutamide or enzalutamide to ADT. The extent of metastatic disease may become one of the most important factors to determine treatment choice. In this review article, we summarize trial data to provide guidance for treatment selection in metastatic castration-naïve prostate cancer.
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Affiliation(s)
- B P S Belderbos
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - R de Wit
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M P J Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - R H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - R J van Soest
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Urology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
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28
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Al‐Mansouri L, Gurney H. Clinical concepts for cabazitaxel in the management of metastatic castration‐resistant prostate cancer. Asia Pac J Clin Oncol 2019; 15:288-295. [DOI: 10.1111/ajco.13193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/07/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Loma Al‐Mansouri
- Department of Medical Oncology and Clinical Trials, Faculty of Medicine and Health SciencesMacquarie University NSW Australia
| | - Howard Gurney
- Department of Medical Oncology and Clinical Trials, Faculty of Medicine and Health SciencesMacquarie University NSW Australia
- Crown Princess Mary Cancer CentreWestmead Hospital NSW Australia
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29
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Ware RE, Williams S, Hicks RJ. Molecular Imaging of Recurrent and Metastatic Prostate Cancer. Semin Nucl Med 2019; 49:280-293. [DOI: 10.1053/j.semnuclmed.2019.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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30
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Bretoni A, Ferrario L, Foglia E. HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:283-300. [PMID: 31114269 PMCID: PMC6489625 DOI: 10.2147/ceor.s189436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/13/2019] [Indexed: 01/22/2023] Open
Abstract
Purpose: To investigate the implications of the introduction of two hormonal therapies, abiraterone acetate + prednisone (AA+P) and enzalutamide (ENZA), for the treatment of naïve patients with metastatic castration-resistant prostate cancer (mCRPC) in the Italian setting. Methods: In 2017–2018, a Health Technology Assessment was conducted in Italy, considering the National Healthcare Service (NHS) perspective. Data were retrieved from literature evidence, economic evaluations, and qualitative questionnaires, considering the 9 EUnetHTA dimensions, and a final multi-criteria approach. Results: On the basis of mCRPC prevalence and incidence rates in Italy, the analysis considered 11,212 males eligible to either AA+P or ENZA treatments. Both drugs led to an improvement of the patients' overall survival, with respect to the standard of care, composed of docetaxel chemotherapy. However, AA+P showed a higher rate of drug-related moderate adverse events and a monitoring activities incidence superior to ENZA (+70%, p-value=0.00), which led to a major resources absorption (€ 1,056.02 vs € 316.25, p-value=0.00), whereas ENZA showed a better cost-effectiveness average value (CEV: 54,586.12 vs 57,624.15). Economic savings ranging from 1.46% to 1.61% emerged for the NHS, as well as organizational advantages, with fewer minutes required for the mCRPC management (AA+P: 815 mins vs ENZA: 500 mins). According to experts’ perceptions, based on a 7-item Likert scale (ranging from −3 to +3), similar results emerged on ethical and social impact (ENZA: 1.35 vs AA+P: 1.48, p-value>0.05), and on legal dimension (ENZA: 0.67 vs AA+P: 0.67, p-value>0.05), since both drugs improved the patients’ quality of life and received approval for use. High-level perceptions related to ENZA adoption emerged with regard to equity (ENZA: 0.69 vs AA+P: 0.25, p-value<0.05), since it is cortisone-free. Multi-criteria approach analysis highlighted a higher score of ENZA than comparator (0.79 vs 0.60, p-value=0.00). Conclusion: The evidence-based information underlined the advantages of ENZA and AA+P treatments as therapeutic options for mCRPC patients. In the appraisal phase, the higher score than the comparator suggested ENZA as the preferred treatment for mCRPC.
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Affiliation(s)
- Alberto Bretoni
- Centre for Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Italy
| | - Lucrezia Ferrario
- Centre for Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Italy
| | - Emanuela Foglia
- Centre for Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Italy
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Impact of new systemic therapies on overall survival of patients with metastatic castration-resistant prostate cancer in a hospital-based registry. Prostate Cancer Prostatic Dis 2019; 22:420-427. [PMID: 30643173 DOI: 10.1038/s41391-018-0121-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 10/30/2018] [Accepted: 11/03/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND In 2004, docetaxel was shown to prolong the overall survival (OS) of patients with metastatic castration-resistance prostate cancer (mCRPC). Since 2010, five new systemic therapies have been shown to prolong OS in men with mCRPC. We sought to evaluate the aggregate impact of these newer therapies on the OS of patients with mCRPC. METHODS Two cohorts of patients diagnosed with mCRPC between 2004 and 2007, treated with drugs used in the limited treatment era only (A), and between 2010 and 2013, treated also with newer therapies (B), were identified from the Dana-Farber Cancer Institute database. The analysis endpoint was OS within 5 years after mCRPC diagnosis. Kaplan-Meier method assessed time-to-event distributions with median (95% confidence interval (CI)). A piece-wise regression model assessed the association between endpoint and treatment cohorts with estimate of hazard ratio (HR) with 95% CI within two time segments in univariate and multivariable analyses adjusting for relevant covariates. RESULTS Compared to cohort A (n = 318), cohort B (n = 272) patients in newer therapy era demonstrated an OS advantage (2.8 vs. 2.2 years) with a 41% decreased risk of death (HR = 0.59; 95% CI, 0.47-0.74; P < 0.0001), and a 3-year OS rate of 46% vs. 33%. This benefit was accentuated (median OS 2.7 vs. 2.1 years; HR = 0.46; 95% CI, 0.32-0.67; P < 0.0001) in patients who initially presented with de-novo metastatic disease (de-novo). On multivariable analysis, longer OS was associated with cohort B vs. A and performance status 0 vs. 1. CONCLUSIONS Using a single-institution registry, mCRPC patients treated since 2010 had a significant survival improvement vs. those treated before 2010. Although the median survival was only modestly improved and less than predicted when simply adding each newer drug survival advantage, the cumulative benefit from the new therapies was more pronounced in longer-term survivors and de-novo patients.
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Choi SY, Ryu J, You D, Jeong IG, Hong JH, Ahn H, Kim CS. Prognostic factors of oncologic outcomes in metastatic chemotherapy-naïve castration-resistant prostate cancer treated with enzalutamide in actual clinical practice in East Asia. Urol Oncol 2018; 36:401.e11-401.e18. [PMID: 30274641 DOI: 10.1016/j.urolonc.2018.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 06/05/2018] [Accepted: 06/09/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We aimed to evaluate the prognostic factors for chemotherapy-naïve castration-resistant prostate cancer (CRPC) treated with enzalutamide in actual clinical practice using easily accessible clinical variables. METHODS AND MATERIALS We retrospectively reviewed the following data from 113 patients with chemotherapy-naïve CRPC treated with enzalutamide: serum levels of prostate-specific antigen (PSA), testosterone, hemoglobin, total protein, albumin, and alkaline phosphatase (ALP); platelet, neutrophil, and lymphocyte counts; neutrophil-to-lymphocyte ratios (NLRs); and liver profiles. PSA progression-free survival (PFS), radiological PFS, and overall survival were estimated by Cox regression analysis. RESULTS Compared with baseline levels, laboratory values at 2 months showed significantly lower PSA (160.2 ± 351.5 ng/ml vs. 47.4 ± 117.1 ng/ml) and ALP levels (201.86 ± 223.77 IU/l vs. 148.25 ± 146.81 IU/l) and a significantly higher percentage of lymphocytes (28.1% ± 10.6% vs. 31.2% ± 9.7%); those at 1 month showed a significantly lower percentage of neutrophils (61.0% ± 11.0% vs. 57.1% ± 12.5%). In the multivariate analysis, poor prognostic factors for PSA PFS were Gleason score ≥ 9 (hazard ratio [HR] 2.022; P = 0.0250); visceral metastasis (HR 3.143; P = 0.0002); high NLR (HR 1.205; P = 0.0126); and high ALP (HR 1.002; P = 0.0015). For radiological PFS, high NLR (HR 1.249; P = 0.0002) and high ALP (HR 1.002; P = 0.0001) were associated with poor outcomes. The predictors of poor overall survival were visceral metastasis (HR 3.155; P < 0.0001); high NLR (HR 1.341; P < 0.0001); and high ALP (HR 1.001; P = 0.0017). CONCLUSION Enzalutamide is less effective in patients with metastatic chemotherapy-naïve CRPC with Gleason scores ≥ 9, visceral metastasis, high NLR, and high ALP.
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Affiliation(s)
- Se Young Choi
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Jeman Ryu
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea.
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Jadvar H, Colletti PM. 18F-NaF/ 223RaCl 2 theranostics in metastatic prostate cancer: treatment response assessment and prediction of outcome. Br J Radiol 2018; 91:20170948. [PMID: 29630398 PMCID: PMC6475949 DOI: 10.1259/bjr.20170948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/03/2018] [Accepted: 04/01/2018] [Indexed: 12/15/2022] Open
Abstract
Theranostics refers to companion agents with identical or similar structure targeted to a specific biological entity for imaging and treatment. Although the concept has a long history with radioiodine in thyroidology, but it has experienced remarkable recent renaissance in management of neuroendocrine tumors and prostate cancer. Bone scintigraphy based on osteoblastic reaction and targeted radionuclide therapy with the alpha-particle calcium-mimetic agent, 223RaCl2, also form a theranostic model for imaging and treatment of osseous metastatic disease. Since the regulatory approval of 223RaCl2 in 2013, there has been accumulating evidence on the potential use of 18F-NaF PET scintigraphy in the assessment of response and prediction of outcome in males with metastatic castrate-resistant prostate cancer who undergo 223RaCl2 therapy. We review the 18F-NaF/223RaCl2 as theranostic companion in the management of prostate cancer with emphasis on the utility of 18F-NaF and other relevant PET radiotracers in the therapy response and prognosis assessments.
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Affiliation(s)
- Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Patrick M Colletti
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Nordstrand A, Bovinder Ylitalo E, Thysell E, Jernberg E, Crnalic S, Widmark A, Bergh A, Lerner UH, Wikström P. Bone Cell Activity in Clinical Prostate Cancer Bone Metastasis and Its Inverse Relation to Tumor Cell Androgen Receptor Activity. Int J Mol Sci 2018; 19:ijms19041223. [PMID: 29670000 PMCID: PMC5979457 DOI: 10.3390/ijms19041223] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/14/2018] [Accepted: 04/14/2018] [Indexed: 12/24/2022] Open
Abstract
Advanced prostate cancer frequently metastasizes to bone and induces a mixed osteoblastic/osteolytic bone response. Standard treatment for metastatic prostate cancer is androgen-deprivation therapy (ADT) that also affects bone biology. Treatment options for patients relapsing after ADT are limited, particularly in cases where castration-resistance does not depend on androgen receptor (AR) activity. Patients with non-AR driven metastases may, however, benefit from therapies targeting the tumor microenvironment. Therefore, the current study specifically investigated bone cell activity in clinical bone metastases in relation to tumor cell AR activity, in order to gain novel insight into biological heterogeneities of possible importance for patient stratification into bone-targeting therapies. Metastasis tissue obtained from treatment-naïve (n = 11) and castration-resistant (n = 28) patients was characterized using whole-genome expression analysis followed by multivariate modeling, functional enrichment analysis, and histological evaluation. Bone cell activity was analyzed by measuring expression levels of predefined marker genes representing osteoclasts (ACP5, CTSK, MMP9), osteoblasts (ALPL, BGLAP, RUNX2) and osteocytes (SOST). Principal component analysis indicated a positive correlation between osteoblast and osteoclast activity and a high variability in bone cell activity between different metastases. Immunohistochemistry verified a positive correlation between runt-related transcription factor 2 (RUNX2) positive osteoblasts and tartrate-resistant acid phosphatase (TRAP, encoded by ACP5) positive osteoclasts lining the metastatic bone surface. No difference in bone cell activity was seen between treatment-naïve and castration-resistant patients. Importantly, bone cell activity was inversely correlated to tumor cell AR activity (measured as AR, FOXA1, HOXB13, KLK2, KLK3, NKX3-1, STEAP2, and TMPRSS2 expression) and to patient serum prostate-specific antigen (PSA) levels. Functional enrichment analysis indicated high bone morphogenetic protein (BMP) signaling in metastases with high bone cell activity and low tumor cell AR activity. This was confirmed by BMP4 immunoreactivity in tumor cells of metastases with ongoing bone formation, as determined by histological evaluation of van Gieson-stained sections. In conclusion, the inverse relation observed between bone cell activity and tumor cell AR activity in prostate cancer bone metastasis may be of importance for patient response to AR and/or bone targeting therapies, but needs to be evaluated in clinical settings in relation to serum markers for bone remodeling, radiography and patient response to therapy. The importance of BMP signaling in the development of sclerotic metastasis lesions deserves further exploration.
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Affiliation(s)
- Annika Nordstrand
- Department of Medical Biosciences, Pathology, Umea University, 901 85 Umea, Sweden.
| | | | - Elin Thysell
- Department of Medical Biosciences, Pathology, Umea University, 901 85 Umea, Sweden.
| | - Emma Jernberg
- Department of Medical Biosciences, Pathology, Umea University, 901 85 Umea, Sweden.
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umea University, 901 85 Umea, Sweden.
| | - Anders Widmark
- Department of Radiation Sciences, Oncology, Umea University, 901 87 Umea, Sweden.
| | - Anders Bergh
- Department of Medical Biosciences, Pathology, Umea University, 901 85 Umea, Sweden.
| | - Ulf H Lerner
- Department of Molecular Periodontology, Umea University, 901 87 Umea, Sweden.
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition at Institute for Medicine, Sahlgrenska Academy at University of Gothenburg, 413 45 Gothenburg, Sweden.
| | - Pernilla Wikström
- Department of Medical Biosciences, Pathology, Umea University, 901 85 Umea, Sweden.
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35
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Treatment effects in prostate cancer. Mod Pathol 2018; 31:S110-121. [PMID: 29297495 DOI: 10.1038/modpathol.2017.158] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 09/24/2017] [Accepted: 09/24/2017] [Indexed: 02/01/2023]
Abstract
Nonsurgical treatments for prostate cancer include androgen-deprivation therapy (ADT), radiation therapy (RT), ablative therapies, chemotherapy, and newly emerging immunotherapies. These approaches can be used alone or in combination depending on the clinical scenario. ADT is typically reserved for high-risk locally or systemically advanced disease that is not amenable to curative surgery. Radiation therapy can be used instead of surgery as primary therapy with curative intent for low-intermediate-risk disease as well as for control of locally advanced disease not suitable for surgery. Ablative therapies can be used as primary therapy for low-intermediate-risk disease or as salvage therapy for clinically localized disease where RT has failed. Chemotherapy and immune-based therapies are currently used for androgen-independent disease, although the indications for these approaches may well change as new data from clinical trials accrue. Pathologists should be able to recognize tissue changes associated with these treatments to provide information that will optimize patient management. This is particularly true in situations where clinical history of recent or remote nonsurgical treatment is not provided with the specimen. In the absence of this information, pathologists encountering the features described herein are encouraged to review patient records or communicate directly with clinical colleagues to determine how a given patient was treated and when.
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Restelli U, Ceresoli GL, Croce D, Evangelista L, Maffioli LS, Gianoncelli L, Bombardieri E. Economic burden of the management of metastatic castrate-resistant prostate cancer in Italy: a cost of illness study. Cancer Manag Res 2017; 9:789-800. [PMID: 29263702 PMCID: PMC5724712 DOI: 10.2147/cmar.s148323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Prostate cancer (PCa) accounts for 20% of all cancers in subjects over 50 years in Italy. The majority of patients with PCa present with localized disease at the time of diagnosis, but many patients develop recurrent metastatic disease after treatment with curative intent. Androgen deprivation therapy is the standard of care for metastatic PCa patients; unfortunately, most of them progress to castrate-resistant prostate cancer (CRPC) within 5 years. Metastatic CRPC (mCRPC) heavily affects patients in terms of quality of life, side effects, and survival, and greatly impacts economic costs. The approval of new effective agents in recent years, including cabazitaxel, abiraterone acetate, enzalutamide, and radium-223, has dramatically changed patient management. Materials and methods Here, we aimed to estimate the current costs of illness of mCRPC in Italy. All patients affected by mCRPC and treated with a single agent in an annual time horizon were considered. Therefore, the analysis was not focused on the management pathway of single patients through different lines of treatment. Direct medical costs referred to therapy, adverse event management, and skeletal-related event management were analyzed. A bottom-up approach was used to estimate the resource consumption: through national guidelines and expert opinions, the mean cost per patient was estimated and then multiplied by the total number of patients diagnosed with mCRPC. Results Direct medical costs ranged from €196.5 million to €228.0 million, representing ~0.2% of the financing of the Italian National Health Service in 2016. The main cost driver was the cost of treatment, which represented more than 77% of the overall economic burden. Conclusion Our analysis, reflective of real clinical practice, shows for the first time the high economic cost of mCRPC in Italy.
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Affiliation(s)
- Umberto Restelli
- Center for Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Italy.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Giovanni Luca Ceresoli
- Medical Oncology Department, Thoracic and Urologic Oncology Unit, Cliniche Humanitas Gavazzeni, Bergamo
| | - Davide Croce
- Center for Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Italy.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laura Evangelista
- Nuclear Medicine and Molecular Imaging Unit, Veneto Institute of Oncology IOV - IRCCS, Padova
| | | | - Letizia Gianoncelli
- Medical Oncology Department, Thoracic and Urologic Oncology Unit, Cliniche Humanitas Gavazzeni, Bergamo
| | - Emilio Bombardieri
- Nuclear Medicine Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy
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