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Rajpar S, Ibrahim T, Carmel A, Merabet Z, Vielh P, Foulon S, Lesaunier F, Delva R, Rolland F, Priou F, Ferrero JM, Houédé N, Mourey L, Théodore C, Krakowski I, Faivre L, Habibian M, Culine S, Gravis G, Chauchereau A, Fizazi K. The Benefit of Combining Docetaxel with Androgen Deprivation Therapy in Localized and Metastatic Hormone-sensitive Prostate Cancer is Predicted by ERG Expression: An Analysis of Two GETUG Phase 3 Trials. Eur Urol Oncol 2024:S2588-9311(24)00173-1. [PMID: 39034169 DOI: 10.1016/j.euo.2024.06.015] [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: 03/21/2024] [Revised: 06/02/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Docetaxel has become a standard component of care for advanced prostate cancer (PC); however, its benefits are not universal among patients. A subset of PC cases exhibit TMPRSS2-ERG gene fusion, resulting in ERG overexpression in tumors. Our aim was to assess biomarkers for docetaxel efficacy in men with hormone-sensitive PC (HSPC). METHODS Pretreatment prostate biopsies were obtained from participants in two randomized phase 3 clinical trials investigating docetaxel in high-risk localized PC (GETUG 12) and metastatic HSPC (GETUG 15). Immunohistochemistry staining for Ki67, PTEN, RB, and phosphorylated RB was conducted for GETUG 12 samples, and ERG staining for GETUG 12 and GETUG 15 samples. We examined biomarker association with outcomes using univariate and multivariable analyses adjusted for other validated prognostic factors. KEY FINDINGS AND LIMITATIONS Among GETUG 12 patients, Ki67 was associated with a worse relapse-free survival (RFS; hazard ratio [HR] 1.72; p = 0.0092). A pooled analysis for the two trials (pinteraction = 0.056) revealed that docetaxel-based chemotherapy improved failure-free survival for patients with ERG-positive cancer (HR 0.58; p = 0.03), but not patients with ERG-negative cancer (HR 1.08; p = 0.72). In the ERG-positive subgroup in GETUG 12 (high-risk localized PC), median RFS was 7.79 yr with androgen deprivation therapy (ADT) alone, and was not reached with ADT + docetaxel. In the ERG-negative subgroup, median progression-free survival (mPFS) was 7.79 yr with ADT alone versus 7.08 yr with ADT + docetaxel. In the ERG-positive subgroup in GETUG 15 (metastatic HSPC), mPFS was 10.7 mo with ADT alone versus 18.8 mo with ADT + docetaxel. In the ERG-negative subgroup, mPFS was 10.6 mo with ADT alone versus 13.2 mo with ADT + docetaxel. CONCLUSIONS AND CLINICAL IMPLICATIONS Ki67 may serve as a prognostic factor in HSPC, while ERG expression appears to predict a response to docetaxel in both high-risk localized and metastatic HSPC. PATIENT SUMMARY We assessed factors that could predict outcomes after docetaxel chemotherapy in patients with advanced prostate cancer. We found that expression of a protein called ERG can predict a good response to docetaxel in these patients.
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Affiliation(s)
| | - Tony Ibrahim
- INSERM U981, Prostate Cancer Group, Université Paris-Saclay, Gustave Roussy, Villejuif, France; Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Alexandra Carmel
- Biostatistics Department, Gustave Roussy, Paris-Saclay University, Paris, France
| | - Zahira Merabet
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Philippe Vielh
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France; Medipath and American Hospital of Paris, Paris, France
| | - Stephanie Foulon
- Biostatistics Department, Gustave Roussy, Paris-Saclay University, Paris, France
| | | | - Rémy Delva
- Institut de Cancerologie de l'Ouest, Angers, France
| | - Frederic Rolland
- Department of Medical Oncology, Centre René Gauducheau, Saint-Herblin, France
| | - Frank Priou
- Department of Medical Oncology, Centre Hospitalier La Roche-sur-Yon, La Roche-sur-Yon, France
| | - Jean-Marc Ferrero
- Medical Oncology Department, Centre Antoine Lacassagne, University Côte d'Azur, Nice, France
| | - Nadine Houédé
- Medical Oncology, Institut de Cancérologie du Gard, Montpellier University, Nimes, France
| | | | | | - Ivan Krakowski
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre Les Nancy, France
| | - Laura Faivre
- Biostatistics Department, Gustave Roussy, Paris-Saclay University, Paris, France
| | | | - Stéphane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Paris, France
| | | | - Anne Chauchereau
- INSERM U981, Prostate Cancer Group, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Karim Fizazi
- INSERM U981, Prostate Cancer Group, Université Paris-Saclay, Gustave Roussy, Villejuif, France; Department of Medical Oncology, Gustave Roussy, Villejuif, France.
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Puente J, Algaba Arrea F, Buisán Rueda Ó, Castellano Gauna D, Durán I, Fernández Ávila JJ, Gómez-Iturriaga A, Parada Blázquez MJ, Pérez Fentes D, Sancho Pardo G, Vallejo Casas JA, Gratal P, Pardo MT, Guillem Porta V. Criteria and indicators to evaluate quality of care in genitourinary tumour boards. Clin Transl Oncol 2024; 26:1639-1646. [PMID: 38341809 DOI: 10.1007/s12094-024-03381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/31/2023] [Indexed: 02/13/2024]
Abstract
PURPOSE Genitourinary (GU) multidisciplinary tumour boards (GUMTBs) are key components of patient care, as they might lead to changes in treatment plan, improved survival, and increased adherence to guidelines. However, there are no guidelines on how GUMTBs should operate or how to assess their quality of performance. METHODS A systematic literature review was conducted to identify criteria and indicators to evaluate quality in GUMTBs. A scientific committee-comprising 12 GU cancer specialists from seven disciplines-proposed a list of criteria and developed indicators, evaluated in two rounds of Delphi method. Appropriateness and utility of indicators were scored using a 9-point Likert scale. Consensus was defined as at least two-thirds of Delphi respondents selecting a score sub-category that encompassed the median score of the group. RESULTS Forty-five criteria were selected to evaluate the quality of GUMTBs covering five dimensions: organisation, personnel, protocol and documentation, resources, and interaction with patients. Then, 33 indicators were developed and evaluated in the first round of Delphi, leading to a selection of 26 indicators in two dimensions: function, governance and resources, and GUMTB sessions. In the second round, consensus was reached on the appropriateness of all 26 indicators and on the utility of 24 of them. Index cards for criteria and indicators were developed to be used in clinical practice. CONCLUSIONS Criteria and indicators were developed to evaluate the quality of GUMTBs, aiming to serve as a guide to improve quality of care and health outcomes in patients with GU cancer.
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Affiliation(s)
- Javier Puente
- Servicio de Oncología Médica, Hospital Universitario Clínico San Carlos, Madrid, Spain.
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain.
| | | | - Óscar Buisán Rueda
- Servicio de Urología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Daniel Castellano Gauna
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain
- Servicio de Oncología Médica, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Ignacio Durán
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain
- Servicio de Oncología Médica, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Juan José Fernández Ávila
- Servicio de Farmacia Hospitalaria, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | - Alfonso Gómez-Iturriaga
- Servicio de Oncología Radioterápica, Hospital Universitario de Cruces, Instituto de Investigación Sanitaria Biobizkaia, Vizcaya, Spain
| | | | - Daniel Pérez Fentes
- Servicio de Urología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Gemma Sancho Pardo
- Servicio de Oncología Radioterápica, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Paula Gratal
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain
| | | | - Vicente Guillem Porta
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain
- Servicio de Oncología Médica, Hospital Vithas 9 de Octubre, Valencia, Spain
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3
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Beck da Silva Etges AP, de Lara LR, Sapper SL, Frankenberg Berger AV, Streck M, Zardo L, Linhares A, Nassif M, Zanotto A, Pereira Lima MN, Vargas R, Polanczyk CA. Redesign of radiotherapy for prostate cancer: a proposal for universal healthcare systems. J Comp Eff Res 2023; 12:e230023. [PMID: 37916706 PMCID: PMC10734317 DOI: 10.57264/cer-2023-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023] Open
Abstract
Aim: This study was designed to recommend strategies to improve prostate patients' access to radiotherapy treatment in the Brazilian Unified Health System, along with a cost-tool to support radiotherapy care pathways' lead times and costs. Methods: Data was collected prospectively from patients with prostate cancer receiving radiotherapy in two Brazilian centers to provide data to apply design thinking and process reengineering techniques. The current status of the radiotherapy pathway was determined and the length of time taken for in-hospital activities was measured using data exported from ARIA®. Interviews with patients were used to estimate their waiting periods. This provided the data used to provide recommended strategies and the cost tool based on time-driven activity-based costing. The strategies were classified according to priority. Results: Data from 47 patients were analyzed. The mean interval from diagnosis to start of radiotherapy was 349 days (SD581), and the mean interval from seeking medical attention to starting treatment was 635 days (SD629). Twelve strategies affecting in-hospital processes and 11 impacting patients' care pathways and experiences are recommended, mostly focused on system improvement opportunities. A time-driven activity-based costing monitoring using data extracted from ARIA was coded and can be used by centers as a cost assessment guide. Conclusion: This study uses reengineering and design techniques to introduce priority strategies to allow more efficient and patient-centered radiotherapy.
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Affiliation(s)
- Ana Paula Beck da Silva Etges
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
- Avant-garde Health, Boston, MA 02111, USA
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul School of Medicine, Porto Alegre, RS, 90035-002, Brazil
| | - Luciana Rodrigues de Lara
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
| | - Stella Lisboa Sapper
- Crialab, Tecnopuc, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, 90619-900, Brazil
| | - Ana Von Frankenberg Berger
- Crialab, Tecnopuc, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, 90619-900, Brazil
| | - Melissa Streck
- Crialab, Tecnopuc, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, 90619-900, Brazil
| | - Laise Zardo
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, 90020-090, Brazil
| | - Armani Linhares
- Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
- Medicine course, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Porto Alegre, RS, 90050-170, Brazil
| | - Marina Nassif
- Universidade Federal do Rio Grande do Sul School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
| | - Angélica Zanotto
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
| | - Marta Nassif Pereira Lima
- Universidade Federal do Rio Grande do Sul School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
| | - Rafael Vargas
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
- Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, 90020-090, Brazil
| | - Carisi Anne Polanczyk
- National Institute of Science & Technology for Health Technology Assessment (IATS) – CNPq/Brazil (project: 465518/2014-1), Porto Alegre, 90035-903, Brazil
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul School of Medicine, Porto Alegre, RS, 90035-002, Brazil
- Universidade Federal do Rio Grande do Sul School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90619-900, Brazil
- Hospital Moinhos de Vento, Porto Alegre, RS, 90035-000, Brazil
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Korczak J, Mardas M, Litwiniuk M, Bogdański P, Stelmach-Mardas M. Androgen Deprivation Therapy for Prostate Cancer Influences Body Composition Increasing Risk of Sarcopenia. Nutrients 2023; 15:nu15071631. [PMID: 37049485 PMCID: PMC10096521 DOI: 10.3390/nu15071631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Computed tomography (CT) scans used in treatment response assessment in prostate cancer (PCa) patients are a useful tool for nutritional status evaluation. The aim of this study was to assess the nutritional status, including sarcopenia development based on CT scans, in PCa patients and its association with progression-free survival (PFS). Sixty-four PCa patients were included (group 1: 34 patients undergoing androgen deprivation therapy (ADT) with docetaxel due to newly diagnosed, hormone-sensitive, metastatic PCa and group 2: 30 patients with castration-resistant metastatic PCa continuing ADT therapy with enzalutamide or abiraterone acetate). Nutritional status was evaluated with anthropometrical parameters, Nutritional Risk Score (NRS), and CT scans at the L3 vertebrae. Survival analyses were performed. According to NRS, nutritional status was significantly related to PFS. In both groups, there was a significant reduction in muscle tissue (total muscle tissue and skeletal muscle index). A significant increase in the distribution of adipose tissue (subcutaneous fat, visceral fat, subcutaneous adipose tissue index, and visceral adipose tissue index) in group one was observed. Sarcopenia was diagnosed in patients but with no influence on PFS. Significant reduction in muscle mass and increase in fat mass was observed in patients treated for PCa with no impact on PFS. The NRS was related to PFS in PCa patients and associated with body composition, assessed by CT after the castration therapy. Long-term castration combined with abiraterone therapy with prednisone or enzalutamide significantly influenced muscle tissue and may lead to sarcopenia development.
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Affiliation(s)
- Jolanta Korczak
- Department of Chemotherapy, The Greater Poland Cancer Center, 61-866 Poznan, Poland;
| | - Marcin Mardas
- Department of Gynecological Oncology, Institute of Oncology, Poznan University of Medical Sciences, 61-569 Poznan, Poland;
| | - Maria Litwiniuk
- Department of Cancer Pathology and Prevention, Poznan University of Medical Sciences, 61-866 Poznan, Poland;
| | - Paweł Bogdański
- Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 61-569 Poznan, Poland;
| | - Marta Stelmach-Mardas
- Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 61-569 Poznan, Poland;
- Correspondence: ; Tel.: +48-697424245
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Pagadala MS, Lynch J, Karunamuni R, Alba PR, Lee KM, Agiri FY, Anglin T, Carter H, Gaziano JM, Jasuja GK, Deka R, Rose BS, Panizzon MS, Hauger RL, Seibert TM. Polygenic risk of any, metastatic, and fatal prostate cancer in the Million Veteran Program. J Natl Cancer Inst 2023; 115:190-199. [PMID: 36305680 PMCID: PMC9905969 DOI: 10.1093/jnci/djac199] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/13/2022] [Accepted: 10/26/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Genetic scores may provide an objective measure of prostate cancer risk and thus inform screening decisions. We evaluated whether a polygenic hazard score based on 290 genetic variants (PHS290) is associated with prostate cancer risk in a diverse population, including Black men, who have higher average risk of prostate cancer death but are often treated as a homogeneously high-risk group. METHODS This was a retrospective analysis of the Million Veteran Program, a national, population-based cohort study of US military veterans conducted 2011-2021. Cox proportional hazards analyses tested for association of genetic and other risk factors (including self-reported race and ethnicity and family history) with age at death from prostate cancer, age at diagnosis of metastatic (nodal or distant) prostate cancer, and age at diagnosis of any prostate cancer. RESULTS A total of 590 750 male participants were included. Median age at last follow-up was 69 years. PHS290 was associated with fatal prostate cancer in the full cohort and for each racial and ethnic group (P < .001). Comparing men in the highest 20% of PHS290 with those in the lowest 20% (based on percentiles from an independent training cohort), the hazard ratio for fatal prostate cancer was 4.42 (95% confidence interval = 3.91 to 5.02). When accounting for guideline-recommended risk factors (family history, race, and ethnicity), PHS290 remained a strong independent predictor of any, metastatic, and fatal prostate cancer. CONCLUSIONS PHS290 stratified US veterans of diverse ancestry for lifetime risk of prostate cancer, including metastatic and fatal cancer. Predicting genetic risk of lethal prostate cancer with PHS290 might inform individualized decisions about prostate cancer screening.
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Affiliation(s)
- Meghana S Pagadala
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Medical Scientist Training Program, University of California San Diego, La Jolla, CA, USA
- Biomedical Science Program, University of California San Diego, La Jolla, CA, USA
| | - Julie Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Healthcare System (VINCI), Salt Lake City, UT, USA
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Patrick R Alba
- VA Informatics and Computing Infrastructure, VA Salt Lake City Healthcare System (VINCI), Salt Lake City, UT, USA
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kyung Min Lee
- VA Informatics and Computing Infrastructure, VA Salt Lake City Healthcare System (VINCI), Salt Lake City, UT, USA
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Fatai Y Agiri
- VA Informatics and Computing Infrastructure, VA Salt Lake City Healthcare System (VINCI), Salt Lake City, UT, USA
| | - Tori Anglin
- VA Informatics and Computing Infrastructure, VA Salt Lake City Healthcare System (VINCI), Salt Lake City, UT, USA
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Hannah Carter
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Guneet Kaur Jasuja
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Rishi Deka
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Brent S Rose
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Matthew S Panizzon
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Center for Behavioral Genetics of Aging, University of California San Diego, La Jolla, CA, USA
| | - Richard L Hauger
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Center for Behavioral Genetics of Aging, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA, USA
| | - Tyler M Seibert
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
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Campal-Espinosa AC, Junco-Barranco JA, Fuentes-Aguilar F, Calzada-Aguilera L, Rivacoba-Betancourt A, Rodríguez-Bueno RH, Bover-Campal AC, Bover-Fuentes EE, González L, de Quesada L, Alvarez A, Garay-Pérez HE. Influence of Humoral Response Against GnRH, Generated by Immunization with a Therapeutic Vaccine Candidate on the Evolution of Patients with Castration-Sensitive Prostate Adenocarcinoma. Technol Cancer Res Treat 2023; 22:15330338231207318. [PMID: 37828833 PMCID: PMC10576932 DOI: 10.1177/15330338231207318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND AND AIMS A gonadotropin-releasing hormone (GnRH)-based therapeutic vaccine candidate against hormone-sensitive prostate cancer has demonstrated its safety and signs of efficacy in phase I/II trials. In this study, we characterized the isotype/subclass profiles of the anti-GnRH humoral response generated by the vaccination and analyzed its association with patients' clinical outcomes. METHODS The immunoglobulin isotypes and IgG subclasses of the antibody responses of 34 patients included in a randomized, open, prospective phase I/II clinical trial were characterized. Every patient included in the study had a diagnosis of locally advanced prostate adenocarcinoma at stages 3 and 4 and received immunization with the vaccine candidate. Additionally, serum testosterone and prostate specific antigen (PSA) concentrations, serving as indicators of tumor response, were determined. The type of anti-GnRH antibody response was correlated to the time elapsed until the first biochemical recurrence in patients and the outcome of the disease. RESULTS All patients developed strong and prolonged anti-GnRH antibody responses, resulting in a short- to mid-term decrease in serum testosterone and PSA levels. Following immunizations, anti-GnRH antibodies of the IgM/IgG and IgG1/IgG3 subclasses were observed. Following radiotherapy, the humoral response switched to IgG (IgG1/IgG4). Patients who experienced a short-term biochemical relapse were characterized by significantly higher levels of anti-GnRH IgG titers, particularly IgG1 and IgG4 subclasses. These characteristics, along with a high response of specific IgM antibodies at the end of immunizations and the development of anti-GnRH IgA antibody responses following radiotherapy, were observed in patients whose disease progressed, compared to those with controlled disease. CONCLUSION The nature of the humoral response against anti-GnRH, induced by vaccination may play a key role in activating additional immunological mechanisms. Collectively, these mechanisms could contribute significantly to the regulation of tumor growth.
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Affiliation(s)
| | - Jesús Arturo Junco-Barranco
- Vaccine Research Group, Research Department, Center of Genetic Engineering and Biotechnology, Camagüey, Cuba
| | - Franklin Fuentes-Aguilar
- Vaccine Research Group, Research Department, Center of Genetic Engineering and Biotechnology, Camagüey, Cuba
| | - Lesvia Calzada-Aguilera
- Vaccine Research Group, Research Department, Center of Genetic Engineering and Biotechnology, Camagüey, Cuba
| | | | | | | | - Eddy Emilio Bover-Fuentes
- Vaccine Research Group, Research Department, Center of Genetic Engineering and Biotechnology, Camagüey, Cuba
| | - Lourdes González
- Department of Urology, Oncological Hospital Camagüey, Camagüey, Cuba
| | | | - Allelin Alvarez
- Department of Urology, Oncological Hospital Camagüey, Camagüey, Cuba
| | - Hilda Elisa Garay-Pérez
- Department of Immunology, Eduardo Agramonte Piña Pediatric Hospital Camagüey, Camagüey, Cuba
- Synthetic Peptides Group, Division of Biomedical Research, Center of Genetic Engineering and Biotechnology, Havana, Cuba
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7
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Zarbá M, Angel M, Losco F, Zarbá JJ, Pupilli JC, Chacon MR, Sade JP. Experience of bipolar androgen therapy (BAT) in Argentinian oncology centres. Ecancermedicalscience 2022; 16:1480. [PMID: 36819799 PMCID: PMC9934967 DOI: 10.3332/ecancer.2022.1480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Indexed: 12/03/2022] Open
Abstract
Background Previous studies with bipolar androgen therapy (BAT) have shown clinical activity in metastatic Castration Resistant Prostate Cancer (mCRPC) as well as the potential to re-sensitise prostate cancer cells to prior androgen receptor-targeted agents. None of these studies had tested BAT after chemotherapy. In this study, we gathered real-world evidence from three centres in Argentina where BAT is being used in castration-resistant prostate cancer (CRPC), not only prior to chemotherapy but also after several lines of treatment. Materials and methods This retro-prospective nonrandomised multicentre cohort study included patients with mCRPC, who received BAT in different scenarios defined by the treating physician at three centres in Argentina. Results A total of 21 asymptomatic patients with mCRPC were included. There was a median of two lines before BAT, with nine patients (42.8%) receiving three or more lines, and 13 patients (61.9%) receiving chemotherapy previously. Previous lines included next-generation hormonal agents (NHA) in 100% (abiraterone 33.3% and enzalutamide 71.4%), chemotherapy in 61.9%, Radium-223 in 47.6% and others in 4.8%. The progression free survival (PFS) after BAT was 3.5 months (95% CI: 3.06-7.97). PSA50 response rate (RR) was 28.5% and the overall RR was 14.3%. Of the 17 patients who had disease progression, 9 had a rechallenge to NHA, achieving a 55% RR, 6 received other treatment (chemotherapy in 5 and 177Lu-PSMA in 1) with a 66% RR and 2 best supportive care. The PFS2, calculated after the initiation of BAT in the 15 patients who received further therapy, was 7.93 months (95% CI: 6.73-NR). Treatment was overall well tolerated, with only two patients requiring hospitalisation and treatment interruption due to worsening pain. Conclusion To the authors' knowledge, this is the first publication of BAT in later lines of therapy in mCRPC. BAT showed clinical activity in this scenario. Our data supports that BAT may play a role in CRPC re-sensitisation after multiple treatment lines.
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Affiliation(s)
- Martín Zarbá
- FUCA, Instituto Alexander Fleming, CABA C1426ANZ, Argentina,https://orcid.org/0000-0003-3642-4035
| | - Martin Angel
- Genitourinary Tumors Department, Instituto Alexander Fleming, CABA C1426ANZ, Argentina,These authors have contributed equally to this work.,https://orcid.org/0000-0002-1463-8887
| | - Federico Losco
- Genitourinary Tumors Department, Instituto Alexander Fleming, CABA C1426ANZ, Argentina,https://orcid.org/0000-0001-5084-3012
| | - Juan José Zarbá
- Oncology Department, Hospital Zenon Santillan, San Miguel de Tucuman T4000IAK, Argentina,https://orcid.org/0000-0003-1013-3993
| | - Juan Carlos Pupilli
- Genitourinary Tumors Department, Sanatorio Británico Rosario, Santa Fé S2000ANZ, Argentina
| | - Matías Rodrigo Chacon
- Oncology Department, Instituto Alexander Fleming, CABA C1426ANZ, Argentina,https://orcid.org/0000-0001-6872-4185
| | - Juan Pablo Sade
- Genitourinary Tumors Department, Instituto Alexander Fleming, CABA C1426ANZ, Argentina,https://orcid.org/0000-0001-9312-5280
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8
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Chen L, Zheng Y, Jiang C, Yang C, Zhang L, Liang C. The established chemokine-related prognostic gene signature in prostate cancer: Implications for anti-androgen and immunotherapies. Front Immunol 2022; 13:1009634. [PMID: 36275733 PMCID: PMC9582844 DOI: 10.3389/fimmu.2022.1009634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundProstate cancer (PCa) was one of the most common malignancies among men, while the prognosis for PCa patients was poor, especially for patients with recurrent and advanced diseases.Materials and methodsFive PCa cohorts were downloaded from The Cancer Genome Atlas and Gene Expression Omnibus databases, and the biochemical recurrence (BCR)-related chemokine genes were identified by LASSO-Cox regression. The chemokine-related prognostic gene signature (CRPGS) was established, and its association with PCa patients’ clinical, pathological and immune characteristics was analyzed. The association between CRPGS and PCa patients’ responses to androgen deprivation therapy (ADT) and immunotherapy was analyzed. The CRPGS was compared with other previously published molecular signatures, and the CRPGS was externally validated in our real-world AHMU-PC cohort.ResultsFour recurrence-free survival (RFS)-related chemokine genes (CXCL14, CCL20, CCL24, and CCL26) were identified, and the CRPGS was established based on the four identified chemokine genes, and TCGA-PRAD patients with high riskscores exhibited poorer RFS, which was validated in the GSE70768 cohort. The CRPGS was associated with the clinical, pathological, and immune characteristics of PCa patients. Low-risk PCa patients were predicted to respond better to ADT and immunotherapy. By comparing with other molecular signatures, the CRPGS could classify PCa patients into two risk groups well, and the CRPGS was associated with the m6A level, as well as TP53 and SPOP mutation status of PCa patients. In the AHMU-PC cohort, the CRPGS was associated with the advanced pathology stage and Gleason score.ConclusionsThe identified chemokine genes and CRPGS were associated with the prognosis of PCa, which could predict PCa patients’ responses to anti-androgen and immunotherapies.
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Affiliation(s)
- Lei Chen
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Yi Zheng
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Changqin Jiang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Cheng Yang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
- *Correspondence: Cheng Yang, ; Li Zhang, ; Chaozhao Liang,
| | - Li Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
- *Correspondence: Cheng Yang, ; Li Zhang, ; Chaozhao Liang,
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
- *Correspondence: Cheng Yang, ; Li Zhang, ; Chaozhao Liang,
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9
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Huhtaniemi R, Sipilä P, Junnila A, Oksala R, Knuuttila M, Mehmood A, Aho E, Laajala TD, Aittokallio T, Laiho A, Elo L, Ohlsson C, Thulin MH, Kallio P, Mäkelä S, Mustonen MV, Poutanen M. High intratumoral dihydrotestosterone is associated with antiandrogen resistance in VCaP prostate cancer xenografts in castrated mice. iScience 2022; 25:104287. [PMID: 35573198 PMCID: PMC9097697 DOI: 10.1016/j.isci.2022.104287] [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: 07/02/2021] [Revised: 03/27/2022] [Accepted: 04/20/2022] [Indexed: 12/24/2022] Open
Abstract
Antiandrogen treatment resistance is a major clinical concern in castration-resistant prostate cancer (CRPC) treatment. Using xenografts of VCaP cells we showed that growth of antiandrogen resistant CRPC tumors were characterized by a higher intratumor dihydrotestosterone (DHT) concentration than that of treatment responsive tumors. Furthermore, the slow tumor growth after adrenalectomy was associated with a low intratumor DHT concentration. Reactivation of androgen signaling in enzalutamide-resistant tumors was further shown by the expression of several androgen-dependent genes. The data indicate that intratumor DHT concentration and expression of several androgen-dependent genes in CRPC lesions is an indication of enzalutamide treatment resistance and an indication of the need for further androgen blockade. The presence of an androgen synthesis, independent of CYP17A1 activity, has been shown to exist in prostate cancer cells, and thus, novel androgen synthesis inhibitors are needed for the treatment of enzalutamide-resistant CRPC tumors that do not respond to abiraterone.
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Affiliation(s)
- Riikka Huhtaniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Turku Center for Disease Modeling, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
| | - Petra Sipilä
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Turku Center for Disease Modeling, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
| | - Arttu Junnila
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Turku Center for Disease Modeling, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
| | | | - Matias Knuuttila
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Turku Center for Disease Modeling, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
| | - Arfa Mehmood
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Eija Aho
- Orion Corporation, Orion Pharma, Turku, Finland
| | - Teemu D. Laajala
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Turku Center for Disease Modeling, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Tero Aittokallio
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Asta Laiho
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Laura Elo
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Turku Center for Disease Modeling, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Drug Treatment, Gothenburg, Sweden
| | - Malin Hagberg Thulin
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Sari Mäkelä
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Turku Center for Disease Modeling, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
- Functional Foods Forum, University of Turku, Turku, Finland
| | | | - Matti Poutanen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Turku Center for Disease Modeling, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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Chen L, Zhang M, Zhou J, Zhang L, Liang C. Establishment of an age- and tumor microenvironment-related gene signature for survival prediction in prostate cancer. Cancer Med 2022; 11:4374-4388. [PMID: 35535438 PMCID: PMC9678094 DOI: 10.1002/cam4.4776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/20/2022] [Accepted: 04/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background The incidence of prostate cancer (PCa) increases with age, and age and tumor microenvironment (TME) have important roles in the development of PCa, while the underlying mechanisms have not been fully elucidated. Materials and method The Cancer Genome Atlas‐Prostate Adenocarcinoma (TCGA‐PRAD) RNA‐Seq, the Surveillance, Epidemiology, and End Results (SEER‐PRAD), and ESTIMATE data were downloaded, and the clinical information of PRAD patients in our cohort was collected. The associations among age, TME, and PCa were analyzed. The age‐ and TME‐related risk score (ATRS) of each TCGA‐PRAD sample was calculated based on the identified age‐ and TME‐related differentially expressed genes (DEGs), and the correlation of ATRS with immune‐related characteristics of PCa patients was analyzed, and the ATRS‐based overall survival (OS)‐predicting nomogram was also established. Results Age was correlated with OS, PSA level, tumor stage, T stage, N stage, Gleason score, nerve invasion of PCa, and age was positively correlated with stromal, immune, and ESTIMATE scores. The compositions of immune cells of TCGA‐PRAD patients altered with age. Nine age‐ and TME‐related prognostic DEGs were identified, and the ATRS of each TCGA‐PRAD patient was calculated based on the identified nine DEGs. The ATRS was associated with the expression of immune checkpoints and intratumoral cytolytic activity, and the ATRS‐based nomogram performed well in predicting the outcomes of PCa patients. Conclusions Age and TME had crucial roles in PCa, and the ATRS gene signature was associated with the immune‐related characteristics of PCa patients, which showed good performance in predicting OS of PCa patients.
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Affiliation(s)
- Lei Chen
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Urology, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Meng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Urology, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Jun Zhou
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Urology, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Li Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Urology, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Urology, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.,Anhui Institute of Translational Medicine, Hefei, China
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11
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Outcomes of Patients with Metastatic Castration-Resistant Prostate Cancer According to Somatic Damage DNA Repair Gene Alterations. Curr Oncol 2022; 29:2776-2791. [PMID: 35448200 PMCID: PMC9030073 DOI: 10.3390/curroncol29040226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: In literature, approximately 20% of mCRPC present somatic DNA damage repair (DDR) gene mutations, and their relationship with response to standard therapies in mCRPC is not well understood. The objective was to evaluate outcomes of mCRPC patients treated with standard therapies according to somatic DDR status. (2) Methods: Eighty-three patients were recruited at Caen Cancer Center (France). Progression-free survival (PFS) after first-line treatment was analyzed according to somatic DDR mutation as primary endpoint. PFS according to first exposure to taxane chemotherapy and PFS2 (time to second event of disease progression) depending on therapeutic sequences were also analyzed. (3) Results: Median first-line PFS was 9.7 months in 33 mutated patients and 8.4 months in 50 non-mutated patients (p = 0.9). PFS of first exposure to taxanes was 8.1 months in mutated patients and 5.7 months in non-mutated patients (p = 0.32) and significantly longer among patients with ATM/BRCA1/BRCA2 mutations compared to the others (10.6 months vs. 5.5 months, p = 0.04). PFS2 was 16.5 months in mutated patients, whatever the sequence, and 11.7 months in non-mutated patients (p = 0.07). The mutated patients treated with chemotherapy followed by NHT had a long median PFS2 (49.8 months). (4) Conclusions: mCRPC patients with BRCA1/2 and ATM benefit from standard therapies, with a long response to taxanes.
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12
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Tan WC, Kanesvaran R. Current standards and practice changing studies in genitourinary (GU) cancers-a review of studies in localized/early GU cancers. ESMO Open 2022; 7:100432. [PMID: 35272133 PMCID: PMC8961274 DOI: 10.1016/j.esmoop.2022.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/29/2022] [Accepted: 02/08/2022] [Indexed: 11/21/2022] Open
Abstract
Optimizing treatment of genitourinary cancers in the early-stage setting continues to remain an area of need, given that the development of distant metastases is often the life-limiting factor in the natural history of these cancers. The use of perioperative therapies in the treatment of these cancers deemed to be at high risk of recurrence has shown considerable benefits in outcomes in recent studies. In this article, we review the recently published studies in early-stage genitourinary cancers (renal cell, urothelial and prostate carcinomas), and their impact on disease outcomes and treatment practices. The results of subgroup analysis from some of these trials, with Asian patients enrolled, give assurance of the clinical efficacy and safety of these therapies in early-stage urological malignancies in the Asian setting. Optimizing treatment of genitourinary cancers in the early-stage setting remains an area of need. Development of distant metastases is often the life-limiting factor in the natural history of these cancers. Recent studies of perioperative systemic therapy have shown considerable benefits in outcomes. Subgroup analyses of trials assure of the efficacy and safety of these therapies in the Asian setting.
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Affiliation(s)
- W C Tan
- National Cancer Centre Singapore, Singapore, Singapore
| | - R Kanesvaran
- National Cancer Centre Singapore, Singapore, Singapore.
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13
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Villalba-Cuesta PL, Álvaro-Vegue C, Carrasco-Muñoz CG, Gomis-Goti C, García-Villa A. Interstitial pneumonitis associated with leuprorelin acetate for a prostate cancer: A case report. J Oncol Pharm Pract 2022; 28:1910-1913. [PMID: 35234109 DOI: 10.1177/10781552221084058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Androgen deprivation therapy remains the essential treatment for disseminated prostate cancer. Interstitial pneumonitis following this therapy has been documented for just a few cases. However, reported cases frequently describe the onset of symptoms after recent administration (days or a few weeks) of both GnRH analogues and androgen antagonists, which makes the precise individual impact of each treatment difficult to estimate. CASE REPORT This report presents a case of a 94-year-old patient with interstitial pneumonitis whose onset started three months after the first dose of leuprorelin and bicalutamide for a metastatic prostate cancer. MANAGEMENT AND OUTCOME Once other possible diagnosis were ruled out, empiric corticosteroid treatment was initiated within 48 h of the admission. A spectacular clinical and radiological improvement was observed after 3 doses of steroids, enabling the patient to recover his basal respiratory situation. We considered that the most probable cause was toxic interstitial pneumonitis induced by leuprorelin. DISCUSSION To our knowledge, it describes the longest interval between last administration of antiandrogen therapy and the development of pneumonitis. This fact may support a direct relation with leuprorelin, whose serum levels remain high for months because of its long-acting depot formulation.
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Affiliation(s)
| | - Carmen Álvaro-Vegue
- Department of Internal Medicine, 16436Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | - Carmen Gomis-Goti
- Department of Urology, 16436Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Adrián García-Villa
- Department of Internal Medicine, 16436Hospital Fundación Jiménez Díaz, Madrid, Spain
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14
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Shabana W, Kotb A, Tesolin D, Ibrahim MFK, Dolcetti K, Boucher A, Bassuony M, Ramchandar K, Zakaria AS, Elmansy H, Shahrour W. Diagnostic assessment program for prostate cancer: Lessons learned after 2 years and degree of compliance to Canadian guidelines. Arch Ital Urol Androl 2021; 93:389-392. [PMID: 34933523 DOI: 10.4081/aiua.2021.4.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/17/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In 2018, our Institute launched the Diagnostic Assessment Program (DAP) for prostate cancer. It enabled quick access to a urologist for patients presented to family physician with elevated PSA and allowed fast multidisciplinary patient care. We aim to document our data over 2 years in comparison to data before implementation of DAP and its impact on the degree of adherence to Canadian guidelines. METHODS From April 2016 to April 2020, 880 patients who were evaluated for prostate cancer at Thunder Bay Regional Health Sciences Centre (TBRHSC) were included in this study. Patients' characteristics, clinical data, waiting times and line of treatment before and after implementation of DAP were calculated and statistically analysed. RESULTS The median waiting time to urology consultation was significantly reduced from 68 (IQR 27-168) days to 34 (23-44) days (p < 0.001). The time from patient's referral to prostate biopsy decreased substantially from 34 (20-66) days to 18(11- 25) days after DAP (p < 0.001). After DAP, the percentage of Gleason 6 detected prostate cancers were significantly increased (19.7% to 30%) (p = 0.02). After DAP, rate for intermediate-risk patients elected for external beam radiotherapy (from 53.5% to 57.9%, p = 0.53) and radical prostatectomy (from 34.5% to 39.4%, p = 0.47) increased. More compliance to Canadian guidelines was observed in intermediate risk patients (88% vs 97.3%, p =.008). CONCLUSIONS Implementation of DAP has led to a notable reduction of waiting time to urology consult and prostate biopsy. There is significant increase in Gleason 6 detected prostate cancer. Increased compliance to Canadian guidelines was detected in intermediate risk patients.
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Affiliation(s)
- Waleed Shabana
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Ahmed Kotb
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Daniel Tesolin
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | | | | | - Amy Boucher
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | | | | | | | - Hazem Elmansy
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Walid Shahrour
- Northern Ontario School of Medicine, Thunder Bay, Ontario.
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15
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Mulati Y, Fan Y, Yu W, Zhang Q, He Z. Novel Androgen Receptor Inhibitors in Non-Metastatic, Castration-Resistant Prostate Cancer: A Systematic Review and Network Meta-Analysis. Front Oncol 2021; 11:733202. [PMID: 34722276 PMCID: PMC8555656 DOI: 10.3389/fonc.2021.733202] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Enzalutamide, apalutamide, and darolutamide have all been approved by Food and Drug Administration to treat high-risk non-metastatic castration-resistant prostate cancer (nmCRPC) since 2018 based on interim results of several phase III clinical trials. Final analyses of long-term overall survival (OS) and adverse events (AEs) results of these trials have been successively published recently. To help clinical practice to precisely select optimal treatment for high-risk nmCRPC patients, we performed a network meta-analysis to indirectly compare the final long-term results among these medications. Methods PubMed, EMBASE, and Cochrane Libraries were searched for phase III clinical trial that reports OS and AEs results in nmCRPC patients published before January 30, 2021. Primary outcome was OS; secondary outcomes were Time to first chemotherapy, Subsequent antineoplastic therapy rate, and AEs. Firstly, class-level effect was assessed as the second-generation androgen receptor antagonists (SGARAs) were regarded as one whole class compared with placebo through traditional meta-analysis by using Revman 5.4, then a Bayesian network meta-analysis was conducted to give indirect comparison among SGARAs by using R 3.5.3 software. Subgroup analysis of OS was only conducted in the certain subgroups which were available in all included studies. Results Three eligible studies including 4,104 participants were finally selected. OS was significantly improved by the SGARAs as a class compared with placebo (HR, 0.74; 95% CI, 0.66–0.84). Darolutamide had the highest likelihood of providing best OS (p-score=0.802). SGARAs also significantly delayed the first time to chemotherapy (HR, 0.58; 95% CI, 0.50–0.66). Patients who received darolutamide experienced similar toxicity compared with placebo regarding AEs of grade 3 or higher (OR, 1.3; 95% CI, 1.0–1.7) and serious AEs (OR, 1.3; 95% CI, 0.99–1.6). When compared with darolutamide, enzalutamide caused significantly higher toxicity in terms of any AEs (OR, 2.3; 95% CI,1.5–3.7) and AEs of grade 3 or higher (OR, 1.6; 95% CI, 1.1–2.2), apalutamide caused significantly more AEs of grade 3 or higher (OR, 1.9; 95% CI, 1.4–2.7) and serious AEs (OR, 1.9; 95% CI, 1.3–2.8). Subgroup analysis showed that SGARAs as a group significantly improved OS in ECOG=1 population, although insignificant results were found in these patients from included studies. Conclusions SGARAs combined with ADT significantly improved OS when compared with ADT alone in high-risk nmCRPC patients. Darolutamide may not only provide best OS but also have the most favorable safety profile among the included SGARAs in high-risk nmCRPC patients.
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Affiliation(s)
- Yelin Mulati
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Yu Fan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Qian Zhang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China.,Peking University Binhai Hospital, Tianjin, China
| | - Zhisong He
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
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16
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Dumont C, Baciarello G, Bosset PO, Lavaud P, Colomba E, Massard C, Loriot Y, Albiges L, Blanchard P, Bossi A, Nenan S, Fizazi K. Long-term Castration-related Outcomes in Patients With High-risk Localized Prostate Cancer Treated With Androgen Deprivation Therapy With or Without Docetaxel and Estramustine in the UNICANCER GETUG-12 Trial. Clin Genitourin Cancer 2020; 18:444-451. [DOI: 10.1016/j.clgc.2020.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 11/26/2022]
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17
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Fizazi K, Drake CG, Beer TM, Kwon ED, Scher HI, Gerritsen WR, Bossi A, den Eertwegh AJMV, Krainer M, Houede N, Santos R, Mahammedi H, Ng S, Danielli R, Franke FA, Sundar S, Agarwal N, Bergman AM, Ciuleanu TE, Korbenfeld E, Sengeløv L, Hansen S, McHenry MB, Chen A, Logothetis C. Final Analysis of the Ipilimumab Versus Placebo Following Radiotherapy Phase III Trial in Postdocetaxel Metastatic Castration-resistant Prostate Cancer Identifies an Excess of Long-term Survivors. Eur Urol 2020; 78:822-830. [PMID: 32811715 PMCID: PMC8428575 DOI: 10.1016/j.eururo.2020.07.032] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/27/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The phase 3 trial CA184-043 evaluated radiotherapy to bone metastases followed by Ipilimumab or placebo in men with metastatic castrate-resistant prostate cancer (mCRPC) who had received docetaxel previously. In a prior analysis, the trial's primary endpoint (overall survival [OS]) was not improved significantly. OBJECTIVE To report the final analysis of OS. DESIGN, SETTING, AND PARTICIPANTS A total of 799 patients were randomized to receive a single dose of radiotherapy to one or more bone metastases followed by either Ipilimumab (n = 399) or placebo (n = 400). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS OS was analyzed in the intention-to-treat population. Prespecified and exploratory subset analyses based on Kaplan-Meier/Cox methodology were performed. RESULTS AND LIMITATIONS During an additional follow-up of approximately 2.4 yr since the primary analysis, 721/799 patients have died. Survival analysis showed crossing of the curves at 7-8 mo, followed by persistent separation of the curves beyond that point, favoring the ipilimumab arm. Given the lack of proportional hazards, a piecewise hazard model showed that the hazard ratio (HR) changed over time: the HR was 1.49 (95% confidence interval 1.12, 1.99) for 0-5 mo, 0.66 (0.51, 0.86) for 5-12 mo, and 0.66 (0.52, 0.84) beyond 12 mo. OS rates were higher in the ipilimumab versus placebo arms at 2 yr (25.2% vs 16.6%), 3 yr (15.3% vs 7.9%), 4 yr (10.1% vs 3.3%), and 5 yr (7.9% vs. 2.7%). Disease progression was the most frequent cause of death in both arms. In seven patients (1.8%) in the ipilimumab arm and one (0.3%) in the placebo arm, the primary cause of death was reported as study drug toxicity. No long-term safety signals were identified. CONCLUSIONS In this preplanned long-term analysis, OS favored ipilimumab plus radiotherapy versus placebo plus radiotherapy for patients with postdocetaxel mCRPC. OS rates at 3, 4, and 5 yr were approximately two to three times higher in the ipilimumab arm. PATIENT SUMMARY After longer follow-up, survival favored the group of men who received ipilimumab, with overall survival rates being two to three times higher at 3 yr and beyond.
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Affiliation(s)
- Karim Fizazi
- Gustave Roussy, University of Paris Sud, Villejuif, France.
| | - Charles G Drake
- Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Tomasz M Beer
- Oregon Health & Science University Knight Cancer Institute, Portland, OR, USA
| | | | - Howard I Scher
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill-Cornell Medical College, New York, NY, USA
| | | | | | | | | | - Nadine Houede
- CHU of Nimes, Nimes, France; Montpellier University, Montpellier, France
| | | | | | - Siobhan Ng
- St John Of God Hospital, Subiaco, Australia
| | | | | | | | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - André M Bergman
- The Netherlands Cancer Institute and Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | | | - Lisa Sengeløv
- Herlev Hospital, Region Hovedstadens Apotek, Herlev, Denmark
| | | | | | - Allen Chen
- Bristol-Myers Squibb Company, Wallingford, CT, USA
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18
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Sun W, Shi H, Yuan Z, Xia L, Xiang X, Quan X, Shi W, Jiang L. Prognostic Value of Genes and Immune Infiltration in Prostate Tumor Microenvironment. Front Oncol 2020; 10:584055. [PMID: 33194726 PMCID: PMC7662134 DOI: 10.3389/fonc.2020.584055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background Prostate cancer (PCa) is one of the most common cancers and the fifth leading cause of cancer-related death in men. Immune responses in the tumor microenvironment are hypothesized to be related to the prognosis of PCa patients; however, no studies are available to confirm the same. In this study, we aimed to explore the potential link between these two factors and identify new biomarkers to estimate the survival rate of PCa patients. Methods A total of 490 cases were obtained from The Cancer Genome Atlas (TCGA) database. The gene expression data were analyzed by the ESTIMATE algorithm to evaluate the immune and stromal scores. The survival rate was calculated according to the case-specific clinical data. Enrichment analysis was performed to discover the main biological processes and signaling pathways of immune responses. We further identified and analyzed hub genes in the protein-protein interaction (PPI) network and evaluated their prognostic values. Results Immune score significantly correlated with immune cell infiltration and overall survival of PCa patients. The genes CXCR4 and GPR183, identified as hub genes in the PPI network, correlated with immune cell infiltration and prognosis of PCa patients. Conclusion CXCR4 and GPR183 participate in immune cell infiltration and function in PCa patients. The immune score, as well as the expression of CXCR4 and GPR183 in prostate cancer tissues, could be potential indexes for the prognosis of prostate cancer.
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Affiliation(s)
- Wenguo Sun
- Department of Urology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Hailin Shi
- Department of Urology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Zhen Yuan
- Department of Urology, Fuyang People's Hospital, Fuyang, China
| | - Li Xia
- Department of Dermatology, Guilin People's Hospital, Guilin, China
| | - Xuebao Xiang
- Department of Urology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Xiangfeng Quan
- Department of Urology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Wenjie Shi
- Department of Gynecology, Pius Hospital of Oldenburg, Oldenburg, Germany
| | - Leiming Jiang
- Department of Urology, Affiliated Hospital of Guilin Medical University, Guilin, China
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19
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Aas K, Dorothea Fosså S, Åge Myklebust T, Møller B, Kvåle R, Vlatkovic L, Berge V. Increased curative treatment is associated with decreased prostate cancer-specific and overall mortality in senior adults with high-risk prostate cancer; results from a national registry-based cohort study. Cancer Med 2020; 9:6646-6657. [PMID: 32750229 PMCID: PMC7520350 DOI: 10.1002/cam4.3297] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 12/24/2022] Open
Abstract
Background The association between curative treatment (CurTrt) and mortality in senior adults (≥70 years) with high‐risk prostate cancer (PCa) is poorly documented. In a population‐based cohort we report temporal trends in treatment and PCa‐specific mortality (PCSM), investigating the association between CurTrt and mortality in senior adults with high‐risk PCa, compared to findings in younger men (<70 years). Methods Observational study from the Cancer Registry of Norway. Patients with high‐risk PCa were stratified for three diagnostic periods (2005‐08, 2009‐12 and 2013‐16), age (<70, vs ≥70) and primary treatment (CurTrt: Radical prostatectomy (RP), Radiotherapy (RAD) vs no curative treatment (NoCurTrt)). Competing risk and Kaplan‐Meier methods estimated PCSM and overall mortality (OM), respectively. Multivariable logistic regression models estimated odds for CurTrt, and multivariable Fine Gray and Cox regression models evaluated the hazard ratios for PCSM and OM. Results Of 19 763 evaluable patients, 54% were aged ≥70 years. Senior adults had more unfavorable PCa characteristics than younger men. Across diagnostic periods, use of CurTrt increased from 15% to 51% in men aged ≥70 and 65% to 81% in men aged < 70 years. With median five years follow‐up, PCSM decreased in all patients (P < .05), in the third period restricted to senior adults. In all patients NoCurTrt was associated with three‐fold higher 5‐year PCSM and two‐fold higher OM compared to CurTrt. Conclusions In high‐risk PCa patients, increased use of CurTrt, greatest in senior men, was observed along with decreased PCSM and OM in both senior and younger adults. CurTrt should increasingly be considered in men ≥70 years.
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Affiliation(s)
- Kirsti Aas
- Department of Surgery, Vestre Viken Hospital Trust, Drammen, Norway
| | - Sophie Dorothea Fosså
- Department of Oncology, Oslo University Hospital (OUH), Oslo, Norway.,Cancer Registry of Norway, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Tor Åge Myklebust
- Cancer Registry of Norway, Oslo, Norway.,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Alesund, Norway
| | | | - Rune Kvåle
- Department of Oncology, Haukeland University Hospital, Bergen, Norway.,Department of Health Registry-based Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Viktor Berge
- University of Oslo, Oslo, Norway.,Department of Urology, OUH, Oslo, Norway
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20
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Identifying Prostate Surface Antigen Patterns of Change in Patients with Metastatic Hormone Sensitive Prostate Cancer Treated with Abiraterone and Prednisone. Target Oncol 2020; 15:477-483. [PMID: 32661959 DOI: 10.1007/s11523-020-00734-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite treatment with abiraterone acetate and prednisone (AA/P), most patients with metastatic hormone sensitive prostate cancer (mHSPC) will develop castration-resistant disease (metastatic castration-resistant prostate cancer [mCRPC]). The early identification of who will progress on AA/P is limited. OBJECTIVE This study investigates the role of prostate surface antigen (PSA) kinetics as a predictor of progression in mHSPC patients treated with AA/P. PATIENTS AND METHODS All patients with mHSPC who initiated androgen deprivation therapy (ADT) and AA/P from June 2017 to February 2019 at the Cleveland Clinic were eligible. PSA-mCRPC was defined as a PSA rise at two consecutive time points. Patients were followed until first mCRPC or last contact after AA/P. Patterns of PSA change were evaluated using a longitudinal mixed model at time 0, 3, 6, 9, and 12 months from AA/P initiation. The association between PSA profile at 3 months and PSA-mCRPC was examined using survival analysis. Radiographic progression (Rad-mCRPC) was also analyzed. RESULTS A total of 130 men with follow-up were included. The median (interquartile range [IQR]) follow-up time was 15.3 (10.5, 22.5) months. Eighty-two percent were Caucasian (median age 68.5 years); participants had a median (IQR) PSA of 16.8 (5.3, 48.0) ng/mL. Half of the patients had de novo disease, and 46.2% had high-risk disease (61% had a Gleason score ≥ 8, 16% had visceral disease, and 54% had three or more bony lesions). The greatest PSA percentage reduction from baseline after AA/P initiation occurred at the first 3 months (median 98.3%). The reduction at 6-12 months from baseline was small (99.7-100%). Patients without PSA-mCRPC had a significantly greater 3-month reduction of PSA values compared to patients who developed PSA-mCRPC (p interaction = 0.0002). 50.8% of patients were able to achieve a non-detectable PSA (median 13.1 months). PSA-mCRPC (n = 20) was observed from 4 to 24 months after AA/P, with the majority of events occurring within the first 12 months. Patients with PSA < 0.3 ng/mL (12-month PSA-mCRPC-free 94.5% vs. 69.4%, p = 0.0004) or a ≥ 98% reduction (94.9% vs. 68.0%, p = 0.0002) at 3 months had better PSA-mCRPC-free survival compared to their counterparts. Absolute reduction at 3 months was not associated with PSA-mCRPC. Similar PSA patterns were seen in those who had Rad-mCRPC compared to no Rad-mCRPC (p interaction < 0.05). CONCLUSION The degree of PSA decline at 3 months predicted serologic progression to mCRPC. Those who developed castration-resistant disease had higher PSA and a lower percentage reduction by 3 months. Tracking early PSA pattern changes may alert clinicians to poor treatment effect and potential progression; they should consider frequent PSA measurement and imaging, as well as the initiation of sequential therapy.
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21
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Dyshlovoy SA, Pelageev DN, Hauschild J, Sabutskii YE, Khmelevskaya EA, Krisp C, Kaune M, Venz S, Borisova KL, Busenbender T, Denisenko VA, Schlüter H, Bokemeyer C, Graefen M, Polonik SG, Anufriev VP, von Amsberg G. Inspired by Sea Urchins: Warburg Effect Mediated Selectivity of Novel Synthetic Non-Glycoside 1,4-Naphthoquinone-6S-Glucose Conjugates in Prostate Cancer. Mar Drugs 2020; 18:md18050251. [PMID: 32403427 PMCID: PMC7281150 DOI: 10.3390/md18050251] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
The phenomenon of high sugar consumption by tumor cells is known as Warburg effect. It results from a high glycolysis rate, used by tumors as preferred metabolic pathway even in aerobic conditions. Targeting the Warburg effect to specifically deliver sugar conjugated cytotoxic compounds into tumor cells is a promising approach to create new selective drugs. We designed, synthesized, and analyzed a library of novel 6-S-(1,4-naphthoquinone-2-yl)-d-glucose chimera molecules (SABs)—novel sugar conjugates of 1,4-naphthoquinone analogs of the sea urchin pigments spinochromes, which have previously shown anticancer properties. A sulfur linker (thioether bond) was used to prevent potential hydrolysis by human glycoside-unspecific enzymes. The synthesized compounds exhibited a Warburg effect mediated selectivity to human prostate cancer cells (including highly drug-resistant cell lines). Mitochondria were identified as a primary cellular target of SABs. The mechanism of action included mitochondria membrane permeabilization, followed by ROS upregulation and release of cytotoxic mitochondrial proteins (AIF and cytochrome C) to the cytoplasm, which led to the consequent caspase-9 and -3 activation, PARP cleavage, and apoptosis-like cell death. These results enable us to further clinically develop these compounds for effective Warburg effect targeting.
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Affiliation(s)
- Sergey A. Dyshlovoy
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumorzentrum, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (J.H.); (M.K.); (T.B.); (C.B.); (G.v.A.)
- G.B. Elyakov Pacific Institute of Bioorganic Chemistry, Far-East Branch, Russian Academy of Sciences, 690022 Vladivostok, Russia; (D.N.P.); (Y.E.S.); (E.A.K.); (K.L.B.); (V.A.D.); (S.G.P.); (V.P.A.)
- School of Natural Sciences, Far Eastern Federal University, 690091 Vladivostok, Russia
- Martini-Klinik, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany;
- Correspondence: or ; Tel.: +4940-7410-53591
| | - Dmitry N. Pelageev
- G.B. Elyakov Pacific Institute of Bioorganic Chemistry, Far-East Branch, Russian Academy of Sciences, 690022 Vladivostok, Russia; (D.N.P.); (Y.E.S.); (E.A.K.); (K.L.B.); (V.A.D.); (S.G.P.); (V.P.A.)
- School of Natural Sciences, Far Eastern Federal University, 690091 Vladivostok, Russia
| | - Jessica Hauschild
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumorzentrum, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (J.H.); (M.K.); (T.B.); (C.B.); (G.v.A.)
| | - Yurii E. Sabutskii
- G.B. Elyakov Pacific Institute of Bioorganic Chemistry, Far-East Branch, Russian Academy of Sciences, 690022 Vladivostok, Russia; (D.N.P.); (Y.E.S.); (E.A.K.); (K.L.B.); (V.A.D.); (S.G.P.); (V.P.A.)
| | - Ekaterina A. Khmelevskaya
- G.B. Elyakov Pacific Institute of Bioorganic Chemistry, Far-East Branch, Russian Academy of Sciences, 690022 Vladivostok, Russia; (D.N.P.); (Y.E.S.); (E.A.K.); (K.L.B.); (V.A.D.); (S.G.P.); (V.P.A.)
- School of Natural Sciences, Far Eastern Federal University, 690091 Vladivostok, Russia
| | - Christoph Krisp
- Institute of Clinical Chemistry and Laboratory Medicine, Mass Spectrometric Proteomics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (C.K.); (H.S.)
| | - Moritz Kaune
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumorzentrum, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (J.H.); (M.K.); (T.B.); (C.B.); (G.v.A.)
| | - Simone Venz
- Department of Medical Biochemistry and Molecular Biology, University of Greifswald, 17489 Greifswald, Germany;
- Interfacultary Institute of Genetics and Functional Genomics, Department of Functional Genomics, University of Greifswald, 17489 Greifswald, Germany
| | - Ksenia L. Borisova
- G.B. Elyakov Pacific Institute of Bioorganic Chemistry, Far-East Branch, Russian Academy of Sciences, 690022 Vladivostok, Russia; (D.N.P.); (Y.E.S.); (E.A.K.); (K.L.B.); (V.A.D.); (S.G.P.); (V.P.A.)
| | - Tobias Busenbender
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumorzentrum, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (J.H.); (M.K.); (T.B.); (C.B.); (G.v.A.)
| | - Vladimir A. Denisenko
- G.B. Elyakov Pacific Institute of Bioorganic Chemistry, Far-East Branch, Russian Academy of Sciences, 690022 Vladivostok, Russia; (D.N.P.); (Y.E.S.); (E.A.K.); (K.L.B.); (V.A.D.); (S.G.P.); (V.P.A.)
| | - Hartmut Schlüter
- Institute of Clinical Chemistry and Laboratory Medicine, Mass Spectrometric Proteomics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (C.K.); (H.S.)
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumorzentrum, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (J.H.); (M.K.); (T.B.); (C.B.); (G.v.A.)
| | - Markus Graefen
- Martini-Klinik, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Sergey G. Polonik
- G.B. Elyakov Pacific Institute of Bioorganic Chemistry, Far-East Branch, Russian Academy of Sciences, 690022 Vladivostok, Russia; (D.N.P.); (Y.E.S.); (E.A.K.); (K.L.B.); (V.A.D.); (S.G.P.); (V.P.A.)
| | - Victor Ph. Anufriev
- G.B. Elyakov Pacific Institute of Bioorganic Chemistry, Far-East Branch, Russian Academy of Sciences, 690022 Vladivostok, Russia; (D.N.P.); (Y.E.S.); (E.A.K.); (K.L.B.); (V.A.D.); (S.G.P.); (V.P.A.)
| | - Gunhild von Amsberg
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumorzentrum, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (J.H.); (M.K.); (T.B.); (C.B.); (G.v.A.)
- Martini-Klinik, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany;
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22
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Al Mahmud MR, Ishii K, Bernal-Lozano C, Delgado-Sainz I, Toi M, Akamatsu S, Fukumoto M, Watanabe M, Takeda S, Cortés-Ledesma F, Sasanuma H. TDP2 suppresses genomic instability induced by androgens in the epithelial cells of prostate glands. Genes Cells 2020; 25:450-465. [PMID: 32277721 PMCID: PMC7497232 DOI: 10.1111/gtc.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 01/08/2023]
Abstract
Androgens stimulate the proliferation of epithelial cells in the prostate by activating topoisomerase 2 (TOP2) and regulating the transcription of target genes. TOP2 resolves the entanglement of genomic DNA by transiently generating double‐strand breaks (DSBs), where TOP2 homodimers covalently bind to 5′ DSB ends, called TOP2‐DNA cleavage complexes (TOP2ccs). When TOP2 fails to rejoin TOP2ccs generating stalled TOP2ccs, tyrosyl DNA phosphodiesterase‐2 (TDP2) removes 5′ TOP2 adducts from stalled TOP2ccs prior to the ligation of the DSBs by nonhomologous end joining (NHEJ), the dominant DSB repair pathway in G0/G1 phases. We previously showed that estrogens frequently generate stalled TOP2ccs in G0/G1 phases. Here, we show that physiological concentrations of androgens induce several DSBs in individual human prostate cancer cells during G1 phase, and loss of TDP2 causes a five times higher number of androgen‐induced chromosome breaks in mitotic chromosome spreads. Intraperitoneally injected androgens induce several DSBs in individual epithelial cells of the prostate in TDP2‐deficient mice, even at 20 hr postinjection. In conclusion, physiological concentrations of androgens have very strong genotoxicity, most likely by generating stalled TOP2ccs.
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Affiliation(s)
- Md Rasel Al Mahmud
- Department of Radiation Genetics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenichiro Ishii
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Cristina Bernal-Lozano
- Centro Andaluz de Biología Molecular y Medicina Regenerativa (CABIMER), CSIC-Universidad de Sevilla Universidad Pablo de Olavide, Sevilla, Spain
| | - Irene Delgado-Sainz
- Centro Andaluz de Biología Molecular y Medicina Regenerativa (CABIMER), CSIC-Universidad de Sevilla Universidad Pablo de Olavide, Sevilla, Spain
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shusuke Akamatsu
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Manabu Fukumoto
- RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Masatoshi Watanabe
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shunichi Takeda
- Department of Radiation Genetics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Felipe Cortés-Ledesma
- Centro Andaluz de Biología Molecular y Medicina Regenerativa (CABIMER), CSIC-Universidad de Sevilla Universidad Pablo de Olavide, Sevilla, Spain.,Topology and DNA Breaks Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Hiroyuki Sasanuma
- Department of Radiation Genetics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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23
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Serum Levels of Matrix Metalloproteinase-1 in Brazilian Patients with Benign Prostatic Hyperplasia or Prostate Cancer. Curr Gerontol Geriatr Res 2020; 2020:6012102. [PMID: 32425999 PMCID: PMC7222547 DOI: 10.1155/2020/6012102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 11/23/2022] Open
Abstract
Metalloproteinases (MMPs) are involved in metastatic tumor processes, with changes in circulating levels detected in several cancer types. Here, we compare serum concentrations of metalloproteinase-1 (MMP-1) across individuals clinically diagnosed with prostate cancer (PCa) or benign prostatic hyperplasia (BPH), correcting results for the rs495366 single nucleotide polymorphism (SNP) that predisposes to differential MMP-1 levels. 196 men aged ≥50 years were followed at a university hospital urology outpatient clinic, with clinical, anthropometric, and rectal examinations performed by one urologist. Blood samples obtained prior to any clinical intervention provided baseline MMP-1 and total/free PSA levels as well as metabolic, hormonal, and inflammatory markers. The SNP was genotyped by real-time PCR. Participants with medical and/or laboratory profile compatible with malignancy composed the PCa group when confirmed by the Gleason scale. As expected, A-allele homozygotes showed reduced levels of MMP-1. Genotype-adjusted analyses revealed the mean MMP-1 level as 2-fold higher in PCa carriers compared to BPH patients. No other differences were found according to the prostatic condition or genotypic distribution, except for the expected raise in total and free PSA levels in PCa. In conclusion, increased serum levels of MMP-1 were observed in this context of prostatic malignancy compared to a benign phenotype, regardless of a genetic influence.
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24
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Armstrong AJ, Lin P, Higano CS, Sternberg CN, Sonpavde G, Tombal B, Templeton AJ, Fizazi K, Phung D, Wong EK, Krivoshik A, Beer TM. Development and validation of a prognostic model for overall survival in chemotherapy-naïve men with metastatic castration-resistant prostate cancer. Ann Oncol 2019; 29:2200-2207. [PMID: 30202945 DOI: 10.1093/annonc/mdy406] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Prognostic models are needed that reflect contemporary practice for men with metastatic castration-resistant prostate cancer (mCRPC). We sought to identify predictive and prognostic variables for overall survival (OS) in chemotherapy-naïve men with mCRPC treated with enzalutamide. Patients and methods Patients from the PREVAIL trial database (enzalutamide versus placebo) were randomly split 2 : 1 into training (n = 1159) and testing (n = 550) sets. Using the training set, 23 predefined variables were analyzed and a multivariable model predicting OS was developed and validated in an independent testing set. Results Patient characteristics and outcomes were well balanced between training and testing sets; median OS was 32.7 months in each. The final validated multivariable model included 11 independent prognostic variables. Median OS for low-, intermediate-, and high-risk groups (testing set) defined by prognostic risk tertiles were not yet reached (NYR) (95% CI NYR-NYR), 34.2 months (31.5-NYR), and 21.1 months (17.5-25.0), respectively. Hazard ratios (95% CI) for OS in the low- and intermediate-risk groups versus high-risk group were 0.20 (0.14-0.29) and 0.40 (0.30-0.53), respectively. Secondary outcomes of response and progression differed widely in model-defined risk groups. Enzalutamide improved outcomes in all prognostic risk groups. Conclusions Our validated prognostic model incorporates variables routinely collected in chemotherapy-naïve men with mCRPC treated with enzalutamide, identifying subsets of patients with widely differing survival outcomes that provide useful information for external validation, patient care, and clinical trial design. Trial registration ClinicalTrials.gov: NCT01212991.
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Affiliation(s)
- A J Armstrong
- Division of Medical Oncology and Urology, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute Duke University, Durham.
| | - P Lin
- Biostatistics (Lin) and Medical Affairs (Wong), Pfizer Inc, San Francisco
| | - C S Higano
- Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, USA
| | - C N Sternberg
- Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - G Sonpavde
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, USA
| | - B Tombal
- Urology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - A J Templeton
- Department of Oncology, St. Claraspital and University of Basel, Basel, Switzerland
| | - K Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy University of Paris Sud, Villejuif, France
| | - D Phung
- Biostatistics, Astellas Pharma Europe BV, Leiden, The Netherlands
| | - E K Wong
- Biostatistics (Lin) and Medical Affairs (Wong), Pfizer Inc, San Francisco
| | - A Krivoshik
- Medical Sciences, Astellas Pharma US, Inc, Northbrook
| | - T M Beer
- Hematology/Medical Oncology, OHSU Knight Cancer Institute Oregon Health & Science University, Portland, USA
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Role of novel hormonal therapies in the management of non-metastatic castration-resistant prostate cancer: a literature-based meta-analysis of randomized trials. Clin Transl Oncol 2019; 22:1033-1039. [PMID: 31617061 DOI: 10.1007/s12094-019-02228-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Novel hormonal therapies have been recently investigated in non-metastatic castration-resistant prostate cancer (CRPC). We performed a meta-analysis to assess the efficacy and safety of novel hormonal therapies in non-metastatic CRPC. MATERIALS AND METHODS The primary outcome was metastasis-free survival (MFS). The secondary endpoints were overall survival (OS), time to PSA progression and safety. We planned a subgroup analysis according to the PSA doubling time (> 6 vs < 6 months), Eastern Cooperative Oncology Group (ECOG) performance status (1 vs 0) and concomitant use of bone-targeting agent (yes vs no). RESULTS Pooled analysis of novel hormonal therapies revealed significantly increased MFS compared with placebo (hazard ratio (HR): HR = 0.32, 95% CI 0.25-0.41; p < 0.00001). The subgroup analysis showed a statistically significant MFS advantage in favour of men with the lower ECOG performance status. Other secondary endpoints favoured the novel hormonal therapies. The relative risk (RR) of grade ≥ 3 adverse events and ≥ 3 hypertension was 1.31 and 1.39, respectively. CONCLUSIONS This study confirmed the efficacy and safety of the novel hormonal therapies in non-metastatic CRPC.
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Watanabe M, Kanao K, Suzuki S, Muramatsu H, Morinaga S, Kajikawa K, Kobayashi I, Nishikawa G, Kato Y, Zennami K, Nakamura K, Tsuzuki T, Yoshikawa K, Ueda R, Sumitomo M. Increased infiltration of CCR4-positive regulatory T cells in prostate cancer tissue is associated with a poor prognosis. Prostate 2019; 79:1658-1665. [PMID: 31390096 DOI: 10.1002/pros.23890] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Regulatory T cells (Tregs) play important roles in the suppression of immune responses, including antitumor immune responses. C-C chemokine receptor 4 (CCR4) is highly expressed on effector Tregs, and anti-CCR4 antibody is attracting attention as a novel immunotherapeutic agent for solid tumors. This study aimed to evaluate the expression of CCR4-positive Tregs (CCR4+Tregs) in prostate cancer and estimate the clinical potential of CCR4-targeting therapy for prostate cancer. METHODS A total of 15 radical prostatectomy (RP) specimens and 60 biopsy specimens from individuals diagnosed with prostate cancer were analyzed to evaluate the infiltration of CCR4+Tregs in prostate cancer. The relationships between the number of CCR4+Tregs and clinical parameters were investigated in RP and biopsy specimens. Moreover, the total number of Tregs, CCR4+Tregs, and T cells and the ratio of CCR4+Tregs to Tregs and T cells in biopsy specimens were compared between patients with poor prognosis who progressed to castration-resistant prostate cancer (CRPC) within 12 months (n = 13) and those with good prognosis who were stable with hormone-sensitive prostate cancer over 12 months (n = 47). Furthermore, biopsy specimens were divided into two groups: low and high CCR4+Treg expression groups and the prognosis was compared between them. RESULTS There was a higher expression of CCR4+Tregs in RP specimens with a higher (≥8) Gleason score than in those with a lower (<8) Gleason score (P = .041). In biopsy specimens, 65.9% Tregs were positive for CCR4. The number of CCR4+Tregs positively correlated with clinical stage (P < .001) and Gleason score (P = .006). The total number of Tregs and CCR4+Tregs significantly increased in the poor prognosis group compared with that in the good prognosis group (P = .024 and .01, respectively). Furthermore, patients with lower CCR4+Treg expression levels showed a significantly longer time to progression to CRPC (not reached vs 27.3 months; P < .001) and median survival time (not reached vs 69.0 months; P = .014) than those with higher expression levels. CONCLUSIONS CCR4+Tregs are highly infiltrated in the prostate tissue of patients with poor prognosis with potential to progress to CRPC. Furthermore, the degree of infiltration of CCR4+Tregs is related to the prognosis of prostate cancer.
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Affiliation(s)
- Masahito Watanabe
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kent Kanao
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Susumu Suzuki
- Department of Tumor Immunology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiroyuki Muramatsu
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Singo Morinaga
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Keishi Kajikawa
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Ikuo Kobayashi
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Genya Nishikawa
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yoshiharu Kato
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kenji Zennami
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kogenta Nakamura
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Kazuhiro Yoshikawa
- Division of Advanced Research Promotion, Institute of Comprehensive Medical Research, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Ryuzo Ueda
- Department of Tumor Immunology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Makoto Sumitomo
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Hsiao CP, Chen MK, Veigl ML, Ellis R, Cooney M, Daly B, Hoppel C. Relationships between expression of BCS1L, mitochondrial bioenergetics, and fatigue among patients with prostate cancer. Cancer Manag Res 2019; 11:6703-6717. [PMID: 31410061 PMCID: PMC6645361 DOI: 10.2147/cmar.s203317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/07/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: Cancer-related fatigue (CRF) is the most debilitating symptom with the greatest adverse side effect on quality of life. The etiology of this symptom is still not understood. The purpose of this study was to examine the relationship between mitochondrial gene expression, mitochondrial oxidative phosphorylation, electron transport chain complex activity, and fatigue in prostate cancer patients undergoing radiotherapy (XRT), compared to patients on active surveillance (AS). Methods: The study used a matched case–control and repeated-measures research design. Fatigue was measured using the revised Piper Fatigue Scale from 52 patients with prostate cancer. Mitochondrial oxidative phosphorylation, electron-transport chain enzymatic activity, and BCS1L gene expression were determined using patients’ peripheral mononuclear cells. Data were collected at three time points and analyzed using repeated measures ANOVA. Results: The fatigue score was significantly different over time between patients undergoing XRT and AS (P<0.05). Patients undergoing XRT experienced significantly increased fatigue at day 21 and day 42 of XRT (P<0.01). Downregulated mitochondrial gene (BC1, ubiquinol-cytochrome c reductase, synthesis-like, BCS1L, P<0.05) expression, decreased OXPHOS-complex III oxidation (P<0.05), and reduced activity of complex III were observed over time in patients with XRT. Moreover, increased fatigue was significantly associated with downregulated BCS1L and decreased complex III oxidation in patients undergoing XRT. Conclusion: Our results suggest that BCS1L and complex III in mitochondrial mononuclear cells are potential biomarkers and feasible therapeutic targets for acute XRT-induced fatigue in this clinical population.
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Affiliation(s)
- Chao-Pin Hsiao
- The Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.,School of Nursing, Taipei Medical University, Taipei , Taiwan
| | - Mei-Kuang Chen
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Martina L Veigl
- Gene Expression & Genotyping Facility, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Rodney Ellis
- Department of Radiation Oncology and Urology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Matthew Cooney
- Department of Medical Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Daly
- The Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Charles Hoppel
- Center for Mitochondrial Disease, Department of Pharmacology and Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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28
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Carroll PR, Parsons JK. Guidelines should be assessed based on the underlying evidence. CMAJ 2019; 191:E871. [PMID: 31387962 DOI: 10.1503/cmaj.72508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Peter R Carroll
- Professor and chair, Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, Calif
| | - J Kellogg Parsons
- Professor and endowed chair for clinical research, Department of Urology; director of genitourinary clinical and translational research, Moores UCSD Comprehensive Cancer Center, UC San Diego Health, La Jolla, Calif
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Active surveillance for prostate and thyroid cancers: evolution in clinical paradigms and lessons learned. Nat Rev Clin Oncol 2019; 16:168-184. [PMID: 30413793 DOI: 10.1038/s41571-018-0116-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The adverse effects of overdiagnosis and overtreatment observed in men with clinically insignificant prostate cancers after the introduction of prostate-specific antigen-based screening are now being observed in those with thyroid cancer, owing to the introduction of new imaging technologies. Thus, the evolving paradigm of active surveillance in prostate and thyroid cancers might be valuable in informing the development of future active surveillance protocols. The lessons learned from active surveillance and their implications include the need to minimize the use of broad, population-based screening programmes that do not incorporate patient education and the need for individualized or shared decision-making, which can decrease the extent of overtreatment. Furthermore, from the experience in patients with prostate cancer, we have learned that consensus is required regarding the optimal selection of patients for active surveillance, using more-specific evidence-based methods for stratifying patients by risk. In this Review, we describe the epidemiology, pathology and screening guidelines for the management of patients with prostate and thyroid cancers; the evidence of overdiagnosis and overtreatment; and provide overviews of existing international active surveillance protocols.
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Roviello G, Corona SP, Conca R, Petrioli R, Rosellini P, Bonetta A, Aieta M. Is there still a place for vinorelbine in advanced metastatic castration resistant prostate cancer? Medicine (Baltimore) 2019; 98:e16249. [PMID: 31261590 PMCID: PMC6616091 DOI: 10.1097/md.0000000000016249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this paper was to evaluate the activity and tolerability of oral vinorelbine in patients with advanced castration resistant prostate cancer (CRPC) who progressed after a minimum of three lines including: abiraterone acetate, docetaxel, cabazitaxel, and enzalutamide.Treatment consisted of weekly oral vinorelbine 60 mg/m. Chemotherapy was administered until disease progression or unacceptable toxicity.Twenty-six patients received vinorelbine: their median age was 74 years (range 58-84 years). Twenty-four (92.3%) patients had bone metastases. A decrease in PSA levels ≥50% was observed in 2 patients (7.7%). Among the subjects who were symptomatic at baseline, pain was reduced in 3 patients (13.6%) with a significant decrease in analgesic use. Median progression-free survival was 9 weeks (95% CI: 7 to 11) and median overall survival was 17 weeks (95% CI: 12 to 22). Treatment was well tolerated, and no grade 4 toxicities were observed.Our findings do not suggest the use of oral vinorelbine on a weekly schedule, in CRPC heavily pre-treated.
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Affiliation(s)
- Giandomenico Roviello
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, Rionero, Vulture (PZ), Italy
| | - Silvia Paola Corona
- Peter MacCallum Cancer Centre, Radiation Oncology Department, Moorabbin Campus, East Bentleigh Victoria, Australia
| | - Raffaele Conca
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, Rionero, Vulture (PZ), Italy
| | - Roberto Petrioli
- Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Viale Bracci - Policlinico “Le Scotte”, Siena
| | - Pietro Rosellini
- Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Viale Bracci - Policlinico “Le Scotte”, Siena
| | - Alberto Bonetta
- Radiotherapy department, ASST Cremona, Viale Concordia 1, Cremona, Italy
| | - Michele Aieta
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, Rionero, Vulture (PZ), Italy
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Zhang E, Dai F, Mao Y, He W, Liu F, Ma W, Qiao Y. Differences of the immune cell landscape between normal and tumor tissue in human prostate. Clin Transl Oncol 2019; 22:344-350. [PMID: 31077088 DOI: 10.1007/s12094-019-02128-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/26/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Over the past few decades, immunological checkpoint therapy has been an increasingly prominent strategy in the treatment of tumors, including prostate cancer (PC). There are few systematic studies of the phenotypic of tumor-infiltrating immune cells in PC tissues. METHODS CIBERSORT is an analytical tool for estimating the abundance of member cell types in mixed cell population by gene expression data. Herein, we analyzed different levels of tumor-infiltrating immunity cells in normal tissue compared with PC using CIBERSORT. RESULTS The results showed that proportion of M1 macrophages and resting mast cells presented significant differences in prostate tumor than these normal tissues. A higher proportion of resting mast cells was associated with a worse outcome and M1 macrophages was associated with a favorable outcome. Moreover, the radiotherapy and targeted molecular therapy can affect the immune infiltration of M1 macrophages and resting mast cells. CONCLUSIONS Resting mast cells and M1 macrophages has an important role in the prognosis of prostate cancer. Our data provides valuable information about the future treatment of PC.
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Affiliation(s)
- E Zhang
- School of Life Sciences, Lanzhou University, No. 222 Tianshui South Road, Lanzhou, 730000, Gansu, People's Republic of China.
| | - F Dai
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Y Mao
- Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - W He
- Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - F Liu
- Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - W Ma
- Lanzhou University First Hospital, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Y Qiao
- Lanzhou University First Hospital, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
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Abiraterone acetate plus prednisone in patients with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (LATITUDE): final overall survival analysis of a randomised, double-blind, phase 3 trial. Lancet Oncol 2019; 20:686-700. [PMID: 30987939 DOI: 10.1016/s1470-2045(19)30082-8] [Citation(s) in RCA: 470] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the interim analyses of the LATITUDE study, the addition of abiraterone acetate plus prednisone to androgen deprivation therapy (ADT) led to a significant improvement in overall survival and radiographic progression-free survival compared with placebos plus ADT in men with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (mCSPC). Here, we present long-term survival outcomes and safety of abiraterone acetate plus prednisone and ADT from the final analysis of the LATITUDE study. METHODS This is a multicentre, randomised, double-blind, phase 3 trial done at 235 sites in 34 countries. Eligible patients (men aged ≥18 years) had newly diagnosed, histologically or cytologically confirmed prostate cancer with metastases, Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, and at least two of the three high-risk prognostic factors (Gleason score of ≥8, presence of three or more lesions on bone scan, or presence of measurable visceral metastasis except lymph node metastasis). Patients were randomly assigned (1:1) to receive abiraterone acetate (1000 mg) once daily orally plus prednisone (5 mg) once daily orally and ADT (abiraterone acetate plus prednisone group) or matching placebos plus ADT (placebo group); each treatment cycle was 28 days. Randomisation was done by a centralised interactive web response system in a country-by-country scheme using permuted block randomisation, stratified by presence of visceral disease and ECOG performance status. The coprimary endpoint of overall survival was assessed in the intention-to-treat population. This study is registered at ClinicalTrials.gov, number NCT01715285 and is complete. FINDINGS Between Feb 12, 2013, and Dec 11, 2014, 1209 patients were screened, of whom ten were ineligible because of study site violations. 1199 patients were randomly assigned to either the abiraterone acetate plus prednisone group (n=597) or placebo group (n=602). After the results of the first interim analysis (cutoff date Oct 31, 2016), the study was unmasked to patients and investigators, and patients in the placebo group were allowed to cross over to receive abiraterone acetate and prednisone plus ADT treatment as per a protocol amendment (Feb 15, 2017) in an open-label extension phase of the study (up to 18 months from the protocol amendment). This final analysis (data cutoff Aug 15, 2018) was done after a median follow-up of 51·8 months (IQR 47·2-57·0) and 618 deaths (275 [46%] of 597 in the abiraterone acetate plus prednisone group and 343 [57%] of 602 in the placebo group). Overall survival was significantly longer in the abiraterone acetate plus prednisone group (median 53·3 months [95% CI 48·2-not reached]) than in the placebo group (36·5 months [33·5-40·0]), with a hazard ratio of 0·66 (95% CI 0·56-0·78; p<0·0001). The most common grade 3-4 adverse events were hypertension (125 [21%] in the abiraterone acetate plus prednisone group vs 60 [10%] in the placebo group vs three [4%] in the 72 patients who crossed over from placebo to abiraterone acetate plus prednisone) and hypokalaemia (70 [12%] vs ten [2%] vs two [3%]). Serious adverse events of any grade occurred in 192 (32%) of 597 patients in the abiraterone acetate plus prednisone group, 151 (25%) of 602 in the placebo group, and four (6%) of 72 in the crossover group. The most common treatment-related serious adverse event was hypokalaemia (four [1%] patients in the abiraterone acetate plus prednisone group and none in the other groups). Treatment-related deaths occurred in three (<1%) patients each in the abiraterone acetate plus prednisone group (gastric ulcer perforation, sudden death, and cerebrovascular accident) and the placebo group (sudden death, cerebrovascular accident, and pneumonia), with none in the crossover group. INTERPRETATION The combination of abiraterone acetate plus prednisone with ADT was associated with significantly longer overall survival than placebos plus ADT in men with newly diagnosed high-risk mCSPC and had a manageable safety profile. These findings support the use of abiraterone acetate plus prednisone as a standard of care in patients with high-risk mCSPC. FUNDING Janssen Research & Development.
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Cordero JA, Sancho G, Bonfill X. Population-based estimate of the use of intermittent androgen deprivation therapy in prostate cancer patients in Catalonia, Spain. Pharmacoepidemiol Drug Saf 2019; 28:796-803. [PMID: 30839139 DOI: 10.1002/pds.4744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 11/13/2018] [Accepted: 12/21/2018] [Indexed: 11/11/2022]
Abstract
PURPOSE To estimate the use of intermittent androgen deprivation (IAD) therapy in patients with prostate cancer (PCa). METHODS Retrospective, non-interventional study based on electronic pharmacy dispensation data of luteinizing hormone-releasing hormone (LHRH) analogs and anti-androgens in Catalonia (Spain). Intermittency was defined as the percentage of time off treatment (%IAD), which was calculated for the whole sample by dividing the sum of all off-IAD periods by the total time on any LHRH analog regimen. The prevalence of patients on an IAD regimen (PIAD ) was also estimated. A small validation study based on data from clinical records confirmed the excellent sensitivity and specificity of this approach. RESULTS A total of 515 803 prescriptions for LHRH analog were dispensed over a 5-year period (2008 to 2012) to 35 089 PCa patients. The mean age (±SD) was 77 years (±9). The %IAD in the cohort was 1.7% whereas the 5-year prevalence (PIAD ) was 4.2%. Only 2.5% of patients on IAD were on IAD for >6 months. Of the physicians (n = 1638) who prescribed hormonal treatment, 24% used IAD at least once. Total expenditures for LHRH analogs were 1.2% of total drug expenditure in this population. CONCLUSIONS This study confirms the validity of the method developed to estimate IAD use based on electronic pharmacy dispensation data. Given the large potential clinical and economic benefits that greater use of IAD could provide, future studies are needed to confirm these findings and to identify new strategies to increase the use of IAD.
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Affiliation(s)
- José A Cordero
- Blanquerna School of Health Science, Universitat Ramon Llull, Barcelona, Spain
| | - Gemma Sancho
- Sant Pau Biomedical Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Service of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Xavier Bonfill
- Sant Pau Biomedical Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Iberoamerican Cochrane Centre, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Roviello G, Petrioli R, Bonetta A, Conca R, Rodriquenz MG, Aieta M. Corticosteroid switch in heavily pre-treated castration-resistant prostate cancer patients progressed on abiraterone acetate plus prednisone. Invest New Drugs 2018; 36:1110-1115. [PMID: 30345466 DOI: 10.1007/s10637-018-0685-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/16/2018] [Indexed: 01/22/2023]
Abstract
The aim of this retrospective study is to evaluate the activity and safety of a steroidal switch from prednisone to dexamethasone in patients with advanced, heavily pre-treated, castration-resistant prostate cancer (CRPC) who progressed on abiraterone acetate. Treatment consisted of oral daily abiraterone plus dexamethasone (0.5 mg once daily) administered until disease progression or unacceptable toxicity. Thirty-six patients were evaluated: all men underwent a prior treatment with enzalutamide. A PSA decrease ≥50% was observed in 11% of patients; median progression-free survival was 10.8 weeks (95% CI: 9.2-16), and median survival was 17.6 weeks (95% CI: 15.8-28.8). Better efficacy and survival were observed in the subgroup of patients treated with abiraterone acetate prior for a period >3 months; treatment was well tolerated, and no grade 3-4 toxicities were observed. Our findings did not suggest the use of steroid switch in all CRPC who were heavily pre-treated. However, the switch could be an option for patients who responded well to prior abiraterone acetate treatment.
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Affiliation(s)
- Giandomenico Roviello
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, 85028 Rionero, Vulture, PZ, Italy.
| | - Roberto Petrioli
- Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Viale Bracci - Policlinico "Le Scotte", 53100, Siena, Italy
| | - Alberto Bonetta
- Radiotherapy Department, ASST Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - Raffaele Conca
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, 85028 Rionero, Vulture, PZ, Italy
| | - Maria Grazia Rodriquenz
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, 85028 Rionero, Vulture, PZ, Italy
| | - Michele Aieta
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, 85028 Rionero, Vulture, PZ, Italy
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Marret G, Doucet L, Hennequin C, Fizazi K, Culine S. Abiraterone in metastatic castration-resistant prostate cancer: Efficacy and safety in unselected patients. Cancer Treat Res Commun 2018; 17:37-42. [PMID: 30347333 DOI: 10.1016/j.ctarc.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/24/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Abiraterone acetate (AA), an androgen biosynthesis inhibitor, is now a standard of care for men with metastatic, castration-sensitive and castration-resistant prostate cancer (mCRPC). Data exploring real-world toxicity and outcomes are scarce. METHODS Retrospective study on unselected patients with mCRPC on AA plus steroids. RESULTS 93 patients were included in the study. Median duration of treatment by AA was 7.5 months (95% CI 5.7-12) among the 58 patients pretreated with chemotherapy, versus 12.7 months ( 95% CI 8.2-35.9) among the 33 chemo-naive patients. Median survivals would reach 13.4 months (95% CI 10.2-19.1) and 36.4 months (95% CI 24.7-41.5) respectively. Rates of hypokalemia, peripheral edema, hypertension, cardiac failure, and overall survival assessments in patients with and without prior chemotherapy were similar to that previously reported in phase 3 randomized trials. The median survival time without adverse event of special interest was 7.5 months for hypokalemia and hypertension, and 5.3 months for liver-function test abnormalities (it was not reached for cardiac disorders). CONCLUSION Our findings provide further evidence for the survival benefits of AA with a low frequency of additional adverse events among unselected patients. In patients who have not developed hypokalemia or a transaminase increase within 7.5 and 5.3 months respectively, a lighter systematic monitoring may be considered.
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Affiliation(s)
- Grégoire Marret
- Department of Cancer Medicine, Hôpital Saint Louis, Paris, France.
| | - Ludovic Doucet
- Department of Cancer Medicine, Hôpital Saint Louis, Paris, France.
| | | | - Karim Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Saclay, Villejuif, France.
| | - Stéphane Culine
- Department of Cancer Medicine, Hôpital Saint Louis, Paris, France.
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Baciarello G, Gizzi M, Fizazi K. Advancing therapies in metastatic castration-resistant prostate cancer. Expert Opin Pharmacother 2018; 19:1797-1804. [PMID: 30311804 DOI: 10.1080/14656566.2018.1527312] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Prostate cancer is the second most common cause of cancer worldwide and is the most frequently detected cancer in the European Union in men over 50 years of age. Androgen deprivation therapy remains the cornerstone of treatment for recurrent or metastatic disease. Unfortunately, nearly all patients will develop resistance to androgen blockade leading to castration-resistant prostate cancer (CRPC). Over the last 10 years, new treatments have dramatically improved overall survival of men with mCRPC. Current therapies are based on AR-axis inhibitors and taxane-based chemotherapies, as well as radiopharmaceuticals and Sipuleucel T. AREAS COVERED The authors provide a review of the current field of systemic therapy in metastatic CRPC. This is followed by an in-depth analysis of recent developments in treatment, and the biological rationale behind these therapies. EXPERT OPINION Since several trials with docetaxel or novel hormonal agents showed improvement in overall survival in metastatic castration-sensitive prostate cancer, as well as in non-metastatic castration-resistant patients, it is expected that a growing subgroup of patients will be exposed earlier to chemotherapy and to AR targeted agents. It becomes then fundamental to find novel strategies to overcome drug resistance and further improve survival.
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Affiliation(s)
- Giulia Baciarello
- a Department of Medical Oncology , Institut Gustave Roussy, University of Paris Sud , Villejuif , France
| | - Marco Gizzi
- b Service d'Oncologie , Grand Hôpital de Charleroi & Cliniques universitaires Saint Luc , Bruxelles , Belgium
| | - Karim Fizazi
- a Department of Medical Oncology , Institut Gustave Roussy, University of Paris Sud , Villejuif , France
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Tosco L, Briganti A, D'amico AV, Eastham J, Eisenberger M, Gleave M, Haustermans K, Logothetis CJ, Saad F, Sweeney C, Taplin ME, Fizazi K. Systematic Review of Systemic Therapies and Therapeutic Combinations with Local Treatments for High-risk Localized Prostate Cancer. Eur Urol 2018; 75:44-60. [PMID: 30286948 DOI: 10.1016/j.eururo.2018.07.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/17/2018] [Indexed: 01/09/2023]
Abstract
CONTEXT Systemic therapies, combined with local treatment for high-risk prostate cancer, are recommended by the international guidelines for specific subgroups of patients; however, for many of the clinical scenarios, it remains a research field. OBJECTIVE To perform a systematic review, and describe current evidence and perspectives about the multimodal treatment of high-risk prostate cancer. EVIDENCE ACQUISITION We performed a systematic review of PubMED, Embase, Cochrane Library, European Society of Medical Oncology/American Society of Clinical Oncology Annual proceedings, and clinicalTrial.gov between January 2010 and February 2018 following the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. EVIDENCE SYNTHESIS Seventy-seven prospective trials were identified. According to multiple randomized trials, combining androgen deprivation therapy (ADT) with external-beam radiotherapy (EBRT) outperforms EBRT alone for both relapse-free and overall survival. Neoadjuvant ADT did not show significant improvement compared with prostatectomy alone. The role of adjuvant ADT after prostatectomy in patients with high-risk disease is still debated, with lack of data from phase 3 trials in pN0 patients. Novel androgen pathway inhibitors have been tested only in early-phase trials in addition to primary treatment. GETUG 12, RTOG 0521, and nonmetastatic subgroup of the STAMPEDE trial showed improved relapse-free survival for docetaxel in patients treated with EBRT plus ADT, although mature metastasis-free survival data are still pending. Both the SPCG-12 and the VACSP#553 trial showed no improvement in relapse-free survival for adjuvant docetaxel after prostatectomy. CONCLUSIONS In contrast to the clearly demonstrated survival benefits of long-term adjuvant ADT when used with EBRT, its role after prostatectomy remains unclear especially in pN0 patients. Adding docetaxel to EBRT-ADT improves relapse-free survival, with immature results on overall survival. Novel androgen receptor pathway inhibitors are currently being tested in the neoadjuvant and adjuvant setting. PATIENT SUMMARY Treatment of high-risk prostate cancer is based on a multimodality approach that includes systemic treatments. The best treatment or therapy combination remains to be defined.
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Affiliation(s)
- Lorenzo Tosco
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Nuclear Medicine & Molecular Imaging, KU Leuven, Leuven, Belgium.
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antony Vincent D'amico
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - James Eastham
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario Eisenberger
- Department of Oncology in the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Martin Gleave
- The Vancouver Prostate Centre & Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Christopher J Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fred Saad
- Department of Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
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Pesapane F, Czarniecki M, Suter MB, Turkbey B, Villeirs G. Imaging of distant metastases of prostate cancer. Med Oncol 2018; 35:148. [DOI: 10.1007/s12032-018-1208-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023]
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Westgeest HM, Uyl-de Groot CA, van Moorselaar RJ, de Wit R, van den Bergh AC, Coenen JL, Beerlage HP, Hendriks MP, Bos MM, van den Berg P, van de Wouw AJ, Spermon R, Boerma MO, Geenen MM, Tick LW, Polee MB, Bloemendal HJ, Cordia I, Peters FP, de Vos AI, van den Bosch J, van den Eertwegh AJ, Gerritsen WR. Differences in Trial and Real-world Populations in the Dutch Castration-resistant Prostate Cancer Registry. Eur Urol Focus 2018; 4:694-701. [DOI: 10.1016/j.euf.2016.09.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/11/2016] [Accepted: 09/28/2016] [Indexed: 11/29/2022]
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Bonfill X, Arevalo-Rodriguez I, Martínez García L, Quintana MJ, Buitrago-Garcia D, Lobos Urbina D, Cordero JA. Intermittent androgen deprivation therapy: recommendations to improve the management of patients with prostate cancer following the GRADE approach. Cancer Manag Res 2018; 10:2357-2367. [PMID: 30122985 PMCID: PMC6080876 DOI: 10.2147/cmar.s164856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The purpose of this study was to provide evidence-based recommendations of intermittent androgen deprivation therapy (IADT) compared with continuous androgen deprivation therapy (CADT) for men with prostate cancer (PCA). METHODS We conducted a comprehensive search in MEDLINE, EMBASE, The Cochrane Library, CINAHL, and ECONLIT, from the database inception to December 2017. We adhered to the Grading of Recommendations, Assessment, Development and Evaluation framework to assess the quality of the evidence and to formulate recommendations. RESULTS We included one systematic review with 15 trials as well as three additional studies that assessed IADT versus CADT, all of them focused on PCA patients in advanced stages. The findings did not show differences for critical and important outcomes, including adverse events. Trials reported the benefits of IADT in terms of selected domains of health-related quality of life, although with high heterogeneity. Evidence quality was considered moderate or low for most of the assessed outcomes. We identified a patient preference study reporting a high preference for IADT, due to issues related to quality of life, general well-being, and side effects, among others. We did not identify economic studies comparing these regimes. We formulate four recommendations: one no-recommendation, one conditional recommendation, and two good practice points. CONCLUSION For men in early stages of PCA, it is not possible to make any recommendation about the preferable use of IADT or CADT due to the lack of available evidence. For men in advanced stages of the disease, an IADT should be considered as soon as clinically reasonable (weak recommendation and low certainty of the evidence). Clinicians should discuss the risks and benefits of IADT and CADT with their patients, taking into account their values and preferences.
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Affiliation(s)
- Xavier Bonfill
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Barcelona, Spain
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Ingrid Arevalo-Rodriguez
- Centro de Investigación en Salud Pública y Epidemiología Clínica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador,
- Hospital Ramon y Cajal (IRYCIS), Clinical Biostatistics Unit, CIBER of Epidemiology and Public Health, Madrid, Spain,
| | | | - Maria Jesús Quintana
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Barcelona, Spain
| | - Diana Buitrago-Garcia
- Centro de Investigación en Salud Pública y Epidemiología Clínica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador,
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Fizazi K, Smith MR, Tombal B. Clinical Development of Darolutamide: A Novel Androgen Receptor Antagonist for the Treatment of Prostate Cancer. Clin Genitourin Cancer 2018; 16:332-340. [PMID: 30197098 DOI: 10.1016/j.clgc.2018.07.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/30/2018] [Accepted: 07/14/2018] [Indexed: 01/09/2023]
Abstract
Prostate cancer (PC) is the second most common cancer in men and is the fifth leading cause of cancer-related deaths among men. Androgen receptor (AR) signaling plays a key role in PC tumor growth and progression, with androgens stimulating PC proliferation and survival. Castration-resistant PC (CRPC) is characterized by increasing levels of prostate-specific antigen or radiographic progression despite androgen-deprivation therapy (ADT). In most patients, castration resistance results from aberrations in AR or the AR signaling pathway. Up to one-third of patients with localized high-risk PC will have disease progression on local therapy and develop CRPC. This review summarizes the key clinical data, including ongoing trials, for hormonal therapies in CRPC and provides an overview of the clinical development of darolutamide, a novel, nonsteroidal AR antagonist currently in phase III development for the treatment of nonmetastatic CRPC and metastatic hormone-sensitive PC. In phase I/II trials, darolutamide has demonstrated a favorable safety profile, antitumor activity, and significant decreases in prostate-specific antigen in patients with metastatic CRPC. In the phase III ARAMIS (NCT02200614; A Multinational, Randomized, Double-Blind, Placebo-Controlled, Phase III Efficacy and Safety Study of Darolutamide [ODM-201] in Men With High-Risk Non-metastatic Castration-Resistant Prostate Cancer) study, metastasis-free survival is being evaluated in men with nonmetastatic CRPC who will receive ADT in combination with darolutamide or placebo. The ARASENS (NCT02799602; A Randomized, Double-Blind, Placebo Controlled Phase III Study of Darolutamide [ODM-201] Versus Placebo in Addition to Standard Androgen Deprivation Therapy and Docetaxel in Patients With Metastatic Hormone Sensitive Prostate Cancer) study is a placebo-controlled trial assessing whether the addition of darolutamide to ADT and docetaxel significantly prolongs overall survival in men with metastatic hormone-sensitive PC.
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Affiliation(s)
- Karim Fizazi
- Institut Gustave Roussy, Department of Cancer Medicine, University of Paris Sud, Villejuif, France.
| | - Matthew R Smith
- Departments of Hematology/Oncology and Medicine, Massachusetts General Hospital, Boston, MA
| | - Bertrand Tombal
- Cliniques Universitaires Saint-Luc Université Catholique de Louvain Brussels, Woluwe-Saint-Lambert, Brussels, Belgium
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Patrikidou A, Maroun P, Patard JJ, Baumert H, Albiges L, Massard C, Loriot Y, Escudier B, Di Palma M, Arfi-Rouche J, Rocher L, Merabet Z, Bossi A, Fizazi K, Blanchard P. Helping patients make informed decisions. Two-year evaluation of the Gustave Roussy prostate cancer multidisciplinary clinic. Clin Transl Radiat Oncol 2018; 12:28-33. [PMID: 30094353 PMCID: PMC6072649 DOI: 10.1016/j.ctro.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 06/28/2018] [Accepted: 07/04/2018] [Indexed: 11/24/2022] Open
Abstract
The initial treatment decision for newly diagnosed non-metastatic prostate cancer is complex. Specialist multidisciplinary consultations focus on shared decision-making. The Gustave Roussy PCMC rendered high patient satisfaction and promoted active participation. Information offered at the Gustave Roussy PCMC strongly influenced final treatment decisions.
Objectives The initial treatment decision for newly diagnosed non-metastatic prostate cancer is complex. Multiple valid approaches exist, without a clear and absolute consensus for every clinical scenario, and therefore specialist opinions may vary. Multidisciplinary consultations focusing on shared decision-making aim to provide an apposite tool for the initial treatment decision. We have evaluated the first two years of activity of the Gustave Roussy Prostate Cancer Multidisciplinary Clinic (PCMC), dedicated to the initial decision-making for non-metastatic prostate cancer. Methods PCMC consists of two consecutive specialist consultations with a urological surgeon and a radiation oncologist, followed by a dedicated Tumor Board discussion. A study questionnaire was addressed to all PCMC patients via postal mail. Medical notes and questionnaire responses of 195 eligible patients were analyzed. Results The questionnaire response rate was 69% (134 patients). Complete satisfaction rate was high (114 of 118 responders, 97%). Patients were offered new treatment options in 55% of cases, and felt better informed in 98% (122 of 125 responders). The double consultation was considered useful (124 of 129 responders, 96%). Reported feeling of active participation was significantly elevated (117 of 131 responders, 89%), while 46% of patients (57 of 125) modified their decision on the management of their prostate cancer following their PCMC consultation. Conclusions The experience of a multidisciplinary consultation in the initial management of non-metastatic prostate cancer renders high patient satisfaction, improves their appreciation of feeling better informed, promotes active participation and shared decision-making and strongly influences their final decision.
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Affiliation(s)
- Anna Patrikidou
- Gustave Roussy, Université Paris-Saclay, Département de médecine oncologique, F-94800 Villejuif, France
| | - Pierre Maroun
- Gustave Roussy, Université Paris-Saclay, Département de Radiothérapie Oncologique, F-94800 Villejuif, France
| | | | - Hervé Baumert
- Hôpital Saint-Joseph, Service d'Urologie, F-75014 Paris, France
| | - Laurence Albiges
- Gustave Roussy, Université Paris-Saclay, Département de médecine oncologique, F-94800 Villejuif, France
| | - Christophe Massard
- Gustave Roussy, Université Paris-Saclay, Département de médecine oncologique, F-94800 Villejuif, France
| | - Yohann Loriot
- Gustave Roussy, Université Paris-Saclay, Département de médecine oncologique, F-94800 Villejuif, France
| | - Bernard Escudier
- Gustave Roussy, Université Paris-Saclay, Département de médecine oncologique, F-94800 Villejuif, France
| | - Mario Di Palma
- Gustave Roussy, Université Paris-Saclay, Département de médecine oncologique, F-94800 Villejuif, France
| | - Julia Arfi-Rouche
- Gustave Roussy, Université Paris-Saclay, Département d'imagerie médicale, F-94800 Villejuif, France
| | - Laurence Rocher
- Hôpital Bicêtre, Service de Radiologie, F-94270 Le Kremlin-Bicêtre, France
| | - Zahira Merabet
- Gustave Roussy, Université Paris-Saclay, Département de biologie et pathologie médicales, F-94800 Villejuif, France
| | - Alberto Bossi
- Gustave Roussy, Université Paris-Saclay, Département de Radiothérapie Oncologique, F-94800 Villejuif, France
| | - Karim Fizazi
- Gustave Roussy, Université Paris-Saclay, Département de médecine oncologique, F-94800 Villejuif, France
| | - Pierre Blanchard
- Gustave Roussy, Université Paris-Saclay, Département de Radiothérapie Oncologique, F-94800 Villejuif, France
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Shore ND, Tammela TL, Massard C, Bono P, Aspegren J, Mustonen M, Fizazi K. Safety and Antitumour Activity of ODM-201 (BAY-1841788) in Chemotherapy-naïve and CYP17 Inhibitor-naïve Patients: Follow-up from the ARADES and ARAFOR Trials. Eur Urol Focus 2018; 4:547-553. [DOI: 10.1016/j.euf.2017.01.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/04/2017] [Accepted: 01/24/2017] [Indexed: 12/12/2022]
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Hussain M, Fizazi K, Saad F, Rathenborg P, Shore N, Ferreira U, Ivashchenko P, Demirhan E, Modelska K, Phung D, Krivoshik A, Sternberg CN. Enzalutamide in Men with Nonmetastatic, Castration-Resistant Prostate Cancer. N Engl J Med 2018; 378:2465-2474. [PMID: 29949494 PMCID: PMC8288034 DOI: 10.1056/nejmoa1800536] [Citation(s) in RCA: 675] [Impact Index Per Article: 112.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Men with nonmetastatic, castration-resistant prostate cancer and a rapidly rising prostate-specific antigen (PSA) level are at high risk for metastasis. We hypothesized that enzalutamide, which prolongs overall survival among patients with metastatic, castration-resistant prostate cancer, would delay metastasis in men with nonmetastatic, castration-resistant prostate cancer and a rapidly rising PSA level. METHODS In this double-blind, phase 3 trial, we randomly assigned, in a 2:1 ratio, men with nonmetastatic, castration-resistant prostate cancer and a PSA doubling time of 10 months or less who were continuing androgen-deprivation therapy to receive enzalutamide (at a dose of 160 mg) or placebo once daily. The primary end point was metastasis-free survival (defined as the time from randomization to radiographic progression or as the time to death without radiographic progression). RESULTS A total of 1401 patients (median PSA doubling time, 3.7 months) underwent randomization. As of June 28, 2017, a total of 219 of 933 patients (23%) in the enzalutamide group had metastasis or had died, as compared with 228 of 468 (49%) in the placebo group. The median metastasis-free survival was 36.6 months in the enzalutamide group versus 14.7 months in the placebo group (hazard ratio for metastasis or death, 0.29; 95% confidence interval, 0.24 to 0.35; P<0.001). The time to the first use of a subsequent antineoplastic therapy was longer with enzalutamide treatment than with placebo (39.6 vs. 17.7 months; hazard ratio, 0.21; P<0.001; such therapy was used in 15% vs. 48% of patients) as was the time to PSA progression (37.2 vs. 3.9 months; hazard ratio, 0.07; P<0.001; progression occurred in 22% vs. 69% of patients). At the first interim analysis of overall survival, 103 patients (11%) receiving enzalutamide and 62 (13%) receiving placebo had died. Adverse events of grade 3 or higher occurred in 31% of the patients receiving enzalutamide, as compared with 23% of those receiving placebo. CONCLUSIONS Among men with nonmetastatic, castration-resistant prostate cancer with a rapidly rising PSA level, enzalutamide treatment led to a clinically meaningful and significant 71% lower risk of metastasis or death than placebo. Adverse events were consistent with the established safety profile of enzalutamide. (Funded by Pfizer and Astellas Pharma; PROSPER ClinicalTrials.gov number, NCT02003924 .).
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Affiliation(s)
- Maha Hussain
- From the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago (M.H.), and Astellas Pharma, Northbrook (D.P., A.K.) - both in Illinois; Institut Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); the University of Montreal Hospital Center, Montreal (F.S.); Herlev Hospital, Herlev, Denmark (P.R.); Carolina Urologic Research Center, Myrtle Beach, SC (N.S.); State University of Campinas (Unicamp), Campinas, Brazil (U.F.); Kiev City Clinical Hospital 3, Kiev, Ukraine (P.I.); Pfizer, San Francisco (E.D., K.M.); and the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome (C.N.S.)
| | - Karim Fizazi
- From the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago (M.H.), and Astellas Pharma, Northbrook (D.P., A.K.) - both in Illinois; Institut Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); the University of Montreal Hospital Center, Montreal (F.S.); Herlev Hospital, Herlev, Denmark (P.R.); Carolina Urologic Research Center, Myrtle Beach, SC (N.S.); State University of Campinas (Unicamp), Campinas, Brazil (U.F.); Kiev City Clinical Hospital 3, Kiev, Ukraine (P.I.); Pfizer, San Francisco (E.D., K.M.); and the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome (C.N.S.)
| | - Fred Saad
- From the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago (M.H.), and Astellas Pharma, Northbrook (D.P., A.K.) - both in Illinois; Institut Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); the University of Montreal Hospital Center, Montreal (F.S.); Herlev Hospital, Herlev, Denmark (P.R.); Carolina Urologic Research Center, Myrtle Beach, SC (N.S.); State University of Campinas (Unicamp), Campinas, Brazil (U.F.); Kiev City Clinical Hospital 3, Kiev, Ukraine (P.I.); Pfizer, San Francisco (E.D., K.M.); and the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome (C.N.S.)
| | - Per Rathenborg
- From the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago (M.H.), and Astellas Pharma, Northbrook (D.P., A.K.) - both in Illinois; Institut Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); the University of Montreal Hospital Center, Montreal (F.S.); Herlev Hospital, Herlev, Denmark (P.R.); Carolina Urologic Research Center, Myrtle Beach, SC (N.S.); State University of Campinas (Unicamp), Campinas, Brazil (U.F.); Kiev City Clinical Hospital 3, Kiev, Ukraine (P.I.); Pfizer, San Francisco (E.D., K.M.); and the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome (C.N.S.)
| | - Neal Shore
- From the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago (M.H.), and Astellas Pharma, Northbrook (D.P., A.K.) - both in Illinois; Institut Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); the University of Montreal Hospital Center, Montreal (F.S.); Herlev Hospital, Herlev, Denmark (P.R.); Carolina Urologic Research Center, Myrtle Beach, SC (N.S.); State University of Campinas (Unicamp), Campinas, Brazil (U.F.); Kiev City Clinical Hospital 3, Kiev, Ukraine (P.I.); Pfizer, San Francisco (E.D., K.M.); and the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome (C.N.S.)
| | - Ubirajara Ferreira
- From the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago (M.H.), and Astellas Pharma, Northbrook (D.P., A.K.) - both in Illinois; Institut Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); the University of Montreal Hospital Center, Montreal (F.S.); Herlev Hospital, Herlev, Denmark (P.R.); Carolina Urologic Research Center, Myrtle Beach, SC (N.S.); State University of Campinas (Unicamp), Campinas, Brazil (U.F.); Kiev City Clinical Hospital 3, Kiev, Ukraine (P.I.); Pfizer, San Francisco (E.D., K.M.); and the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome (C.N.S.)
| | - Petro Ivashchenko
- From the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago (M.H.), and Astellas Pharma, Northbrook (D.P., A.K.) - both in Illinois; Institut Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); the University of Montreal Hospital Center, Montreal (F.S.); Herlev Hospital, Herlev, Denmark (P.R.); Carolina Urologic Research Center, Myrtle Beach, SC (N.S.); State University of Campinas (Unicamp), Campinas, Brazil (U.F.); Kiev City Clinical Hospital 3, Kiev, Ukraine (P.I.); Pfizer, San Francisco (E.D., K.M.); and the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome (C.N.S.)
| | - Eren Demirhan
- From the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago (M.H.), and Astellas Pharma, Northbrook (D.P., A.K.) - both in Illinois; Institut Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); the University of Montreal Hospital Center, Montreal (F.S.); Herlev Hospital, Herlev, Denmark (P.R.); Carolina Urologic Research Center, Myrtle Beach, SC (N.S.); State University of Campinas (Unicamp), Campinas, Brazil (U.F.); Kiev City Clinical Hospital 3, Kiev, Ukraine (P.I.); Pfizer, San Francisco (E.D., K.M.); and the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome (C.N.S.)
| | - Katharina Modelska
- From the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago (M.H.), and Astellas Pharma, Northbrook (D.P., A.K.) - both in Illinois; Institut Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); the University of Montreal Hospital Center, Montreal (F.S.); Herlev Hospital, Herlev, Denmark (P.R.); Carolina Urologic Research Center, Myrtle Beach, SC (N.S.); State University of Campinas (Unicamp), Campinas, Brazil (U.F.); Kiev City Clinical Hospital 3, Kiev, Ukraine (P.I.); Pfizer, San Francisco (E.D., K.M.); and the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome (C.N.S.)
| | - De Phung
- From the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago (M.H.), and Astellas Pharma, Northbrook (D.P., A.K.) - both in Illinois; Institut Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); the University of Montreal Hospital Center, Montreal (F.S.); Herlev Hospital, Herlev, Denmark (P.R.); Carolina Urologic Research Center, Myrtle Beach, SC (N.S.); State University of Campinas (Unicamp), Campinas, Brazil (U.F.); Kiev City Clinical Hospital 3, Kiev, Ukraine (P.I.); Pfizer, San Francisco (E.D., K.M.); and the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome (C.N.S.)
| | - Andrew Krivoshik
- From the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago (M.H.), and Astellas Pharma, Northbrook (D.P., A.K.) - both in Illinois; Institut Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); the University of Montreal Hospital Center, Montreal (F.S.); Herlev Hospital, Herlev, Denmark (P.R.); Carolina Urologic Research Center, Myrtle Beach, SC (N.S.); State University of Campinas (Unicamp), Campinas, Brazil (U.F.); Kiev City Clinical Hospital 3, Kiev, Ukraine (P.I.); Pfizer, San Francisco (E.D., K.M.); and the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome (C.N.S.)
| | - Cora N Sternberg
- From the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago (M.H.), and Astellas Pharma, Northbrook (D.P., A.K.) - both in Illinois; Institut Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); the University of Montreal Hospital Center, Montreal (F.S.); Herlev Hospital, Herlev, Denmark (P.R.); Carolina Urologic Research Center, Myrtle Beach, SC (N.S.); State University of Campinas (Unicamp), Campinas, Brazil (U.F.); Kiev City Clinical Hospital 3, Kiev, Ukraine (P.I.); Pfizer, San Francisco (E.D., K.M.); and the Department of Medical Oncology, San Camillo Forlanini Hospital, Rome (C.N.S.)
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Lavaud P, Gravis G, Foulon S, Joly F, Oudard S, Priou F, Latorzeff I, Mourey L, Soulié M, Delva R, Krakowski I, Laguerre B, Théodore C, Ferrero JM, Beuzeboc P, Habibian M, Rolland F, Deplanque G, Pouessel D, Zanetta S, Berdah JF, Dauba J, Baciuchka M, Platini C, Linassier C, Tubiana-Mathieu N, Machiels JP, Kouri CE, Ravaud A, Suc E, Eymard JC, Hasbini A, Bousquet G, Culine S, Boher JM, Tergemina-Clain G, Legoupil C, Fizazi K. Anticancer Activity and Tolerance of Treatments Received Beyond Progression in Men Treated Upfront with Androgen Deprivation Therapy With or Without Docetaxel for Metastatic Castration-naïve Prostate Cancer in the GETUG-AFU 15 Phase 3 Trial. Eur Urol 2018; 73:696-703. [DOI: 10.1016/j.eururo.2017.09.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/19/2017] [Indexed: 12/19/2022]
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Seibert TM, Fan CC, Wang Y, Zuber V, Karunamuni R, Parsons JK, Eeles RA, Easton DF, Kote-Jarai ZS, Al Olama AA, Garcia SB, Muir K, Grönberg H, Wiklund F, Aly M, Schleutker J, Sipeky C, Tammela TL, Nordestgaard BG, Nielsen SF, Weischer M, Bisbjerg R, Røder MA, Iversen P, Key TJ, Travis RC, Neal DE, Donovan JL, Hamdy FC, Pharoah P, Pashayan N, Khaw KT, Maier C, Vogel W, Luedeke M, Herkommer K, Kibel AS, Cybulski C, Wokolorczyk D, Kluzniak W, Cannon-Albright L, Brenner H, Cuk K, Saum KU, Park JY, Sellers TA, Slavov C, Kaneva R, Mitev V, Batra J, Clements JA, Spurdle A, Teixeira MR, Paulo P, Maia S, Pandha H, Michael A, Kierzek A, Karow DS, Mills IG, Andreassen OA, Dale AM. Polygenic hazard score to guide screening for aggressive prostate cancer: development and validation in large scale cohorts. BMJ 2018; 360:j5757. [PMID: 29321194 PMCID: PMC5759091 DOI: 10.1136/bmj.j5757] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To develop and validate a genetic tool to predict age of onset of aggressive prostate cancer (PCa) and to guide decisions of who to screen and at what age. DESIGN Analysis of genotype, PCa status, and age to select single nucleotide polymorphisms (SNPs) associated with diagnosis. These polymorphisms were incorporated into a survival analysis to estimate their effects on age at diagnosis of aggressive PCa (that is, not eligible for surveillance according to National Comprehensive Cancer Network guidelines; any of Gleason score ≥7, stage T3-T4, PSA (prostate specific antigen) concentration ≥10 ng/L, nodal metastasis, distant metastasis). The resulting polygenic hazard score is an assessment of individual genetic risk. The final model was applied to an independent dataset containing genotype and PSA screening data. The hazard score was calculated for these men to test prediction of survival free from PCa. SETTING Multiple institutions that were members of international PRACTICAL consortium. PARTICIPANTS All consortium participants of European ancestry with known age, PCa status, and quality assured custom (iCOGS) array genotype data. The development dataset comprised 31 747 men; the validation dataset comprised 6411 men. MAIN OUTCOME MEASURES Prediction with hazard score of age of onset of aggressive cancer in validation set. RESULTS In the independent validation set, the hazard score calculated from 54 single nucleotide polymorphisms was a highly significant predictor of age at diagnosis of aggressive cancer (z=11.2, P<10-16). When men in the validation set with high scores (>98th centile) were compared with those with average scores (30th-70th centile), the hazard ratio for aggressive cancer was 2.9 (95% confidence interval 2.4 to 3.4). Inclusion of family history in a combined model did not improve prediction of onset of aggressive PCa (P=0.59), and polygenic hazard score performance remained high when family history was accounted for. Additionally, the positive predictive value of PSA screening for aggressive PCa was increased with increasing polygenic hazard score. CONCLUSIONS Polygenic hazard scores can be used for personalised genetic risk estimates that can predict for age at onset of aggressive PCa.
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Affiliation(s)
- Tyler M Seibert
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Chun Chieh Fan
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Yunpeng Wang
- NORMENT, KG Jebsen Centre, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Verena Zuber
- NORMENT, KG Jebsen Centre, Oslo University Hospital and University of Oslo, Oslo, Norway
- MRC Biostatistics Unit, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK
| | - Roshan Karunamuni
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
| | - J Kellogg Parsons
- Department of Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Rosalind A Eeles
- Institute of Cancer Research, London, SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | | | - Ali Amin Al Olama
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, R3, Box 83, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Sara Benlloch Garcia
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - Kenneth Muir
- Institute of Population Health, University of Manchester, Manchester, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Markus Aly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Solna, 171 76 Stockholm, Sweden
- Department of Urology, Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden
| | - Johanna Schleutker
- Department of Medical Biochemistry and Genetics, Institute of Biomedicine, Kiinamyllynkatu 10, FI-20014 University of Turku, Finland
- Tyks Microbiology and Genetics, Department of Medical Genetics, Turku University Hospital, Turku, Finland
- BioMediTech, 30014 University of Tampere, Tampere, Finland
| | - Csilla Sipeky
- Department of Medical Biochemistry and Genetics, Institute of Biomedicine, Kiinamyllynkatu 10, FI-20014 University of Turku, Finland
- Tyks Microbiology and Genetics, Department of Medical Genetics, Turku University Hospital, Turku, Finland
| | - Teuvo Lj Tammela
- Department of Urology, Tampere University Hospital and Medical School, University of Tampere, Finland
| | - Børge G Nordestgaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Sune F Nielsen
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Maren Weischer
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Rasmus Bisbjerg
- Department of Urology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - M Andreas Røder
- Copenhagen Prostate Cancer Centre, Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Iversen
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Copenhagen Prostate Cancer Centre, Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tim J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford OX3 7LF, UK
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford OX3 7LF, UK
| | - David E Neal
- Nuffield Department of Surgical Sciences, Faculty of Medical Science, University of Oxford, John Radcliffe Hospital, Oxford, UK
- University of Cambridge, Department of Oncology, Box 279, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, Faculty of Medical Science, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Paul Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Nora Pashayan
- University College London, Department of Applied Health Research, London WC1E 7HB, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Kay-Tee Khaw
- Clinical Gerontology Unit, University of Cambridge, Cambridge UK
| | - Christiane Maier
- Institute of Human Genetics, University Hospital of Ulm, Ulm, Germany
| | - Walther Vogel
- Institute of Human Genetics, University Hospital of Ulm, Ulm, Germany
| | - Manuel Luedeke
- Institute of Human Genetics, University Hospital of Ulm, Ulm, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar der Technischen Universitaet Muenchen, Munich, Germany
| | - Adam S Kibel
- Division of Urologic Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, 75 Francis Street, Boston, MA 02115, USA
| | - Cezary Cybulski
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Dominika Wokolorczyk
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Kluzniak
- International Hereditary Cancer Centre, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Lisa Cannon-Albright
- Division of Genetic Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katarina Cuk
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jong Y Park
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Thomas A Sellers
- Office of the Center Director, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Chavdar Slavov
- Department of Urology and Alexandrovska University Hospital, Medical University, Sofia, Bulgaria
| | - Radka Kaneva
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University, Sofia, 2 Zdrave Str, 1431 Sofia, Bulgaria
| | - Vanio Mitev
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University, Sofia, 2 Zdrave Str, 1431 Sofia, Bulgaria
| | - Jyotsna Batra
- Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, Australia
| | - Judith A Clements
- Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, Australia
| | - Amanda Spurdle
- Molecular Cancer Epidemiology Laboratory, Queensland Institute of Medical Research, Brisbane, Australia
- Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, Australia
- Australian Prostate Cancer BioResource, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, Australia
| | - Manuel R Teixeira
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
- Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Paula Paulo
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
| | - Sofia Maia
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
| | | | | | | | - David S Karow
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Ian G Mills
- NORMENT, KG Jebsen Centre, Oslo University Hospital and University of Oslo, Oslo, Norway
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, UK
- Nuffield Department of Surgical Sciences, Faculty of Medical Science, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Anders M Dale
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
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Beer TM, Hotte SJ, Saad F, Alekseev B, Matveev V, Fléchon A, Gravis G, Joly F, Chi KN, Malik Z, Blumenstein B, Stewart PS, Jacobs CA, Fizazi K. Custirsen (OGX-011) combined with cabazitaxel and prednisone versus cabazitaxel and prednisone alone in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel (AFFINITY): a randomised, open-label, international, phase 3 trial. Lancet Oncol 2017; 18:1532-1542. [PMID: 29033099 DOI: 10.1016/s1470-2045(17)30605-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Docetaxel and cabazitaxel improve overall survival compared with mitoxantrone in patients with metastatic castration-resistant prostate cancer. Custirsen (OGX011) is a second generation highly specific antisense oligonucleotide that inhibits the production of clusterin, an antiapoptotic protein that is upregulated in response to chemotherapy and that confers treatment resistance. We aimed to assess whether custirsen in combination with cabazitaxel and prednisone increases overall survival in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel. METHODS In this randomised, open-label, international, phase 3 trial, men with radiographically documented metastatic castration-resistant prostate cancer that had progressed after docetaxel treatment with a Karnofsky performance status of more than 70% and who were fit for chemotherapy, were recruited from 95 cancer treatment centres in eight countries. Patients were randomly assigned (1:1) centrally using permuted blocks (block size 8) to receive cabazitaxel plus prednisone (cabazitaxel 25 mg/m2 intravenously every 21 days plus oral prednisone 10 mg daily) with or without custirsen (640 mg intravenously on days 1, 8, and 15, plus three previous loading doses) until disease progression, unacceptable toxicity, or the completion of ten treatment cycles. Randomisation was stratified by use of opioids for prostate cancer-related pain at screening, disease progression following first-line docetaxel treatment established by radiographic evidence, and previous treatment with abiraterone or enzalutamide. The co-primary endpoints were overall survival in all randomly assigned patients and in a poor-prognosis subgroup. All analyses were intention to treat with the exception of safety, which was reported for patients who received any assigned treatment. The trial has been completed and the results presented here are the final analysis. This trial is registered with Clinicaltrials.gov, number NCT01578655. FINDINGS Between Sept 9, 2012, and Sept 29, 2014, 795 patients were screened for enrolment. 635 men were eligible for inclusion and were randomly assigned (n=317 in the cabazitaxel and prednisone plus custirsen group and n=318 in the cabazitaxel and prednisone group). Median follow up was 28·3 months (IQR 24·4-34·5) for the custirsen group and 29·8 months (IQR 25·3-35·2) for the control group. Median overall survival in all randomly assigned patients did not differ between the two groups (14·1 months [95% CI 12·7-15·9] in the curtisen group vs 13·4 months [12·1-14·9] in the control group; hazard ratio [HR] 0·95 [95% CI 0·80-1·12]; log-rank p=0·53). In the poor prognosis subgroup, median overall survival also did not differ between the two treatment groups (11·0 months [95% CI 9·3-13·3] in the custursin group vs 10·9 months [8·2-12·4] in the control group; HR 0·97 [95% CI 0·80-1·21]; two-sided p=0·80). The most frequently reported grade 3 or worse adverse events in the custirsen versus control groups were neutropenia (70 [22%] of 315 vs 61 [20%] of 312), anaemia (68 [22%] vs 49 [16%]), fatigue (23 [7%] vs 18 [6%]), asthenia (16 [5%] vs 8 [3%]), bone pain (16 [5%] vs 5 [2%]), and febrile neutropenia (16 [5%] vs 9 [3%]). Serious adverse events were reported in 155 (49%) versus 132 (42%). 27 patients died within 30 days of treatment in the cabazitaxel and prednisone plus custirsen group, seven of which were deemed to be treatment related, versus 17 in the cabazitaxel and prednisone group, eight of which were deemed to be treatment related. Of the 21 deaths reported, 15 were reported as complications related to study treatment, either chemotherapy (eight and three, respectively) or study drug (none and four, respectively). INTERPRETATION We noted no survival benefit in men with metastatic castration-resistant prostate cancer with the addition of custirsen to cabazitaxel and prednisone treatment. Cabazitaxel and prednisone remains the standard of care for patients with metastatic castration-resistant prostate cancer progressing after docetaxel chemotherapy. FUNDING OncoGenex Pharmaceuticals.
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Affiliation(s)
| | | | - Fred Saad
- Centre Hospitalier de l'Université de Montréal, Institut du Cancer de Montréal, Montréal, QC, Canada
| | - Boris Alekseev
- P A Herzen Moscow Cancer Research Institute, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Vsevolod Matveev
- N N Blokhin Cancer Research Center, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | | | | | - Kim N Chi
- University of British Columbia, BC Cancer Agency-Vancouver Centre, Vancouver, BC, Canada
| | - Zafar Malik
- The Clatterbridge Cancer Centre, Bebington, UK
| | | | | | | | - Karim Fizazi
- Gustave Roussy, University of Paris Saclay, Villejuif, France
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Renzi C, Fioretti C, Oliveri S, Mazzocco K, Zerini D, Alessandro O, Rojas DP, Jereczek-Fossa BA, Pravettoni G. A Qualitative Investigation on Patient Empowerment in Prostate Cancer. Front Psychol 2017; 8:1215. [PMID: 28798701 PMCID: PMC5526923 DOI: 10.3389/fpsyg.2017.01215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/03/2017] [Indexed: 12/04/2022] Open
Abstract
Purpose: Men with prostate cancer often describe low levels of empowerment. eHealth interventions may represent useful tools to deliver care and education and to meet patients' needs within an empowerment framework. In order to design a platform for cancer patients' empowerment within the H2020 iManageCancer project, the perspective of the target population for the platform was assessed. The present study aims to assess the qualitative experience of prostate cancer patients during treatment in order to provide insights for clinical practice with a particular focus on the design of a web platform to promote cancer patients' empowerment. Methods: Ten patients undergoing radiation therapy treatment took part in a semi-structured interview to explore different aspects of patient empowerment. Four main thematic areas were addressed: patient-healthcare providers' communication, decision-making, needs, and resources. A qualitative approach using thematic analysis was followed. Results: Half of the patients reported little to no possibility to share information and questions with healthcare providers. With regards to decision-making, the role of healthcare providers was perceived as directive/informative, but half of the patients perceived to assume an active role in at least one interaction. Difficulties and needs included the choice of the specialist or of the structure after diagnosis, clinicians' support in self-management, surgical consequences, and side effects, preparation for radiation therapy. Resources included family and social support both from a practical and from an emotional perspective, coping style, and work schedule management. Conclusions: These results suggest that relations with healthcare providers should be supported, especially immediately after diagnosis and after surgery. Support to self-management after surgery and at the beginning of radiation therapy treatment also constitutes a priority. The adoption of a personalized approach from the beginning of prostate cancer care flow may promote patient empowerment, overcoming the aforementioned needs and mobilizing resources. The social network represents an important resource that could be integrated in interventions. These considerations will be taken into account in the design of a cancer self-management platform aiming to increase patients' empowerment.
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Affiliation(s)
- Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy
| | - Chiara Fioretti
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy
| | - Serena Oliveri
- Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy.,Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Dario Zerini
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy
| | - Ombretta Alessandro
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Damaris P Rojas
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Barbara A Jereczek-Fossa
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy.,Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
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Rijnders M, de Wit R, Boormans JL, Lolkema MPJ, van der Veldt AAM. Systematic Review of Immune Checkpoint Inhibition in Urological Cancers. Eur Urol 2017. [PMID: 28645491 DOI: 10.1016/j.eururo.2017.06.012] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONTEXT In patients with advanced and metastatic urological cancers, clinical outcome may be improved by immune checkpoint inhibitors (ICIs). OBJECTIVE To systematically review relevant literature on efficacy and safety of ICIs in patients with advanced and metastatic urothelial cell cancer (UCC), renal cell cancer (RCC), and prostate cancer. EVIDENCE ACQUISITION Relevant databases, including Medline, Embase, and the Cochrane Library, were searched up to March 16, 2017. A narrative review of randomized clinical trials (RCTs) was performed. EVIDENCE SYNTHESIS Six RCTs were included for the systematic review. In platinum-pretreated UCC, efficacy of pembrolizumab was superior to chemotherapy, with longer median overall survival (OS; 10.3 vs 7.4 mo), a higher objective response rate (ORR; 21.1% vs 11.4%, p=0.001), and a lower adverse event rate (60.9% vs 90.2%). Three RCTs assessed the safety and efficacy of nivolumab in advanced RCC. The median OS (25.0 vs 19.6 mo) and the ORR (25% vs 5%) were higher in patients treated with nivolumab compared with second-line everolimus. In all three studies, the safety profile of nivolumab was favorable. In patients with metastatic castration-resistant prostate cancer, two RCTs were identified, which did not show significant benefits for ipilimumab over placebo. In UCC and RCC, there was no conclusive association between programmed cell death receptor ligand 1 (PD-L1) expression in tumor tissue and clinical outcome during pembrolizumab and nivolumab treatment, respectively. CONCLUSION In metastatic UCC and RCC, pembrolizumab and nivolumab have superior efficacy and safety to second-line chemotherapy and everolimus, respectively. No beneficial effect of ipilimumab was observed in prostate cancer patients. PD-L1 expression status is currently not suitable as a predictive marker for treatment outcome. PATIENT SUMMARY Immune checkpoint inhibitors are able to reactivate the immune system against tumor cells. In second-line setting, pembrolizumab and nivolumab are safe and confer survival benefit in advanced urothelial cell and renal cell cancer, respectively.
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Affiliation(s)
- Maud Rijnders
- Department of Medical Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands.
| | - Joost L Boormans
- Department of Urology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands
| | - Martijn P J Lolkema
- Department of Medical Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands
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