1
|
Viscuse P, Skelton WP, Devitt MM, Dreicer R. When You Get to the Fork in the Road, Take It: The Challenges in Managing Patients With Advanced Prostate Cancer. JCO Oncol Pract 2024:OP2400591. [PMID: 39353159 DOI: 10.1200/op-24-00591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/03/2024] [Accepted: 09/03/2024] [Indexed: 10/04/2024] Open
Abstract
As is the case with most solid tumors, the heterogeneity of the disease biology of prostate cancer presents clinicians managing this disease with daily challenges. However, in contrast to other common cancers such as breast, lung, and colorectal cancers, there are unique challenges in prostate cancer management, including the variety of clinicians who manage aspects of the disease (urologists, medical oncologist, radiation oncologists) and the striking absence of prospective comparative data to inform the optimal sequence of systemic therapy in patients with metastatic castration-resistant disease. The purpose of this review is to attempt to assist practicing oncologists with sorting through the myriad of prostate cancer disease subsets and the challenges in making therapeutic decisions in multiple data-free zones given the absence of level 1 comparative clinical trials in the metastatic hormone-sensitive and castration-resistant states.
Collapse
Affiliation(s)
- Paul Viscuse
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA
| | - William P Skelton
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA
| | - Michael M Devitt
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA
| | - Robert Dreicer
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA
| |
Collapse
|
2
|
Morris MJ, Castellano D, Herrmann K, de Bono JS, Shore ND, Chi KN, Crosby M, Piulats JM, Fléchon A, Wei XX, Mahammedi H, Roubaud G, Študentová H, Nagarajah J, Mellado B, Montesa-Pino Á, Kpamegan E, Ghebremariam S, Kreisl TN, Wilke C, Lehnhoff K, Sartor O, Fizazi K. 177Lu-PSMA-617 versus a change of androgen receptor pathway inhibitor therapy for taxane-naive patients with progressive metastatic castration-resistant prostate cancer (PSMAfore): a phase 3, randomised, controlled trial. Lancet 2024; 404:1227-1239. [PMID: 39293462 DOI: 10.1016/s0140-6736(24)01653-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/10/2024] [Accepted: 08/09/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND [177Lu]Lu-PSMA-617 (177Lu-PSMA-617) prolongs radiographic progression-free survival and overall survival in patients with metastatic castration-resistant prostate cancer previously treated with androgen receptor pathway inhibitor (ARPI) and taxane therapy. We aimed to investigate the efficacy of 177Lu-PSMA-617 in patients with taxane-naive metastatic castration-resistant prostate cancer. METHODS In this phase 3, randomised, controlled trial conducted at 74 sites across Europe and North America, taxane-naive patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer who had progressed once on a previous ARPI were randomly allocated (1:1) to open-label, intravenous 177Lu-PSMA-617 at a dosage of 7·4 GBq (200 mCi) ± 10% once every 6 weeks for six cycles, or a change of ARPI (to abiraterone or enzalutamide, administered orally on a continuous basis per product labelling). Crossover from ARPI change to 177Lu-PSMA-617 was allowed after centrally confirmed radiographic progression. The primary endpoint was radiographic progression-free survival, defined as the time from randomisation until radiographic progression or death, assessed in the intention-to-treat population. Safety was a secondary endpoint. This study is registered with ClinicalTrials.gov (NCT04689828) and is ongoing. In this primary report of the study, we present primary (first data cutoff) and updated (third data cutoff) analyses of radiographic progression-free survival; all other data are based on the third data cutoff. FINDINGS Overall, of the 585 patients screened, 468 met all eligibility criteria and were randomly allocated between June 15, 2021 and Oct 7, 2022 to receive 177Lu-PSMA-617 (234 [50%] patients) or ARPI change (234 [50%]). Baseline characteristics were mostly similar between groups; median number of 177Lu-PSMA-617 cycles was 6·0 (IQR 4·0-6·0). Of patients assigned to ARPI change, 134 (57%) crossed over to receive 177Lu-PSMA-617. In the primary analysis (median time from randomisation to first data cutoff 7·26 months [IQR 3·38-10·55]), the median radiographic progression-free survival was 9·30 months (95% CI 6·77-not estimable) in the 177Lu-PSMA-617 group versus 5·55 months (4·04-5·95) in the ARPI change group (hazard ratio [HR] 0·41 [95% CI 0·29-0·56]; p<0·0001). In the updated analysis at time of the third data cutoff (median time from randomisation to third data cutoff 24·11 months [IQR 20·24-27·40]), median radiographic progression-free survival was 11·60 months (95% CI 9·30-14·19) in the 177Lu-PSMA-617 group versus 5·59 months (4·21-5·95) in the ARPI change group (HR 0·49 [95% CI 0·39-0·61]). The incidence of grade 3-5 adverse events was lower in the 177Lu-PSMA-617 group (at least one event in 81 [36%] of 227 patients; four [2%] grade 5 [none treatment related]) than the ARPI change group (112 [48%] of 232; five [2%] grade 5 [one treatment related]). INTERPRETATION 177Lu-PSMA-617 prolonged radiographic progression-free survival relative to ARPI change, with a favourable safety profile. For patients with PSMA-positive metastatic castration-resistant prostate cancer who are being considered for a change of ARPI after progression on a previous ARPI, 177Lu-PSMA-617 may be an effective treatment alternative. FUNDING Novartis.
Collapse
Affiliation(s)
- Michael J Morris
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Daniel Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, I+12 Research Institute, Madrid, Spain
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, German Cancer Consortium-University Hospital Essen, Essen, Germany; National Center for Tumor Diseases, NCT West, Heidelberg, Germany
| | - Johann S de Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, UK
| | - Neal D Shore
- Carolina Urologic Research Center, AU Clinics, Myrtle Beach, SC, USA
| | | | | | | | | | - Xiao X Wei
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Hana Študentová
- Department of Oncology, Palacký University, Faculty of Medicine and Dentistry, University Hospital, Olomouc, Czech Republic
| | - James Nagarajah
- Radboud University Medical Centre, Nijmegen, Netherlands; Roentgeninstitut Düsseldorf, Düsseldorf, Germany
| | - Begoña Mellado
- Medical Oncology Department, Hospital Clínic de Barcelona, Institut d' Investigacions Biomèdiques Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Álvaro Montesa-Pino
- UGCI Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, IBIMA, Málaga, Spain
| | | | | | - Teri N Kreisl
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Karim Fizazi
- Gustave Roussy Institute, Paris-Saclay University, Paris, France
| |
Collapse
|
3
|
Xiao S, Yin H, Lv X, Wang Z, Jiang L, Xia Y, Liu Y. Efficacy and safety of androgen receptor inhibitors for treatment of advanced prostate cancer: A systematic review and network meta-analysis. Br J Clin Pharmacol 2024; 90:2067-2078. [PMID: 38992964 DOI: 10.1111/bcp.16176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024] Open
Abstract
AIMS Androgen receptor inhibitors (ARIs) have become an effective treatment for advanced prostate cancer (PC). However, it is unknown which ARI is the most helpful and safe for men with advanced PC. Our aim is to help physicians make clinical decisions and provide medication guidelines for patients with advanced PC to avoid potential risks when using ARIs for treatment. METHODS We systematically searched the following databases: PubMed, Embase and Cochrane Library, with a literature publication deadline of February 2023. The primary efficacy outcomes were 18-month overall survival (OS), treatment-emergent adverse events (TEAEs), hypertension and fatigue. The network meta-analysis (NMA) was performed by Stata 15.1, and Revman 5.3 was used to assess the included studies' risk of bias. RESULTS The analysis included 26 trials with 26 263 people. The surface under the cumulative ranking curve (SUCRA) concluded that enzalutamide (86.8%) showed the best effect in prolonging the OS of patients. Flutamide led to the highest risk of TEAEs (29.9%) and AEs leading to discontinuation (12.8%). Apalutamide (13.4%) led to the highest risk of grade ≥3 TEAEs. Enzalutamide had the highest risk of hypertension (0.2%), grade ≥3 hypertension (4.5%) and fatigue (5.2%). CONCLUSIONS This NMA indicates there is no one ARI to reach both the most effective and safe therapy aims for treating advanced PC and that there is a compromise between the efficacy and safety of ARIs in the treatment of advanced PC. Physicians should weigh the risks to safety against the anticipated benefits when prescribing these drugs to patients with PC.
Collapse
Affiliation(s)
- Shichao Xiao
- School of Chemical Engineering, Ocean and Life Sciences, Dalian University of Technology, Panjin, China
| | - Hang Yin
- School of Chemical Engineering, Ocean and Life Sciences, Dalian University of Technology, Panjin, China
| | - Xin Lv
- School of Chemical Engineering, Ocean and Life Sciences, Dalian University of Technology, Panjin, China
| | - Zhen Wang
- School of Chemical Engineering, Ocean and Life Sciences, Dalian University of Technology, Panjin, China
| | - Lili Jiang
- School of Chemical Engineering, Ocean and Life Sciences, Dalian University of Technology, Panjin, China
| | - Yangliu Xia
- School of Chemical Engineering, Ocean and Life Sciences, Dalian University of Technology, Panjin, China
| | - Yong Liu
- School of Chemical Engineering, Ocean and Life Sciences, Dalian University of Technology, Panjin, China
| |
Collapse
|
4
|
Wang M, Dai B, Liu Q, Zhang X. Prognostic and immunological implications of heterogeneous cell death patterns in prostate cancer. Cancer Cell Int 2024; 24:297. [PMID: 39182081 PMCID: PMC11344416 DOI: 10.1186/s12935-024-03462-7] [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: 02/05/2024] [Accepted: 07/28/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Prostate cancer is one of the most common cancers in men with a significant proportion of patients developing biochemical recurrence (BCR) after treatment. Programmed cell death (PCD) mechanisms are known to play critical roles in tumor progression and can potentially serve as prognostic and therapeutic biomarkers in PCa. This study aimed to develop a prognostic signature for BCR in PCa using PCD-related genes. MATERIALS AND METHODS We conducted an analysis of 19 different modes of PCD to develop a comprehensive model. Bulk transcriptomic, single-cell transcriptomic, genomic, and clinical data were collected from multiple cohorts, including TCGA-PRAD, GSE58812, METABRIC, GSE21653, and GSE193337. We analyzed the expression and mutations of the 19 PCD modes and constructed, evaluated, and validated the model. RESULTS Ten PCD modes were found to be associated with BCR in PCa, with specific PCD patterns exhibited by various cell components within the tumor microenvironment. Through Lasso Cox regression analysis, we established a Programmed Cell Death Index (PCDI) utilizing an 11-gene signature. High PCDI values were validated in five independent datasets and were found to be associated with an increased risk of BCR in PCa patients. Notably, older age and advanced T and N staging were associated with higher PCDI values. By combining PCDI with T staging, we constructed a nomogram with enhanced predictive performance. Additionally, high PCDI values were significantly correlated with decreased drug sensitivity, including drugs such as Docetaxel and Methotrexate. Patients with lower PCDI values demonstrated higher immunophenoscores (IPS), suggesting a potentially higher response rate to immune therapy. Furthermore, PCDI was associated with immune checkpoint genes and key components of the tumor microenvironment, including macrophages, T cells, and NK cells. Finally, clinical specimens validated the differential expression of PCDI-related PCDRGs at both the gene and protein levels. CONCLUSION In conclusion, we developed a novel PCD-based prognostic feature that successfully predicted BCR in PCa patients and provided insights into drug sensitivity and potential response to immune therapy. These findings have significant clinical implications for the treatment of PCa.
Collapse
Affiliation(s)
- Ming Wang
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui, China
| | - Bangshun Dai
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui, China
| | - Qiushi Liu
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui, China
| | - Xiansheng Zhang
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui, China.
| |
Collapse
|
5
|
Wang H, Xie M, Zhao Y, Zhang Y. Establishment of a prognostic risk model for prostate cancer based on Gleason grading and cuprotosis related genes. J Cancer Res Clin Oncol 2024; 150:376. [PMID: 39085482 PMCID: PMC11291559 DOI: 10.1007/s00432-024-05899-9] [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: 04/29/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Prostate cancer (PCa) is common in aging males, diagnosed via the Gleason grading system. The study explores the unexamined prognostic value of cuprotosis, a distinct cell death type, alongside Gleason grades in PCa. METHODS We explored Cuprotosis-related genes (CRGs) in prostate cancer (PCa), using NMF on TCGA-PRAD data for patient classification and WGCNA to link genes with Gleason scores and prognosis. A risk model was crafted via LASSO Cox regression. STX3 knockdown in PC-3 cells, analyzed for effects on cell behaviors and tumor growth in mice, highlighted its potential therapeutic impact. RESULTS We identified five genes crucial for a prognostic risk model, with higher risk scores indicating worse prognosis. Survival analysis and ROC curves confirmed the model's predictive accuracy in TCGA-PRAD and GSE70769 datasets. STX3 was a key adverse prognostic factor, with its knockdown significantly reducing mRNA and protein levels, impairing PC-3 cell functions. In vivo, STX3 knockdown in PC-3 cells led to significantly smaller tumors in nude mice, underscoring its potential therapeutic value. CONCLUSION Our prognostic model, using five genes linked to Gleason scores, effectively predicts prostate cancer outcomes, offering a novel treatment strategy angle.
Collapse
Affiliation(s)
- Haicheng Wang
- Department of Urology, Hebei Medical University, Shijiazhuang, China
- Department of Urology, Qinhuangdao First Hospital, No. 258 Wenhua Road, Haigang District, Qinhuangdao, 066000, China
| | - Meiyi Xie
- Department of Urology, Qinhuangdao First Hospital, No. 258 Wenhua Road, Haigang District, Qinhuangdao, 066000, China
| | - Yuming Zhao
- Department of Urology, Qinhuangdao First Hospital, No. 258 Wenhua Road, Haigang District, Qinhuangdao, 066000, China
| | - Yong Zhang
- Department of Urology, Hebei Medical University, Shijiazhuang, China.
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
6
|
Small EJ, Chi KN, Chowdhury S, Bevans KB, Bhaumik A, Saad F, Chung BH, Karsh LI, Oudard S, De Porre P, Brookman-May SD, McCarthy SA, Mundle SD, Uemura H, Smith MR, Agarwal N. Post Hoc Analysis of Rapid and Deep Prostate-specific Antigen Decline and Patient-reported Health-related Quality of Life in SPARTAN and TITAN Patients with Advanced Prostate Cancer. Eur Urol Oncol 2024; 7:844-852. [PMID: 38072759 DOI: 10.1016/j.euo.2023.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/23/2023] [Accepted: 11/17/2023] [Indexed: 07/19/2024]
Abstract
BACKGROUND Adding apalutamide to androgen-deprivation therapy (ADT) resulted in a rapid (at 3- and 6-mo treatment) and deep prostate-specific antigen (PSA) decline (to ≤0.2 ng/ml or ≥90% from baseline), improved overall survival, reduced risk of disease progression, and prolonged health-related quality of life (HRQoL) in nonmetastatic castration-resistant prostate cancer (nmCRPC) in SPARTAN and metastatic castration-sensitive PC (mCSPC) in TITAN. OBJECTIVE To evaluate the association of a rapid, deep PSA decline at 3 and 6 mo achieved with the addition of apalutamide to ADT with patient-reported outcomes (PROs) in SPARTAN and TITAN. DESIGN, SETTING, AND PARTICIPANTS A post hoc analysis of SPARTAN and TITAN PRO data was performed. INTERVENTION Apalutamide versus placebo plus concurrent ADT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PROs were assessed using Functional Assessment of Cancer Therapy-Prostate (FACT-P; SPARTAN and TITAN), Brief Pain Inventory-Short Form (BPI-SF; TITAN), and Brief Fatigue Inventory (BFI; TITAN) at baseline, prespecified cycles during treatment, and after progression for ≤1 yr. The association between a deep PSA decline at landmark 3 or 6 mo of apalutamide and the time to worsening of PROs was assessed using the Kaplan-Meier methodology and Cox proportional-hazard modeling. RESULTS AND LIMITATIONS Among 806 SPARTAN and 525 TITAN apalutamide-treated patients, the median treatment duration was 32.9 and 39.3 mo, respectively. Patients achieving a deep PSA decline at 3 mo had longer time to worsening in FACT-P total, FACT-P physical well-being, BPI-SF worst pain intensity, or BFI worst fatigue intensity. The 6-mo PSA decline results were similar. Limitations of patient characteristics in clinical studies should be considered. CONCLUSIONS Attaining a deep and rapid PSA decline at 3 mo with apalutamide plus ADT was associated with longer preservation of overall HRQoL and physical well-being in nmCRPC and mCSPC. PATIENT SUMMARY Quality of life is maintained in individuals with advanced prostate cancer who achieve a deep prostate-specific antigen decline at 3 mo of apalutamide plus drugs that lower male sex hormones.
Collapse
Affiliation(s)
- Eric J Small
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
| | - Kim N Chi
- BC Cancer and Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Simon Chowdhury
- Guy's, King's, and St. Thomas' Hospitals and Sarah Cannon Research Institute, London, UK
| | | | | | - Fred Saad
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Byung Ha Chung
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Stéphane Oudard
- Georges Pompidou Hospital, Université Paris Descartes, Paris, France
| | | | - Sabine D Brookman-May
- Ludwig-Maximilians-University, Munich, Germany; Janssen Research & Development, Spring House, PA, USA
| | | | | | | | - Matthew R Smith
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
7
|
von Eyben FE, Virgolini I, Baum R. Review on the Increasing Role for PSMA-Based Radioligand Therapy in Prostate Cancer. Cancers (Basel) 2024; 16:2520. [PMID: 39061160 PMCID: PMC11274522 DOI: 10.3390/cancers16142520] [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: 05/29/2024] [Revised: 07/02/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
In 2021, two randomized controlled trials (RCTs), TheraP and VISION, demonstrated that 177Lu-PSMA-617 as monotherapy was more effective for the decline of PSA than the comparator third-line treatments. METHODS Our review summarizes new RCTs that add to the use of radioligand therapy (RLT) for patients with high-risk prostate cancer (PCa). RESULTS Four past and present RCTs included 1081 patients. An RCT, ENZA-p, studied first-line treatment of patients with metastatic castration-resistant PCa (mCRPC). A combination of enzalutamide (ENZA) and 177Lu-PSMA-617 gave longer progression-free survival than ENZA as monotherapy. Other RCTs of patients with mCRPC, including the PSMAfore, and SPLASH trials, showed 177Lu-PSMA-617 as second-line treatment gave better progression-free survival than androgen receptor pathway inhibitors (combined p value < 6.9 × 10-6). CONCLUSIONS Patients with PCa gain if they are given PSMA-RLT early in the treatment of PCa and as part of combination therapies.
Collapse
Affiliation(s)
| | - Irene Virgolini
- Department of Nuclear Medicine, University Hospital Innsbruck, 6020 Innsbruck, Austria
| | - Richard Baum
- DKD Helios Clinic, 65 191 Frankfurth-Wiesbaden, Germany
| |
Collapse
|
8
|
Chen B, Xu P, Yang JC, Nip C, Wang L, Shen Y, Ning S, Shang Y, Corey E, Gao AC, Gestwicki JE, Wei Q, Liu L, Liu C. Plexin D1 emerges as a novel target in the development of neural lineage plasticity in treatment-resistant prostate cancer. Oncogene 2024; 43:2325-2337. [PMID: 38877132 PMCID: PMC11286220 DOI: 10.1038/s41388-024-03081-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024]
Abstract
Treatment-induced neuroendocrine prostate cancer (t-NEPC) often arises from adenocarcinoma via lineage plasticity in response to androgen receptor signaling inhibitors, such as enzalutamide. However, the specific regulators and targets involved in the transition to NEPC are not well understood. Plexin D1 (PLXND1) is a cellular receptor of the semaphorin (SEMA) family that plays important roles in modulating the cytoskeleton and cell adhesion. Here, we found that PLXND1 was highly expressed and positively correlated with neuroendocrine markers in patients with NEPC. High PLXND1 expression was associated with poorer prognosis in prostate cancer patients. Additionally, PLXND1 was upregulated and negatively regulated by androgen receptor signaling in enzalutamide-resistant cells. Knockdown or knockout of PLXND1 inhibited neural lineage pathways, thereby suppressing NEPC cell proliferation, patient derived xenograft (PDX) tumor organoid viability, and xenograft tumor growth. Mechanistically, the heat shock protein 70 (HSP70) regulated PLXND1 protein stability through degradation, and inhibition of HSP70 decreased PLXND1 expression and NEPC organoid growth. In summary, our findings indicate that PLXND1 could serve as a promising therapeutic target and molecular marker for NEPC.
Collapse
Affiliation(s)
- Bo Chen
- Department of Urologic Surgery, University of California, Davis, CA, USA
- Department of Urology, West China Hospital, Sichuan University, Sichuan, China
| | - Pengfei Xu
- Department of Urologic Surgery, University of California, Davis, CA, USA
| | - Joy C Yang
- Department of Urologic Surgery, University of California, Davis, CA, USA
| | - Christopher Nip
- Department of Urologic Surgery, University of California, Davis, CA, USA
| | - Leyi Wang
- Department of Urologic Surgery, University of California, Davis, CA, USA
- Graduate Group in Integrative Pathobiology, University of California, Davis, CA, USA
| | - Yuqiu Shen
- Department of Urologic Surgery, University of California, Davis, CA, USA
| | - Shu Ning
- Department of Urologic Surgery, University of California, Davis, CA, USA
| | - Yufeng Shang
- Department of Urologic Surgery, University of California, Davis, CA, USA
| | - Eva Corey
- Department of Urology, University of Washington, Washington, WA, USA
| | - Allen C Gao
- Department of Urologic Surgery, University of California, Davis, CA, USA
- University of California, Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Jason E Gestwicki
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA, USA
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Sichuan, China
| | - Liangren Liu
- Department of Urology, West China Hospital, Sichuan University, Sichuan, China
| | - Chengfei Liu
- Department of Urologic Surgery, University of California, Davis, CA, USA.
- Graduate Group in Integrative Pathobiology, University of California, Davis, CA, USA.
- University of California, Davis Comprehensive Cancer Center, Sacramento, CA, USA.
| |
Collapse
|
9
|
Obinata D, Takayama K, Lawrence MG, Funakoshi D, Hara M, Niranjan B, Teng L, Taylor RA, Risbridger GP, Takahashi S, Inoue S. Patient-derived castration-resistant prostate cancer model revealed CTBP2 upregulation mediated by OCT1 and androgen receptor. BMC Cancer 2024; 24:554. [PMID: 38698344 PMCID: PMC11067191 DOI: 10.1186/s12885-024-12298-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Prostate cancer is dependent on androgen receptor (AR) signaling, and androgen deprivation therapy (ADT) has proven effective in targeting prostate cancer. However, castration-resistant prostate cancer (CRPC) eventually emerges. AR signaling inhibitors (ARSI) have been also used, but resistance to these agents develops due to genetic AR alterations and epigenetic dysregulation. METHODS In this study, we investigated the role of OCT1, a member of the OCT family, in an AR-positive CRPC patient-derived xenograft established from a patient with resistance to ARSI and chemotherapy. We conducted a genome-wide analysis chromatin immunoprecipitation followed by sequencing and bioinformatic analyses using public database. RESULTS Genome-wide analysis of OCT1 target genes in PDX 201.1 A revealed distinct OCT1 binding sites compared to treatment-naïve cells. Bioinformatic analyses revealed that OCT1-regulated genes were associated with cell migration and immune system regulation. In particular, C-terminal Binding Protein 2 (CTBP2), an OCT1/AR target gene, was correlated with poor prognosis and immunosuppressive effects in the tumor microenvironment. Metascape revealed that CTBP2 knockdown affects genes related to the immune response to bacteria. Furthermore, TISIDB analysis suggested the relationship between CTBP2 expression and immune cell infiltration in prostate cancer, suggesting that it may contribute to immune evasion in CRPC. CONCLUSIONS Our findings shed light on the genome-wide network of OCT1 and AR in AR-positive CRPC and highlight the potential role of CTBP2 in immune response and tumor progression. Targeting CTBP2 may represent a promising therapeutic approach for aggressive AR-positive CRPC. Further validation will be required to explore novel therapeutic strategies for CRPC management.
Collapse
Affiliation(s)
- Daisuke Obinata
- Department of Urology, Nihon University School of Medicine, 30-1, Ooyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
| | - Kenichi Takayama
- Department of Systems Aging Science and Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku Tokyo, Tokyo, 173-0015, Japan
| | - Mitchell G Lawrence
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
- Cancer Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC, 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, 305 Grattan Street, Parkville, VIC, 3010, Australia
- Cabrini Institute, Cabrini Health, 183 Wattletree Road, Malvern, VIC, 3144, Australia
| | - Daigo Funakoshi
- Department of Urology, Nihon University School of Medicine, 30-1, Ooyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Makoto Hara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, 30-1, Ooyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Birunthi Niranjan
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
| | - Linda Teng
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
| | - Renea A Taylor
- Cancer Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC, 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, 305 Grattan Street, Parkville, VIC, 3010, Australia
- Cabrini Institute, Cabrini Health, 183 Wattletree Road, Malvern, VIC, 3144, Australia
- Monash Biomedicine Discovery Institute, Department of Physiology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
| | - Gail P Risbridger
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
- Cancer Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC, 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, 305 Grattan Street, Parkville, VIC, 3010, Australia
- Cabrini Institute, Cabrini Health, 183 Wattletree Road, Malvern, VIC, 3144, Australia
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, 30-1, Ooyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Satoshi Inoue
- Department of Systems Aging Science and Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku Tokyo, Tokyo, 173-0015, Japan.
- Research Center for Genomic Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1241, Japan.
| |
Collapse
|
10
|
Akamatsu S, Naito Y, Nagayama J, Sano Y, Inoue S, Matsuo K, Sano T, Ishida S, Matsukawa Y, Kato M. Treatment escalation and de-escalation of de-novo metastatic castration-sensitive prostate cancer. NAGOYA JOURNAL OF MEDICAL SCIENCE 2024; 86:169-180. [PMID: 38962407 PMCID: PMC11219222 DOI: 10.18999/nagjms.86.2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/21/2023] [Indexed: 07/05/2024]
Abstract
Androgen receptor signaling inhibitors combined with androgen deprivation therapy have become the standard of care for metastatic castration-sensitive prostate cancer (mCSPC), regardless of tumor volume or risk. However, survival of approximately one-third of these patients has not improved, necessitating further treatment escalation. On the other hand, for patients with oligometastatic mCSPC, there is an emerging role for local radiation therapy. Although data remain scarce, it is expected that treatment of both primary tumor as well as metastasis-directed therapy may improve survival outcomes. In these patients, systemic therapy may be de-escalated to intermittent therapy. However, precise risk stratification is necessary for risk-based treatment escalation or de-escalation. In addition to risk stratification based on clinical parameters, research has been conducted to incorporate genomic and/or transcriptomic data into risk stratification. In future, an integrated risk model is expected to precisely stratify patients and guide treatment strategies. Here, we first review the transition of the standard treatment for mCSPC over the last decade and further discuss the newest concept of escalating or de-escalating treatment using a multi-modal approach based on the currently available literature.
Collapse
Affiliation(s)
- Shusuke Akamatsu
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yushi Naito
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Nagayama
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuta Sano
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Inoue
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuna Matsuo
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoyasu Sano
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shohei Ishida
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihisa Matsukawa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
11
|
Yu A, Van Uffel M, Jiao JJ, Rosales R, Erba M, Haddish-Berhane N. Bioequivalence of 240 mg Apalutamide Tablets and Preparation in Aqueous Food Vehicles for Alternative Administration. Clin Pharmacol Drug Dev 2024; 13:432-439. [PMID: 37987029 DOI: 10.1002/cpdd.1346] [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: 09/07/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
A 240-mg single tablet has been developed with the focus of reducing the pill burden of the apalutamide daily dose of 240 mg (4 × 60-mg tablets). An open-label, randomized, single-dose phase 1 study with a 2-sequence and 2-period crossover design in healthy men determined the bioequivalence of a 240-mg single tablet versus the currently available 4 × 60-mg tablets (Part 1, N = 74) and assessed effect of a high-fat meal (Part 2, N = 21) on apalutamide maximum plasma concentration (Cmax) and the area under the plasma concentration-time curve (AUC0-72 h). The 90% confidence interval of geometric mean ratios for Cmax and AUC0-72 h fell between 80% and 125% for both Part 1 and Part 2. No new safety concerns with the 240-mg single tablet were observed. To support the use of different food vehicles as well as nasogastric (NG) tubes for alternative administration, we conducted in vitro compatibility studies to evaluate the purity, dose, and stability of 240-mg tablets dispersed in applesauce/yogurt/orange juice/green tea as well as in NG tubes (polyurethane/silicone/polyvinyl chloride). The studies confirmed the alternative administrations do not affect the purity, dose-accuracy, or stability of apalutamide. The apalutamide 240-mg tablet is bioequivalent to 4 × 60-mg tablets and compatible with the tested food vehicles and NG tubes.
Collapse
Affiliation(s)
- Alex Yu
- Clinical Pharmacology & Pharmacometrics, Janssen Research & Development, Spring House, PA, USA
| | | | - Juhui J Jiao
- Clinical Pharmacology & Pharmacometrics, Janssen Research & Development, Spring House, PA, USA
| | - Rosamerlinda Rosales
- Clinical Pharmacology & Pharmacometrics, Janssen Research & Development, Spring House, PA, USA
| | - Maura Erba
- CMC Leadership SMPD, Janssen Research & Development, Latina, Italy
| | - Nahor Haddish-Berhane
- Clinical Pharmacology & Pharmacometrics, Janssen Research & Development, Spring House, PA, USA
| |
Collapse
|
12
|
Liu C, Chen B, Xu P, Yang J, Nip C, Wang L, Shen Y, Ning S, Shang Y, Corey E, Gao AC, Gestwicki J, Wei Q, Liu L. Plexin D1 emerges as a novel target in the development of neural lineage plasticity in treatment-resistant prostate cancer. RESEARCH SQUARE 2024:rs.3.rs-4095949. [PMID: 38585965 PMCID: PMC10996809 DOI: 10.21203/rs.3.rs-4095949/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Treatment-induced neuroendocrine prostate cancer (t-NEPC) often arises from adenocarcinoma via lineage plasticity in response to androgen receptor signaling inhibitors, such as enzalutamide. However, the specific regulators and targets involved in the transition to NEPC are not well understood. Plexin D1 (PLXND1) is a cellular receptor of the semaphorin (SEMA) family that plays important roles in modulating the cytoskeleton and cell adhesion. Here, we found that PLXND1 is highly expressed and positively correlated with neuroendocrine markers in patients with NEPC. High PLXND1 expression is associated with poorer prognosis in prostate cancer patients. Additionally, PLXND1 was upregulated and negatively regulated by androgen receptor signaling in enzalutamide-resistant cells. Knockdown or knockout of PLXND1 inhibit neural lineage pathways, suppressing NEPC cell proliferation, PDX tumor organoid viability, and xenograft tumor growth. Mechanistically, the chaperone protein HSP70 regulates PLXND1 protein stability through degradation, and inhibition of HSP70 decreases PLXND1 expression and NEPC organoid growth. In summary, our findings suggest that PLXND1 could be a new therapeutic target and molecular indicator for NEPC.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Qiang Wei
- West China Hospital of Sichuan University
| | | |
Collapse
|
13
|
Hadfield MJ, Lyall V, Holle LM, Dennison M. Updates in the Treatment of Non-Metastatic Castrate-Resistant Prostate Cancer: The Benefit of Second-Generation Androgen Receptor Antagonists. Ann Pharmacother 2023; 57:1302-1311. [PMID: 36840339 DOI: 10.1177/10600280231155441] [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: 02/26/2023] Open
Abstract
OBJECTIVE To review pharmacology, efficacy, safety, and considerations for use, of second-generation androgen receptor (AR) antagonists in treatment of nonmetastatic castrate-resistant prostate cancer (M0CRPC). DATA SOURCES Conducted search in PubMed and Google scholar (January, 1, 2002-December 31, 2022), using relevant terms. STUDY SELECTION AND DATA EXTRACTION Relevant English-language studies, conducted in humans evaluating second-generation AR antagonists for M0CRPC, and additional articles and package inserts were considered. DATA SYNTHESIS Apalutamide, darolutamide, and enzalutamide are effective in delaying the time to development of metastatic prostate cancer in men with M0CRPC with a rapid prostate-specific antigen (PSA) doubling time (<10 months). No head-to-head, randomized, clinical trials have been conducted. The most common adverse effects include fatigue and hypertension, and quality of life is maintained in most patients. Cost is similar among the agents (~$15,000/month). Drug-drug interactions vary among these agents and should be considered, when selecting therapy as well as likely adherence. Darolutamide is administered twice daily with the others once daily. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Second-generation AR antagonists are effective in reducing time to development of metastatic disease and prolonging overall survival in patients with M0CRPC and a PSA doubling time of <10 months. Recent imaging advances may alter how we evaluate outcomes. CONCLUSIONS Second-generation AR antagonists improve disease control and overall survival. Generally, they are well tolerated and QOL is maintained. Selection of the best agent is based on the adverse effect profile, potential for drug- and disease-interactions, administration, cost, and patient preference.
Collapse
Affiliation(s)
- Matthew J Hadfield
- Department of Medical Oncology, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Vikram Lyall
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Lisa M Holle
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Morgan Dennison
- University of Connecticut School of Pharmacy, Storrs, CT, USA
| |
Collapse
|
14
|
Tsujino T, Tokushige S, Komura K, Fukuokaya W, Adachi T, Hirasawa Y, Hashimoto T, Yoshizawa A, Saruta M, Ohno T, Nakamori K, Maenosono R, Nishimura K, Yamazaki S, Uchimoto T, Yanagisawa T, Mori K, Urabe F, Tsuzuki S, Iwatani K, Yamamoto S, Takahara K, Inamoto T, Kimura T, Ohno Y, Shiroki R, Azuma H. Real-world survival outcome comparing abiraterone acetate plus prednisone and enzalutamide for nonmetastatic castration-resistant prostate cancer. Cancer Med 2023; 12:19414-19422. [PMID: 37706578 PMCID: PMC10587977 DOI: 10.1002/cam4.6536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/16/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND There is little evidence of abiraterone acetate (AA) plus prednisone for patients with non-metastatic castration-resistant prostate cancer (nmCRPC). In this study, we conducted a comparative analysis of real-world survival outcomes between AA plus prednisone and enzalutamide (Enz) in patients with nmCRPC, utilizing our consortium dataset. MATERIALS AND METHODS The clinical records of 133 nmCRPC patients treated with first-line Enz or AA plus prednisone were analyzed. The primary endpoints of the study were overall survival (OS) and cancer-specific survival (CSS). Cumulative incidence function (CIF) using Fine and Gray models was also utilized to assess non-cancer-caused death considering the competing risk of cancer-caused death. RESULTS During a median follow-up of 36 months, 34 patients (25.6%) had deceased, with a median OS of 99 months in the entire cohort. There were no significant differences in comorbidities between the Enz and AA groups. Time to PSA progression (TTPP: HR 0.81, 95% CI 0.51-1.30, P = 0.375) and CSS (HR 1.32, 95% CI 0.55-3.44, P = 0.5141) were comparable between the two groups. However, intriguingly, there was a trend towards shorter OS in patients treated with AA plus prednisone compared to Enz (HR 0.57, 95% CI 0.29-1.12, P = 0.0978, median of 99 and 69 months in Enz and AA groups, respectively). CIF analysis revealed that nmCRPC patients treated with AA plus prednisone were more likely to result in non-cancer-caused death than those treated with Enz (HR 5.22, 95% CI 1.88-14.50, P = 0.0014). CONCLUSIONS Our real-world survival analysis suggests that while AA plus prednisone may demonstrate comparable treatment efficacy to Enz in the context of nmCRPC, there may be an increased risk of non-cancer-caused death. Physicians should take into consideration this information when making treatment decisions for patients with nmCRPC.
Collapse
Affiliation(s)
- Takuya Tsujino
- Department of UrologyOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Satoshi Tokushige
- Department of UrologyOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Kazumasa Komura
- Department of UrologyOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Wataru Fukuokaya
- Department of UrologyThe Jikei University School of MedicineMinato‐kuJapan
| | - Takahiro Adachi
- Department of UrologyTokyo Medical UniversityShinjuku‐kuJapan
| | - Yosuke Hirasawa
- Department of UrologyTokyo Medical UniversityShinjuku‐kuJapan
| | | | - Atsuhiko Yoshizawa
- Department of UrologyFujita‐Health University School of MedicineToyoakeJapan
| | - Masanobu Saruta
- Department of UrologyFujita‐Health University School of MedicineToyoakeJapan
| | - Takaya Ohno
- Department of UrologyOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Keita Nakamori
- Department of UrologyOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Ryoichi Maenosono
- Department of UrologyOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Kazuki Nishimura
- Department of UrologyOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Shogo Yamazaki
- Department of UrologyOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Taizo Uchimoto
- Department of UrologyOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | | | - Keiichiro Mori
- Department of UrologyThe Jikei University School of MedicineMinato‐kuJapan
| | - Fumihiko Urabe
- Department of UrologyThe Jikei University School of MedicineMinato‐kuJapan
| | - Shunsuke Tsuzuki
- Department of UrologyThe Jikei University School of MedicineMinato‐kuJapan
| | - Kosuke Iwatani
- Department of UrologyThe Jikei University School of MedicineMinato‐kuJapan
| | - Shutaro Yamamoto
- Department of UrologyThe Jikei University School of MedicineMinato‐kuJapan
| | - Kiyoshi Takahara
- Department of UrologyFujita‐Health University School of MedicineToyoakeJapan
| | - Teruo Inamoto
- Department of UrologyOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Takahiro Kimura
- Department of UrologyThe Jikei University School of MedicineMinato‐kuJapan
| | - Yoshio Ohno
- Department of UrologyTokyo Medical UniversityShinjuku‐kuJapan
| | - Ryoichi Shiroki
- Department of UrologyFujita‐Health University School of MedicineToyoakeJapan
| | - Haruhito Azuma
- Department of UrologyOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| |
Collapse
|
15
|
Yanagisawa T, Kawada T, Mori K, Shim SR, Mostafaei H, Sari Motlagh R, Quhal F, Laukhtina E, von Deimling M, Bianchi A, Majdoub M, Pallauf M, Pradere B, Kimura T, Shariat SF, Rajwa P. Impact of performance status on efficacy of systemic therapy for prostate cancer: a meta-analysis. BJU Int 2023; 132:365-379. [PMID: 37395151 DOI: 10.1111/bju.16106] [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: 07/04/2023]
Abstract
OBJECTIVE To evaluate the efficacy of systemic therapies in patients with worse performance status (PS) treated for high-risk non-metastatic prostate cancer (PCa), metastatic hormone-sensitive PCa (mHSPC), and non-metastatic/metastatic castration-resistant PCa (nmCRPC/mCRPC), as there is sparse pooled data showing the effect of PS on oncological outcomes in patients with PCa. METHODS Three databases were queried in June 2022 for randomised controlled trials (RCTs) analysing patients with PCa treated with systemic therapy (i.e., adding androgen receptor signalling inhibitor [ARSI] or docetaxel [DOC] to androgen-deprivation therapy [ADT]). We analysed the oncological outcomes of patients with PCa with worse PS, defined as Eastern Cooperative Oncology Group PS ≥ 1, treated with combination therapies and compared these to patients with good PS. The main outcomes of interest were overall survival (OS), metastasis-free survival (MFS), and progression-free survival. RESULTS Overall, 25 and 18 RCTs were included for systematic review and meta-analyses/network meta-analyses, respectively. In all clinical settings, combination systemic therapies significantly improved OS in patients with worse PS as well as in those with good PS, while the MFS benefit from ARSI in the nmCRPC setting was more pronounced in patients with good PS than in those with worse PS (P = 0.002). Analysis of treatment ranking in patients with mHSPC revealed that triplet therapy had the highest likelihood of improved OS irrespective of PS; specifically, adding darolutamide to DOC + ADT had the highest likelihood of improved OS in patients with worse PS. Analyses were limited by the small proportion of patients with a PS ≥ 1 (19%-28%) and that the number of PS 2 was rarely reported. CONCLUSIONS Among RCTs, novel systemic therapies seem to benefit the OS of patients with PCa irrespective of PS. Our findings suggest that worse PS should not discourage treatment intensification across all disease stages.
Collapse
Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sung Ryul Shim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Korea
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Markus von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alberto Bianchi
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Muhammad Majdoub
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Maximilian Pallauf
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - Takahiro Kimura
- Department of Urology, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| |
Collapse
|
16
|
Fizazi K, Gillessen S. Updated treatment recommendations for prostate cancer from the ESMO Clinical Practice Guideline considering treatment intensification and use of novel systemic agents. Ann Oncol 2023; 34:557-563. [PMID: 36958590 DOI: 10.1016/j.annonc.2023.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/25/2023] Open
Affiliation(s)
- K Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - S Gillessen
- Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland
| |
Collapse
|
17
|
Madan RA, Bilusic M, Stein MN, Donahue RN, Arlen PM, Karzai F, Plimack E, Wong YN, Geynisman DM, Zibelman M, Mayer T, Strauss J, Chen G, Rauckhorst M, McMahon S, Couvillon A, Steinberg S, Figg WD, Dahut WL, Schlom J, Gulley JL. Flutamide With or Without PROSTVAC in Non-metastatic Castration Resistant (M0) Prostate Cancer. Oncologist 2023:7150994. [PMID: 37134294 DOI: 10.1093/oncolo/oyad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/10/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Before 2018, there was no standard of care for non-metastatic (M0) castration resistant prostate cancer nmCRPC. Androgen receptor antagonists (ARAs) were commonly used sequentially nmCRPC. METHODS This was a multicenter, randomized clinical trial comparing the ARA flutamide+/-PROSTVAC, a pox viral vaccine targeting PSA that includes T-cell co-stimulatory molecules. Eligible men had negative CT and Tc99 bone scans, and rising PSA on ADT. Previous treatment with ARA was a stratification factor. Patients were also evaluated for antigen-specific immune responses using intracellular cytokine staining. RESULTS Thirty-three patients randomized to flutamide and 31 to flutamide+vaccine. The median age was 71.8 and 69.8 years, respectively. The median time to treatment failure after a median potential follow-up of 46.7 months was, 4.5 months (range 2-70) for flutamide alone vs. 6.9 months (2.5-40; P = .38) with flutamide+vaccine. Seven patients in each arm had a >50% PSA response. Antigen-specific responses were similar in both arms (58% of patients in flutamide alone and 56% in flutamide+vaccine). The treatments were well tolerated. The most common side effect > grade 2 was injection site reaction seen in 29/31 vaccine patients which were self-limiting. CONCLUSION The combination of flutamide+PROSTVAC did not improve outcomes in men with nmCRPC compared with flutamide alone. (ClinicalTrials.gov Identifier: NCT00450463).
Collapse
Affiliation(s)
| | | | - Mark N Stein
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY, USA
| | | | | | | | - Elizabeth Plimack
- Department of Hematology/Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | | | - Daniel M Geynisman
- Department of Hematology/Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Matthew Zibelman
- Department of Hematology/Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Tina Mayer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Gang Chen
- National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Jardim DL, Gonçalves E Silva A, Pompeo ASFL, Sarkis AS, Cardoso APG, Sasse AD, Fay AP, Soares A, Pompeo ACL, Carneiro A, Kann AG, Fogassa C, De Freitas CH, Chade DC, Herchenhorn D, De Almeida DVP, Da Rosa DAR, Wiermann EG, Schutz FAB, Kater FR, De Moura F, Korkes F, Meyer F, De Oliveira FNG, Sabino F, Almeida GL, Avanço G, Guimaraes GC, Lemos GC, Carvalhal GF, Kim H, Morbeck IP, Campagnari JC, Rinck JA, Da Ponte JRT, Da Trindade KM, Atem L, Borges L, Nogueira LM, Batista LTEA, Maia MC, Sadi MV, Rocha MAA, Luz MDA, Smaletz O, Lages PSM, Matuda RMK, Reis RBD, Indio RF, Fernandes RDC, Cavallero SR, Souza VC, Busato W, Alfer W, Maluf F. "Non-metastatic, Castration-resistant Prostate Cancer: Diagnostic and Treatment Recommendations by an Expert Panel from Brazil". Clin Genitourin Cancer 2023; 21:e58-e69. [PMID: 36266221 DOI: 10.1016/j.clgc.2022.09.005] [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: 05/09/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Non-metastatic, castration-resistant prostate cancer (nmCRPC) is an important clinical stage of prostate cancer, prior to morbidity and mortality from clinical metastases. In particular, the introduction of novel androgen-receptor signaling inhibitors (ARSi) has changed the therapeutic landscape in nmCRPC. Given recent developments in this field, we update our recommendations for the management of nmCRPC. METHODS A panel of 51 invited medical oncologists and urologists convened in May of 2021 with the aim of discussing and providing recommendations regarding the most relevant issues concerning staging methods, antineoplastic therapy, osteoclast-targeted therapy, and patient follow-up in nmCRPC. Panel members considered the available evidence and their practical experience to address the 73 multiple-choice questions presented. RESULTS Key recommendations and findings include the reliance on prostate-specific antigen doubling time for treatment decisions, the absence of a clear preference between conventional and novel (i.e., positron-emission tomography-based) imaging techniques, the increasing role of ARSis in various settings, the general view that ARSis have similar efficacy. Panelists highlighted the slight preference for darolutamide, when safety is of greater concern, and a continued need to develop high-level evidence to guide the intensity of follow-up in this subset of prostate cancer. DISCUSSION Despite the limitations associated with a consensus panel, the topics addressed are relevant in current practice, and the recommendations can help practicing clinicians to provide state-of-the-art treatment to patients with nmCRPC in Brazil and other countries with similar healthcare settings.
Collapse
Affiliation(s)
- Denis L Jardim
- Hospital Sírio Libanês, Sociedade Beneficente de Senhoras, São Paulo, SP, Brasil
| | | | - Alexandre Saad Fere Lima Pompeo
- Hospital Beneficência Portuguesa, Departamento de Uro-Oncologia, São Paulo, SP, Brasil; Grupo de Uro-Oncologia do Hcor, São Paulo, SP, Brasil
| | - Alvaro Sadek Sarkis
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | | | | | | | - Andrey Soares
- Hospital Israelita Albert Einstein, Departamento de Oncologia, São Paulo, SP, Brasil; Grupo Oncoclínicas, São Paulo, SP, Brasil; Latin American Cooperative Oncology Group (LACOG), Genitourinary Group
| | | | - Arie Carneiro
- Hospital Israelita Albert Einstein, Departamento de Oncologia, São Paulo, SP, Brasil
| | | | - Camilla Fogassa
- Hospital Israelita Albert Einstein, Departamento de Oncologia, São Paulo, SP, Brasil
| | | | - Daher Cezar Chade
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da USP, São Paulo, SP, Brasil
| | - Daniel Herchenhorn
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Rede D'Or, Rio de Janeiro, RJ, Brasil
| | | | | | | | | | - Fabio Roberto Kater
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil
| | - Fernando De Moura
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil
| | - Fernando Korkes
- Grupo de uro-oncologia da Faculdade de Medicina do ABC, Santo André, SP, Brasil; Hospital Israelita Albert Einstein, Departamento de Urologia, São Paulo, SP, Brasil
| | - Fernando Meyer
- Sociedade Brasileira de Urologia, Curitiba, PR, Brasil; Hospital Universitário Cajuru, Curitiba, PR, Brasil; Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
| | - Fernando Nunes Galvao De Oliveira
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Clínica de Oncologia do Grupo CAM (CLION), Salvador, BA, Brasil
| | - Fernando Sabino
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Hospital Santa Lúcia, Brasília, DF, Brasil; Hospital Universitário de Brasília, Brasília, DF, Brasil
| | | | | | | | | | - Gustavo Franco Carvalhal
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil; Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | - Hanna Kim
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil
| | - Igor Protzner Morbeck
- Hospital Sírio Libanês, Sociedade Beneficente de Senhoras, São Paulo, SP, Brasil; Universidade Católica de Brasília, Brasília, DF, Brasil
| | - Joao Carlos Campagnari
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil; Clínica de Urologia e Nefrologia, São Paulo, SP, Brasil
| | | | | | - Karine Martins Da Trindade
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Rede D'Or, Fortaleza, CE, Brasil
| | | | - Leonardo Borges
- Hospital Israelita Albert Einstein, Departamento de Urologia, São Paulo, SP, Brasil
| | - Lucas Mendes Nogueira
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
| | | | - Manuel Caitano Maia
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Hospital Porto Dias, Department of Medical Oncology, Belém, Pará, Brasil
| | | | | | - Murilo De Almeida Luz
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil; Hospital Erasto Gaertner, Curitiba, PR, Brasil
| | - Oren Smaletz
- Hospital Israelita Albert Einstein, Departamento de Oncologia, São Paulo, SP, Brasil
| | | | | | | | | | - Roni De Carvalho Fernandes
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil; Irmandade da Santa Casa de Misericórdia de São Paulo - Hospital Central, São Paulo, SP, Brasil
| | - Sandro Roberto Cavallero
- Centro de Tratamento Oncológico (CTO), Belém, PA, Brasil; Hospital Adventista de Belém (HAB), Belém, PA, Brasil
| | - Vinicius Carrera Souza
- Instituto D'Or de Ensino e Pesquisa, Salvador, BA, Brasil; Rede D'Or, Salvador, BA, Brasil
| | - Wilson Busato
- Universidade do Vale do Itajai (UNIVALI), Itajai, SC, Brasil
| | - Wladimir Alfer
- Hospital Israelita Albert Einstein, Departamento de Urologia, São Paulo, SP, Brasil
| | - Fernando Maluf
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil; Hospital Israelita Albert Einstein, Departamento de Urologia, São Paulo, SP, Brasil.
| |
Collapse
|
19
|
Pollock Y, Smith MR, Saad F, Chowdhury S, Oudard S, Hadaschik B, Olmos D, Lee JY, Uemura H, Bhaumik A, Londhe A, Rooney B, Brookman-May SD, De Porre P, Mundle SD, Small EJ. Clinical characteristics associated with falls in patients with non-metastatic castration-resistant prostate cancer treated with apalutamide. Prostate Cancer Prostatic Dis 2023; 26:156-161. [PMID: 36209239 DOI: 10.1038/s41391-022-00592-9] [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: 09/30/2021] [Revised: 08/05/2022] [Accepted: 08/31/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The phase III SPARTAN study demonstrated that apalutamide significantly improves metastasis-free survival and overall survival vs. placebo in patients with non-metastatic castration-resistant prostate cancer (nmCRPC). However, patients receiving apalutamide experienced falls more frequently vs. those receiving placebo (15.6% vs. 9.0%). METHODS 806 patients with nmCRPC randomized to apalutamide in SPARTAN and treated with apalutamide in addition to ongoing androgen deprivation therapy (ADT) were included in this post-hoc analysis investigating clinical variables associated with a subsequent fall. Time to a fall was assessed with Cox proportional-hazards models adjusted for baseline characteristics and time-varying factors. Statistical inference was based on final multivariable models. RESULTS Falls were reported for 125/803 (15.6%) patients treated with apalutamide and ADT. Most falls were grade 1 or 2 and did not require hospitalization. Median time from randomization to first fall was 9.2 months (range 0.1-25.3 months). In the final multivariable model of both baseline and after-baseline covariates, baseline patient characteristics (older age, poor Eastern Cooperative Oncology Group performance status, history of neuropathy, and α-blocker use before study treatment) remained significantly associated with fall; after-baseline clinical characteristics significantly associated with time to fall were development of neuropathy, arthralgia, and weight loss before fall. CONCLUSIONS This analysis identified risk factors for fall among nmCRPC patients treated with apalutamide. Clinical management can minimize these identified risks while enhancing patient outcomes. Preventive interventions should be considered when the identified baseline conditions and post-treatment neuropathy, arthralgia, or weight decrease are present, to reduce risk of fall. TRIAL REGISTRATION ClinicalTrials.gov: NCT01946204.
Collapse
Affiliation(s)
- YaoYao Pollock
- The Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
- St. Joseph Health Medical Group, Providence St. Joseph Health, Santa Rosa, CA, USA.
| | - Matthew R Smith
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Fred Saad
- Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Simon Chowdhury
- Guy's, King's and St. Thomas' Hospitals, Great Maze Pond, London, UK
| | - Stéphane Oudard
- Georges Pompidou Hospital, University de Paris, Paris, France
| | - Boris Hadaschik
- University of Duisburg-Essen, Essen, and Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - David Olmos
- Spanish National Cancer Research Centre (CNIO), Madrid and Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hiroji Uemura
- Yokohama City University Medical Center, Yokohama, Japan
| | | | - Anil Londhe
- Janssen Research & Development, Titusville, NJ, USA
| | | | - Sabine D Brookman-May
- Janssen Research & Development, Los Angeles, CA, USA
- Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Eric J Small
- The Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
20
|
Berruti A, Bracarda S, Caffo O, Cortesi E, D'Angelillo R, Del Re M, Facchini G, Pappagallo G, Procopio G, Sabbatini R, Santini D. nmCRPC, a look in the continuous care of prostate cancer patients: state of art and future perspectives. Cancer Treat Rev 2023; 115:102525. [PMID: 36822009 DOI: 10.1016/j.ctrv.2023.102525] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
Non-metastatic castration resistant prostate cancer (nmCRPC) is a clinical setting defined as confirmed rising levels of PSA in patients treated with ADT but without detectable metastases on conventional imaging with computerized tomography (CT) and technetium-99 m scintigraphy. Men with nmCRPC and a PSA doubling time (PSADT) ≤ 10 months are considered at high risk of rapidly developing metastases with a consequent possible impact on survival. Three recent phase III trials have demonstrated, in this setting, the efficacy of adding a next-generation androgen receptor targeted agent (ARTA) to ADT in respect to ADT only, in delaying the development of metastases (metastasis-free survival, MFS) and prolong overall survival. The magnitude of clinical benefit of these agents was even more meaningful if considering the low incidence of drug related adverse events. Our review described the latest advances in the management of nmCRPC, deriving from the pivotal clinical trials, SPARTAN, PROSPER and ARAMIS, in order to support clinicians to optimally manage these patients. Of note, the emergence of novel, more accurate, next-generation imaging techniques (including Ga PSMA-PET/CT), as well as eventual future tumor biomarkers, is modifying the entity and definition of the nmCRPC setting, with a consequent impact on patient's diagnosis and management.
Collapse
Affiliation(s)
- Alfredo Berruti
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy.
| | - Sergio Bracarda
- Medical and Translational Oncology Unit, Department of Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy.
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy.
| | - Enrico Cortesi
- Medical Oncology Department, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
| | | | - Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Gaetano Facchini
- Oncology Complex Unit, "S. Maria delle Grazie" Hospital, ASL NA2 NORD, Pozzuoli, Italy.
| | - Giovanni Pappagallo
- School of Methodology of Clinical Research, IRCCS "Sacro Cuore-Don Calabria" Hospital, 37024 Negrar di Valpolicella, VR, Italy.
| | - Giuseppe Procopio
- Medical Oncology Unit, Programma Prostata, Fondazione Istituto Nazionale Tumori, Milano.
| | - Roberto Sabbatini
- SC Oncologia, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy.
| | - Daniele Santini
- UOC oncologia medica territoriale, La Sapienza Università, Polo Pontino, Latina, Italy.
| |
Collapse
|
21
|
Niu W, Zhang T, Ma L. Correlation analysis between immune-related genes and cell infiltration revealed prostate cancer immunotherapy biomarkers linked to T cells gamma delta. Sci Rep 2023; 13:2459. [PMID: 36774376 PMCID: PMC9922294 DOI: 10.1038/s41598-023-28475-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/19/2023] [Indexed: 02/13/2023] Open
Abstract
Prostate cancer (PCa) is a urological malignancy with poor prognosis. Immune-related genes are associated with immune infiltration in prostate cancer, but their role in immunogenic PCa is less well understood. We assessed the infiltration patterns of 22 immune cells in PCa and the relationship of immune-related differentially expressed genes (IDEGs) with them. The 87 IDEGs are involved in the interaction between the extracellular matrix and the tumor microenvironment. The model, including seven IDEGs (SLPI, DES, IAPP, NPY, ISG15, PLA2G2A, and HLA-DMB), showed a good predictive power. The SLPI expression is positively correlated with the infiltration level of T cells gamma delta. In addition, PCa has high infiltration levels in Macrophages M1 (18.07%) and Dendritic cells activated (17.64%). The correlation analysis between IDEGs and immune cell infiltration suggested that PCa immunotherapy biomarkers may be closely related to T cells gamma delta.
Collapse
Affiliation(s)
- Wenkang Niu
- College of Life Science, Shihezi University, Shihezi, Xinjiang, China
| | - Tingting Zhang
- College of Life Science, Shihezi University, Shihezi, Xinjiang, China.
| | - Lei Ma
- College of Life Science, Shihezi University, Shihezi, Xinjiang, China.
| |
Collapse
|
22
|
Direct healthcare costs of non-metastatic castration-resistant prostate cancer in Italy. Int J Technol Assess Health Care 2023; 39:e2. [PMID: 36606465 DOI: 10.1017/s0266462322003336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The management of non-metastatic castration-resistant prostate cancer (nmCRPC) is rapidly evolving; however, little is known about the direct healthcare costs of nmCRPC. We aimed to estimate the cost-of-illness (COI) of nmCRPC from the Italian National Health Service perspective. METHODS Structured, individual qualitative interviews were carried out with clinical experts to identify what healthcare resources are consumed in clinical practice. To collect quantitative estimates of healthcare resource consumption, a structured expert elicitation was performed with clinical experts using a modified version of a previously validated interactive Excel-based tool, EXPLICIT (EXPert eLICItation Tool). For each parameter, experts were asked to provide the lowest, highest, and most likely value. Deterministic and probabilistic sensitivity analyses (PSA) were carried out to test the robustness of the results. RESULTS Ten clinical experts were interviewed, and six of them participated in the expert elicitation exercise. According to the most likely estimate, the yearly cost per nmCRPC patient is €4,710 (range, €2,243 to €8,243). Diagnostic imaging (i.e., number/type of PET scans performed) had the highest impact on cost. The PSA showed a 50 percent chance for the yearly cost per nmCRPC patient to be within €5,048 using a triangular distribution for parameters, and similar results were found using a beta-PERT distribution. CONCLUSIONS This study estimated the direct healthcare costs of nmCRPC in Italy based on a mixed-methods approach. Delaying metastases may be a reasonable goal also from an economic standpoint. These findings can inform decision-making about treatments at the juncture between non-metastatic and metastatic prostate cancer disease.
Collapse
|
23
|
Rusarova N, Vitaskova D, Kalabova H, Ondruskova A, Purova D, Melichar B, Studentova H. The role of carboplatin in combination with paclitaxel in patients with castration-resistant prostate cancer. Future Oncol 2022; 18:4183-4192. [PMID: 36519589 DOI: 10.2217/fon-2022-0914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The aim of the present study was to examine the efficacy of carboplatin in combination with paclitaxel in patients with metastatic castration-resistant prostate cancer pretreated with multiple regimens including docetaxel and androgen receptor-targeted agents. Methods: Clinical data from patients treated with carboplatin plus paclitaxel were collected retrospectively from a single institution. Results: 43 patients with metastatic castration-resistant prostate cancer were identified. Median number of cycles was ten (range: 1 to 23), prostate-specific antigen response was observed in 18 (42%) patients, median progression-free survival was 115 days and median overall survival was 8.1 months. Conclusion: Combination chemotherapy using taxane with carboplatin is an effective and well-tolerated therapy in heavily pretreated patients with metastatic castration-resistant prostate cancer.
Collapse
Affiliation(s)
- Nikol Rusarova
- Department of Oncology, Palacky University, Faculty of Medicine & Dentistry & University Hospital Olomouc, Olomouc, 77900, Czech Republic
| | - Denisa Vitaskova
- Department of Oncology, Palacky University, Faculty of Medicine & Dentistry & University Hospital Olomouc, Olomouc, 77900, Czech Republic
| | - Hana Kalabova
- Department of Oncology, Palacky University, Faculty of Medicine & Dentistry & University Hospital Olomouc, Olomouc, 77900, Czech Republic
| | - Andrea Ondruskova
- Department of Oncology, Palacky University, Faculty of Medicine & Dentistry & University Hospital Olomouc, Olomouc, 77900, Czech Republic
| | - Dana Purova
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, 77900, Czech Republic
| | - Bohuslav Melichar
- Department of Oncology, Palacky University, Faculty of Medicine & Dentistry & University Hospital Olomouc, Olomouc, 77900, Czech Republic
| | - Hana Studentova
- Department of Oncology, Palacky University, Faculty of Medicine & Dentistry & University Hospital Olomouc, Olomouc, 77900, Czech Republic
| |
Collapse
|
24
|
Ventimiglia E, Bill-Axelson A, Adolfsson J, Aly M, Eklund M, Westerberg M, Stattin P, Garmo H. Modeling Disease Trajectories for Castration-resistant Prostate Cancer Using Nationwide Population-based Data. EUR UROL SUPPL 2022; 44:46-51. [PMID: 36185582 PMCID: PMC9520495 DOI: 10.1016/j.euros.2022.07.010] [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] [Accepted: 07/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Little is known about disease trajectories for men with castration-resistant prostate cancer (CRPC). Objective To create a state transition model that estimates time spent in the CRPC state and its outcomes. Design, setting, and participants The model was generated using population-based prostate-specific antigen data from 40% of the Swedish male population, which were linked to nationwide population-based databases. We compared the observed and predicted cumulative incidence of transitions to and from the CRPC state. Outcome measurements and statistical analysis We measured time spent in the CRPC state and the proportion of men who died of prostate cancer during follow-up by CRPC risk category. Results and limitations Time spent in the CRPC state varied from 1.1 yr for the highest risk category to 3.9 yr for the lowest risk category. The proportion of men who died from prostate cancer within 10 yr ranged from 93% for the highest risk category to 54% for the lowest. There was good agreement between the model estimates and observed data. Conclusions There is large variation in the time spent in the CRPC state, varying from 1 yr to 4 yr according to risk category. Patient summary It is possible to accurately estimate the disease trajectory and duration for men with castration-resistant prostate cancer.
Collapse
Affiliation(s)
- Eugenio Ventimiglia
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Corresponding author. Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, ingång 70, 1 tr751 85, Uppsala, Sweden.
| | - Anna Bill-Axelson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Westerberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Garmo
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
25
|
Wu X, Han H, Zhang C, Song W. The Overall Survival and Safety of Men with Metastatic Hormone-Sensitive Prostate Cancer Treated with Combination Therapy of Novel Androgen Receptor Antagonists and Androgen-Deprivation Therapy: A Systematic Review and Meta-Analysis. JOURNAL OF ONCOLOGY 2022; 2022:6211059. [PMID: 39280891 PMCID: PMC11401698 DOI: 10.1155/2022/6211059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/13/2022] [Indexed: 09/18/2024]
Abstract
Background Several novel androgen receptor antagonists have been introduced into the treatment of metastatic hormone-sensitive prostate cancer (mHSPC). We conducted a meta-analysis to evaluate the survival and safety of the combination therapy of novel androgen receptor antagonist and androgen-deprivation therapy (ADT) in patients with mHSPC. Methods Electronic databases were searched for randomized controlled trials (RCTs) of ADT combined with novel androgen receptor antagonists compared with ADT alone in men with mHSPC. Revman 5.4 and STATA 14.0 were used to performed the meta-analysis, and hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (CIs) were used as the measurement indicators of outcome variables. Results Six RCTs were eventually identified for meta-analysis. Compared with ADT alone, the combination therapy of novel androgen receptor antagonists and ADT can significantly improve the overall survival (OS) and progression-free survival (PFS), as the pooled HR were 0.66, 95%CI (0.60, 0.72), P < 0.00001 and 0.43, 95%CI (0.34, 0.54), P < 0.00001, respectively, despite increasing the risk of any serious adverse events (OR: 1.18, 95%CI (1.04, 1.33), P=0.008). Discussion. This study showed that compared with ADT alone, the combination therapy of novel androgen receptor antagonists and ADT can significantly improve the survival status of mHSPC patients, while it increases the risk of serious adverse events.
Collapse
Affiliation(s)
- Xupeng Wu
- Department of Urology, Jincheng People's Hospital, Jincheng, China
| | - Haisong Han
- Department of Urology, Jincheng People's Hospital, Jincheng, China
| | - Chao Zhang
- Department of Urology, Jincheng People's Hospital, Jincheng, China
| | - Wei Song
- Department of Urology, Jincheng People's Hospital, Jincheng, China
| |
Collapse
|
26
|
Emerging Biomarker-Guided Therapies in Prostate Cancer. CURRENT ONCOLOGY (TORONTO, ONT.) 2022; 29:5054-5076. [PMID: 35877260 PMCID: PMC9319825 DOI: 10.3390/curroncol29070400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 12/25/2022]
Abstract
Prostate cancer remains one of the leading causes of cancer death in men worldwide. In the past decade, several new treatments for advanced prostate cancer have been approved. With a wide variety of available drugs, including cytotoxic agents, androgen receptor axis-targeted therapies, and alpha-emitting radiation therapy, identifying their optimal sequencing remains a challenge. Progress in the understanding of the biology of prostate cancer has provided an opportunity for a more refined and personalized treatment selection process. With the advancement of molecular sequencing techniques, genomic precision through the identification of potential treatment targets and predictive biomarkers has been rapidly evolving. In this review, we discussed biomarker-driven treatments for advanced prostate cancer. First, we presented predictive biomarkers for established, global standard treatments for advanced diseases, such as chemotherapy and androgen receptor axis-targeted agents. We also discussed targeted agents with recent approval for special populations, such as poly ADP ribose polymerase (PARP) inhibitors in patients with metastatic castrate-resistant prostate cancer with homologous recombination repair-deficient tumors, pembrolizumab in patients with high levels of microsatellite instability or high tumor mutational burden, and prostate-specific membrane antigen (PSMA) directed radioligand theragnostic treatment for PSMA expressing tumors. Additionally, we discussed evolving treatments, such as cancer vaccines, chimeric antigen receptor T-cells (CAR-T), Bispecific T-cell engagers (BiTEs), other targeted agents such as AKT inhibitors, and various combination treatments. In summary, advances in molecular genetics have begun to propel personalized medicine forward in the management of advanced prostate cancer, allowing for a more precise, biomarker-driven treatment selection with the goal of improving overall efficacy.
Collapse
|
27
|
Rahnama'i MS. Prostate Cancer Drug Therapy: What Have Clinicians Missed During the COVID-19 Pandemic. Am J Mens Health 2022; 16:15579883221115593. [PMID: 35950609 PMCID: PMC9380218 DOI: 10.1177/15579883221115593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Due to the COVID-19 pandemic, major congresses and many teaching
opportunities as well as the usual visits from medical advisors of
pharmaceutical firms have been postponed and canceled. The major
trials of prostate cancer in the last 5 years in each state are
shortly discussed providing a panoramic overview of the available
evidence and data on prostate cancer treatment. Apalutamide,
enzalutamide, and darolutamide have proven to have clinical benefits
when added to androgen deprivation therapy for patients with
nonmetastatic castration-resistant prostate cancer. In patients in the
metastatic hormone-sensitive setting, next to docetaxel, abiraterone,
enzalutamide, and apalutamide have been shown to significantly improve
overall survival and progression-free survival in comparison to
standard hormone therapy. In addition, docetaxel abiraterone and
enzalutamide are widely used in the metastatic setting. For
second-line therapy of metastasized prostate cancer patients who have
received either docetaxel or abiraterone or enzalutamide, olaparib,
cabazitaxel, radium, and lutetium therapy have been shown to be
beneficial in selected patient groups.
Collapse
Affiliation(s)
- M S Rahnama'i
- Department of Urology, Maastricht University, Maastricht, The Netherlands.,Department of Urology, University Hospital RWTH Aachen, Aachen, Germany
| |
Collapse
|
28
|
Tombal B, Sternberg CN, Hussain M, Ganguli A, Li Y, Sandin R, Bhadauria H, Oh M, Saad F. Matching-adjusted indirect treatment comparison of the efficacy of enzalutamide versus apalutamide for the treatment of nonmetastatic castration-resistant prostate cancer. ESMO Open 2022; 7:100510. [PMID: 35714477 PMCID: PMC9271511 DOI: 10.1016/j.esmoop.2022.100510] [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] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/25/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To date, the efficacy of the androgen receptor inhibitors enzalutamide and apalutamide for the treatment of nonmetastatic castration-resistant prostate cancer (nmCRPC) has not been compared directly in a clinical trial setting. Indirect comparisons can be used to assess relative efficacy and provide important information to guide treatment decisions. PROSPER and SPARTAN were double-blind, randomized, placebo-controlled, phase III trials in patients with nmCRPC with overall similar study designs and inclusion and exclusion criteria. Using an anchored matching-adjusted indirect comparison, based on the final data from the PROSPER and SPARTAN studies, we assessed the comparative efficacy of enzalutamide and apalutamide, both plus androgen deprivation therapy. METHODS Using placebo as the common comparator, individual patient data from PROSPER were matched to the aggregate patient data from SPARTAN and efficacy endpoints from PROSPER were re-weighted accordingly. Patient baseline characteristics and endpoints were clinically and statistically tested to identify potential effect modifiers, according to National Institute for Health and Care Excellence guidelines. Hazard ratios for overall survival (OS), metastasis-free survival (MFS), and time to chemotherapy (TTCx) were re-estimated for PROSPER using weighted Cox proportional hazards models and indirectly compared with those of SPARTAN using a Bayesian network meta-analysis. RESULTS Estimated hazard ratios [95% credible interval (CrI)] for enzalutamide versus apalutamide were 0.80 (95% CrI 0.58-1.10) for OS, 0.94 (95% CrI 0.69-1.29) for MFS2, and 0.90 (95% CrI 0.63-1.29) for TTCx. Similar results were seen for sensitivity analyses conducted for OS and MFS. Bayesian probability analyses showed a 91.7% favoring enzalutamide for OS, 65.1% for MFS, and 71.4% for TTCx. CONCLUSIONS The results of this matching-adjusted indirect comparison of final data from PROSPER and SPARTAN indicate comparable efficacy of enzalutamide and apalutamide with potentially a greater probability of longer MFS, OS, and TTCx in patients with nmCRPC treated with enzalutamide versus apalutamide.
Collapse
Affiliation(s)
- B Tombal
- Institut de Recherche Clinique (IREC), Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| | - C N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine, Sandra and Edward Meyer Cancer Center, New York, USA
| | - M Hussain
- Lurie Cancer Center, Northwestern University, Chicago, USA
| | - A Ganguli
- HEOR, Oncology, Medical Affairs, Astellas Pharma Inc., Chicago, USA
| | - Y Li
- Solutions UK IQVIA, London, UK
| | - R Sandin
- Global Health and Value, Outcomes and Evidence, Oncology, Pfizer AB, Sollentuna, Sweden
| | - H Bhadauria
- HEOR, Oncology, Medical Affairs, Astellas Pharma Inc., Chicago, USA
| | - M Oh
- HEOR, Oncology, Medical Affairs, Astellas Pharma Inc., Chicago, USA
| | - F Saad
- Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| |
Collapse
|
29
|
André L, Antherieu G, Boinet A, Bret J, Gilbert T, Boulahssass R, Falandry C. Oncological Treatment-Related Fatigue in Oncogeriatrics: A Scoping Review. Cancers (Basel) 2022; 14:2470. [PMID: 35626074 PMCID: PMC9139887 DOI: 10.3390/cancers14102470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/17/2022] Open
Abstract
Fatigue is a highly prevalent symptom in both cancer patients and the older population, and it contributes to quality-of-life impairment. Cancer treatment-related fatigue should thus be included in the risk/benefit assessment when introducing any treatment, but tools are lacking to a priori estimate such risk. This scoping review was designed to report the current evidence regarding the frequency of fatigue for the different treatment regimens proposed for the main cancer indications, with a specific focus on age-specific data, for the following tumors: breast, ovary, prostate, urothelium, colon, lung and lymphoma. Fatigue was most frequently reported using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) versions 3 to 5. A total of 324 regimens were analyzed; data on fatigue were available for 217 (67%) of them, and data specific to older patients were available for 35 (11%) of them; recent pivotal trials have generally reported more fatigue grades than older studies, illustrating increasing concern over time. This scoping review presents an easy-to-understand summary that is expected to provide helpful information for shared decisions with patients regarding the anticipation and prevention of fatigue during each cancer treatment.
Collapse
Affiliation(s)
- Louise André
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Gabriel Antherieu
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Amélie Boinet
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Judith Bret
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Thomas Gilbert
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
- Research on Healthcare Professionals and Performance RESHAPE, Inserm U1290, Lyon 1 University, 69008 Lyon, France
| | - Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de Nice, 06000 Nice, France;
- FHU OncoAge, 06000 Nice, France
- Faculty of Medicine, University of Nice Sofia Antilpolis, 06000 Nice, France
| | - Claire Falandry
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
- FHU OncoAge, 06000 Nice, France
- CarMeN Laboratory, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Bâtiment CENS-ELI 2D, Hôpital Lyon Sud Secteur 2, 69310 Pierre-Bénite, France
- UCOGIR—Auvergne-Rhône-Alpes Ouest–Guyane, Hôpital Lyon Sud, 69495 Pierre-Bénite, France
- Faculty of Medicine and Maieutics Charles Mérieux, Lyon 1 University, 69310 Pierre-Bénite, France
| |
Collapse
|
30
|
Yanev I, Gatete J, Aprikian AG, Guertin JR, Dragomir A. The Health Economics of Metastatic Hormone-Sensitive and Non-Metastatic Castration-Resistant Prostate Cancer—A Systematic Literature Review with Application to the Canadian Context. Curr Oncol 2022; 29:3393-3424. [PMID: 35621665 PMCID: PMC9140131 DOI: 10.3390/curroncol29050275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Health economic evaluations are needed to assess the impact on the healthcare system of emerging treatment patterns for advanced prostate cancer. The objective of this study is to review the scientific literature identifying cost-effectiveness and cost analyses that are assessing treatments for metastatic hormone-sensitive prostate cancer (mHSPC) and nonmetastatic castration-resistant prostate cancer (nmCRPC). Methods: On 29 June 2021, we searched the scientific (MEDLINE, Embase, and EBSCO) and grey literature for health economic studies targeting mHSPC and nmCRPC. We used the CHEC-extended checklist and the Welte checklist for risk-of-bias assessment and transferability analysis, respectively. Results: We retained 20 cost-effectiveness and 4 cost analyses in the mHSPC setting, and 14 cost-effectiveness and 6 cost analyses in the nmCRPC setting. Docetaxel in combination with androgen deprivation therapy (ADT) was the most cost-effective treatment in the mHSPC setting. Apalutamide, darolutamide, and enzalutamide presented similar results vs. ADT alone and were identified as cost-effective treatments for nmCRPC. An increase in costs as patients transitioned from nmCRPC to mCRPC was noted. Conclusions: We concluded that there is an important unmet need for health economic evaluations in the mHSPC and nmCRPC setting incorporating real-world data to support healthcare decision making.
Collapse
Affiliation(s)
- Ivan Yanev
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (I.Y.); (J.G.J.)
- Experimental Surgery, McGill University, Montreal, QC H3A 0G4, Canada
| | - Jessy Gatete
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (I.Y.); (J.G.J.)
- Experimental Surgery, McGill University, Montreal, QC H3A 0G4, Canada
| | - Armen G. Aprikian
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Jason Robert Guertin
- Département de Médecine Sociale et Préventive, Université Laval, Quebec City, QC G1V 0A6, Canada;
- Centre de Recherche du CHU de Québec-Université Laval, Quebec City, QC G1V 4G2, Canada
| | - Alice Dragomir
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (I.Y.); (J.G.J.)
- Experimental Surgery, McGill University, Montreal, QC H3A 0G4, Canada
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada;
- Correspondence:
| |
Collapse
|
31
|
Jazayeri SB, Srivastava A, Shore N. Review of second-generation androgen receptor inhibitor therapies and their role in prostate cancer management. Curr Opin Urol 2022; 32:283-291. [PMID: 35552309 DOI: 10.1097/mou.0000000000000984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We review the published literature on the indications of second-generation androgen receptor inhibitors, Poly(ADP-Ribose) Polymerase (PARP) inhibitors, combination therapies, and their evolution throughout the advanced prostate cancer continuum. RECENT FINDINGS Enzalutamide trials have published data supporting its use in metastatic hormone-sensitive prostate cancer (mHSPC), nonmetastatic castration-resistant prostate cancer (nmCRPC), and metastatic castration-resistant prostate cancer (mCRPC). Apalutamide trials have supported its indication for mHSPC and nmCRPC. Darolutamide trials currently support its use for nmCRPC. Abiraterone trials have supported its use in mCRPC and mHSPC. Olaparib and rucaparib have shown clinical benefit in heavily pretreated patients with mCRPC and DNA repair mutation genes. SUMMARY Phase 3 trials and peer-reviewed literature demonstrate that enzalutamide, apalutamide, and darolutamide prolong overall survival (OS) in men with nmCRPC. Abiraterone, enzalutamide, and apalutamide improve OS in men with mHSPC. Abiraterone and enzalutamide have data supporting improvement in OS in men with mCRPC.
Collapse
Affiliation(s)
| | | | - Neal Shore
- Genesis Care, Myrtle Beach, South Carolina, USA
| |
Collapse
|
32
|
Obinata D, Funakoshi D, Takayama K, Hara M, Niranjan B, Teng L, Lawrence MG, Taylor RA, Risbridger GP, Suzuki Y, Takahashi S, Inoue S. OCT1-target neural gene PFN2 promotes tumor growth in androgen receptor-negative prostate cancer. Sci Rep 2022; 12:6094. [PMID: 35413990 PMCID: PMC9005514 DOI: 10.1038/s41598-022-10099-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/23/2022] [Indexed: 12/12/2022] Open
Abstract
Androgen and androgen receptor (AR) targeted therapies are the main treatment for most prostate cancer (PC) patients. Although AR signaling inhibitors are effective, tumors can evade this treatment by transforming to an AR-negative PC via lineage plasticity. OCT1 is a transcription factor interacting with the AR to enhance signaling pathways involved in PC progression, but its role in the emergence of the AR-negative PC is unknown. We performed chromatin immunoprecipitation sequencing (ChIP-seq) in patient-derived castration-resistant AR-negative PC cells to identify genes that are regulated by OCT1. Interestingly, a group of genes associated with neural precursor cell proliferation was significantly enriched. Then, we focused on neural genes STNB1 and PFN2 as OCT1-targets among them. Immunohistochemistry revealed that both STNB1 and PFN2 are highly expressed in human AR-negative PC tissues. Knockdown of SNTB1 and PFN2 by siRNAs significantly inhibited migration of AR-negative PC cells. Notably, knockdown of PFN2 showed a marked inhibitory effect on tumor growth in vivo. Thus, we identified OCT1-target genes in AR-negative PC using a patient-derived model, clinicopathologial analysis and an animal model.
Collapse
Affiliation(s)
- Daisuke Obinata
- Department of Urology, Nihon University School of Medicine, 30-1, Ooyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan.,Prostate Cancer Research Group, Monash Biomedicine Discovery Institute Cancer Program, Department of Anatomy and Developmental Biology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
| | - Daigo Funakoshi
- Department of Urology, Nihon University School of Medicine, 30-1, Ooyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kenichi Takayama
- Department of Systems Aging Science and Medicine, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Makoto Hara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, 30-1, Ooyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Birunthi Niranjan
- Prostate Cancer Research Group, Monash Biomedicine Discovery Institute Cancer Program, Department of Anatomy and Developmental Biology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
| | - Linda Teng
- Prostate Cancer Research Group, Monash Biomedicine Discovery Institute Cancer Program, Department of Anatomy and Developmental Biology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
| | - Mitchell G Lawrence
- Prostate Cancer Research Group, Monash Biomedicine Discovery Institute Cancer Program, Department of Anatomy and Developmental Biology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia.,Cancer Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, 305 Grattan Street, Parkville, VIC, 3010, Australia.,Melbourne Urological Research Alliance (MURAL), Monash Biomedicine Discovery Institute Cancer Program, Monash University, Wellington Road, Clayton, VIC, 3800, Australia.,Cabrini Institute, Cabrini Health, 183 Wattletree Road, Malvern, VIC, 3144, Australia
| | - Renea A Taylor
- Cancer Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, 305 Grattan Street, Parkville, VIC, 3010, Australia.,Melbourne Urological Research Alliance (MURAL), Monash Biomedicine Discovery Institute Cancer Program, Monash University, Wellington Road, Clayton, VIC, 3800, Australia.,Cabrini Institute, Cabrini Health, 183 Wattletree Road, Malvern, VIC, 3144, Australia.,Prostate Cancer Research Group, Monash Biomedicine Discovery Institute Cancer Program, Department of Physiology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
| | - Gail P Risbridger
- Prostate Cancer Research Group, Monash Biomedicine Discovery Institute Cancer Program, Department of Anatomy and Developmental Biology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia.,Cancer Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, 305 Grattan Street, Parkville, VIC, 3010, Australia.,Melbourne Urological Research Alliance (MURAL), Monash Biomedicine Discovery Institute Cancer Program, Monash University, Wellington Road, Clayton, VIC, 3800, Australia.,Cabrini Institute, Cabrini Health, 183 Wattletree Road, Malvern, VIC, 3144, Australia
| | - Yutaka Suzuki
- Department of Computational Biology and Medical Sciences Graduate School of Frontier Sciences, University of Tokyo, 5-1-5, Kashiwanoha, Chiba, Chiba, 277-8562, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, 30-1, Ooyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Satoshi Inoue
- Department of Systems Aging Science and Medicine, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan. .,Research Center for Genomic Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1241, Japan.
| |
Collapse
|
33
|
Molecular landscape of c-Myc signaling in prostate cancer: A roadmap to clinical translation. Pathol Res Pract 2022; 233:153851. [DOI: 10.1016/j.prp.2022.153851] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 12/16/2022]
|
34
|
Chowdhury S, Oudard S, Uemura H, Joniau S, Dearden L, Capone C, Van Sanden S, Diels J, Hadaschik BA. Apalutamide Compared with Darolutamide for the Treatment of Non-metastatic Castration-Resistant Prostate Cancer: Efficacy and Tolerability in a Matching-Adjusted Indirect Comparison. Adv Ther 2022; 39:518-531. [PMID: 34797506 PMCID: PMC8799579 DOI: 10.1007/s12325-021-01885-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/03/2021] [Indexed: 01/21/2023]
Abstract
Introduction Apalutamide and darolutamide are next-generation androgen receptor inhibitors that have demonstrated superior efficacy compared to placebo in men with non-metastatic castration-resistant prostate cancer (nmCRPC) receiving androgen deprivation therapy (ADT). In the absence of head-to-head studies, the present study sought to indirectly compare the efficacy and tolerability between these two treatments. Methods This anchored matching-adjusted indirect comparison (MAIC) used patient-level data from the phase 3, randomized, controlled SPARTAN study (apalutamide + ADT), weighted to match aggregate published data from the ARAMIS study (darolutamide + ADT) for clinically relevant baseline measures. Hazard ratios (HR) and 95% credible intervals (CrI) were estimated for efficacy endpoints: metastasis-free survival (MFS), prostate-specific antigen (PSA) progression, progression-free survival (PFS), and overall survival (OS). Odds ratios were estimated for tolerability outcomes: adverse events and serious adverse events. Results Before weighting, baseline characteristics from SPARTAN versus ARAMIS were different for median PSA (7.8 vs. 9.2 ng/mL), Eastern Cooperative Oncology Group performance status of 1 (23% vs. 31%), use of bone-targeted agents (10% vs. 4%), median time from initial diagnosis (94.9 vs. 85.4 months), and proportion of patients from North America (35% vs. 12%) and Europe (50% vs. 64%). After matching (n = 455), our analysis demonstrated that apalutamide + ADT had a Bayesian probability of being more effective than darolutamide + ADT for MFS [98.3%; HR 0.70 (95% CrI 0.51, 0.98)], PSA progression [~ 100%; HR 0.46 (95% CrI 0.33, 0.64)], and PFS [93.2%; HR 0.79 (95% CrI 0.59, 1.08)]. Results for OS and tolerability were similar between apalutamide + ADT and darolutamide + ADT. Conclusion This anchored MAIC analysis of pivotal phase 3 studies in patients with nmCRPC suggests that apalutamide + ADT is more effective than darolutamide + ADT for MFS, progression-free survival (PFS), and prostate-specific antigen (PSA) progression, with a similar OS benefit and tolerability profile. Trial Registration ARAMIS ClinicalTrials.gov number: NCT02200614; SPARTAN ClinicalTrials.gov number: NCT01946204.
Collapse
Affiliation(s)
- Simon Chowdhury
- Department of Medical Oncology, Guy's, King's, and St. Thomas' Hospitals, London, UK.
| | - Stephane Oudard
- Georges Pompidou Hospital, University of Paris, Paris, France
| | - Hiroji Uemura
- Yokohama City University Medical Center, Yokohama, Japan
| | | | | | | | | | | | - Boris A Hadaschik
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
35
|
Vogl UM, Beer TM, Davis ID, Shore ND, Sweeney CJ, Ost P, Attard G, Bossi A, de Bono J, Drake CG, Efstathiou E, Fanti S, Fizazi K, Halabi S, James N, Mottet N, Padhani AR, Roach M, Rubin M, Sartor O, Small E, Smith MR, Soule H, Sydes MR, Tombal B, Omlin A, Gillessen S. Lack of consensus identifies important areas for future clinical research: Advanced Prostate Cancer Consensus Conference (APCCC) 2019 findings. Eur J Cancer 2022; 160:24-60. [PMID: 34844839 DOI: 10.1016/j.ejca.2021.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Innovations in treatments, imaging and molecular characterisation have improved outcomes for people with advanced prostate cancer; however, many aspects of clinical management are devoid of high-level evidence. At the Advanced Prostate Cancer Consensus Conference (APCCC) 2019, many of these topics were addressed, and consensus was not always reached. The results from clinical trials will most reliably plus the gaps. METHODS An invited panel of 57 experts voted on 123 multiple-choice questions on clinical management at APCCC 2019. No consensus was reached on 88 (71.5%) questions defined as <75% of panellists voting for the same answer option. We reviewed clinicaltrials.gov to identify relevant ongoing phase III trials in these areas of non-consensus. RESULTS A number of ongoing phase III trials were identified that are relevant to these non-consensus issues. However, many non-consensus issues appear not to be addressed by current clinical trials. Of note, no phase III but only phase II trials were identified, investigating side effects of hormonal treatments and their management. CONCLUSIONS Lack of consensus almost invariably indicates gaps in existing evidence. The high percentage of questions lacking consensus at APCCC 2019 highlights the complexity of advanced prostate cancer care and the need for robust, clinically relevant trials that can fill current gaps with high-level evidence. Our review of these areas of non-consensus and ongoing trials provides a useful summary, indicating areas in which future consensus may soon be reached. This review may facilitate academic investigators to identify and prioritise topics for future research.
Collapse
Affiliation(s)
- Ursula M Vogl
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Tomasz M Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Ian D Davis
- Monash University and Eastern Health, Victoria, Australia
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Christopher J Sweeney
- Dana-Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Piet Ost
- Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Alberto Bossi
- Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France
| | - Johann de Bono
- The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Charles G Drake
- Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | | | - Anwar R Padhani
- Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK
| | - Mack Roach
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Mark Rubin
- Bern Center for Precision Medicine, Bern, Switzerland; Department for Biomedical Research, University of Bern, Bern, Switzerland
| | | | - Eric Small
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew R Smith
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | - Aurelius Omlin
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; University of Bern, Bern, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland; Division of Cancer Science, University of Manchester, Manchester, UK.
| |
Collapse
|
36
|
Rizzo A, Oderda M, Mollica V, Merler S, Morelli F, Fragomeno B, Taveri E, Sorgentoni G, Santoni M, Massari F. A meta-analysis on overall survival and safety outcomes in patients with nonmetastatic castration-resistant prostate cancer treated with novel hormonal agents. Anticancer Drugs 2022; 33:e43-e51. [PMID: 34387593 DOI: 10.1097/cad.0000000000001168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several novel androgen receptor (AR)-inhibitors have been introduced for nonmetastatic castration-resistant prostate cancer (nmCRPC) treatment, with the improvement of survival outcomes which need to be balanced against the risk of adverse events. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating enzalutamide, apalutamide and darolutamide in nmCRPC patients, to assess overall survival (OS), incidence and risk of adverse drug events, adverse-events-related death and adverse-events-related treatment discontinuation. We selected three RCTs (SPARTAN, PROSPER and ARAMIS). New hormonal agents administration resulted in better OS, despite the increased risk of several any grade and grade 3-4 adverse events. In the decision-making process, careful evaluation of expected adverse events, patients' comorbidities and maintenance of quality of life are mandatory.
Collapse
Affiliation(s)
- Alessandro Rizzo
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Marco Oderda
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin
| | - Veronica Mollica
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Sara Merler
- U.O.C. Oncology, Azienda Ospedaliera Universitaria Integrata, University and Hospital Trust of Verona, Verona
| | - Franco Morelli
- Medical Oncology Department, Casa Sollievo Della Sofferenza Hospital, IRCCS, San Giovanni Rotondo
| | - Benedetta Fragomeno
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Elena Taveri
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | | | | | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| |
Collapse
|
37
|
Yue W, Du X, Wang X, Gui N, Zhang W, Sun J, You J, He D, Geng X, Huang Y, Hou J. Prognostic values of the core components of the mammalian circadian clock in prostate cancer. PeerJ 2021; 9:e12539. [PMID: 34966582 PMCID: PMC8667750 DOI: 10.7717/peerj.12539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/04/2021] [Indexed: 12/24/2022] Open
Abstract
Background Prostate cancer (PC) is one of the most common malignancies in males. Extensive and complex connections between circadian rhythm and cancer were found. Nonetheless, in PC, the potential role of the core components of the mammalian circadian clock (CCMCCs) in prognosis prediction has not been fully clarified. Methods We firstly collected 605 patients with PC from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) databases. Survival analysis was carried out for each CCMCC. Then, we investigated the prognostic ability of CCMCCs by Cox regression analysis. Independent prognostic signatures were extracted for the establishment of the circadian clock-based risk score model. We explored the predictive performance of the risk score model in the TCGA training cohort and the independent GEO dataset. Finally, the relationships between risk score and clinicopathological parameters, biological processes, and signaling pathways were evaluated. Results The expression levels of CCMCCs were widely correlated with age, tumor status, lymph node status, disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS). Nine circadian clock genes, including CSNK1D, BTRC, CLOCK, CSNK1E, FBXL3, PRKAA2, DBP, NR1D2, and RORB, were identified as vital prognostic factors in PC and were used to construct the circadian clock-based risk score model. For DFS, the area under the 3-year or 5-year receiver operating characteristic curves ranged from 0.728 to 0.821, suggesting better predictive performance. When compared with T3-4N1 stage, PC patients at T2N0 stage might be benefited more from the circadian clock-based risk score model. Furthermore, a high circadian clock-based risk score indicated shorter DFS (p < 0.0001), early progression (p < 0.0001), and higher 5-year death rate (p = 0.007) in PC. The risk score was related to tumor status (p < 0.001), lymph node status (p < 0.001), and ribosome-related biogenesis and pathways. Conclusions The vital roles of circadian clock genes in clinical outcomes were fully depicted. The circadian clock-based risk score model could reflect and predict the prognosis of patients with PC.
Collapse
Affiliation(s)
- Wenchang Yue
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao Du
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuhong Wang
- Department of Urology, Tongcheng people's Hospital, Tongcheng, China
| | - Niu Gui
- General Surgery Ward 2, Fengtaixian Hospital of Chinese Medicine, Huainan, China
| | - Weijie Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiale Sun
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiawei You
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dong He
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinyu Geng
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhua Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianquan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
38
|
Nigro MC, Mollica V, Marchetti A, Cheng M, Rosellini M, Montironi R, Cheng L, Massari F. Current androgen receptor antagonists under investigation for resistant prostate cancer. Expert Rev Anticancer Ther 2021; 22:191-202. [DOI: 10.1080/14737140.2022.2020651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Maria Concetta Nigro
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Veronica Mollica
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Marchetti
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michael Cheng
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matteo Rosellini
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Liang Cheng
- Department of Pathology and the Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| |
Collapse
|
39
|
Rodriguez-Vida A, Rodríguez-Alonso A, Useros-Rodríguez E, Lopez-Campos F, Amor-Carro O, Arribas-Ruiz A, Martinez-Torres J, Roca-Pardiñas J, Quesada-García A, Muñoz-Del-Toro JR, Juárez-Soto Á. Impact of New Systemic Therapies in Overall Survival in Non-Metastatic Castration Resistant Prostate Cancer: Systematic Review and Meta-Analysis. Clin Genitourin Cancer 2021; 20:197.e1-197.e10. [PMID: 34920959 DOI: 10.1016/j.clgc.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/03/2022]
Abstract
There was a high medical need for patients with non-metastatic castration-resistant prostate cancer (nmCRPC) when several next-generation anti-androgens (apalutamide, enzalutamide, and darolutamide) demonstrated clinically relevant delays in metastasis onset. However, to date, few publications have assessed the pooled effect of these treatments on overall survival (OS). We performed a systematic review and meta-analysis of all randomized, placebo-controlled studies investigating a systemic treatment in nmCRPC. Publications were identified by searching several databases on April 7, 2021. The primary objective of this analysis was to determine the OS benefit. Secondary outcomes included the relative risk (RR) of adverse events (AEs) and grade 3-4 AEs. A sensitivity analysis with simulated data was also conducted to examine the influence of the study designs on the results. Three randomized controlled studies (SPARTAN, PROSPER, ARAMIS) met our inclusion criteria. Pooled meta-analyses showed a significant benefit in OS with the active agents versus placebo (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.65-0.83), as well as increased risk of any grade (RR 1.09, 95% CI 1.01-1.17) and grade 3-4 AEs (RR 1.50, 95% CI 1.23-1.83). The sensitivity analysis with SPARTAN-like simulated populations demonstrated that when using ARAMIS statistical design, OS would be statistically significant in 98.1% of the cases, at a shorter follow-up and with lower number of events. First-line treatment of nmCRPC patients with anti-androgens increased OS with an acceptable safety profile. In light of the different study designs and follow-up, results should be interpreted separately.
Collapse
Affiliation(s)
- Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar, IMIM Research Institute, Barcelona, Spain.
| | | | | | | | | | | | | | - Javier Roca-Pardiñas
- Statistics and Operational Research Department, University of Vigo, Vigo, Pontevedra, Spain
| | | | | | | |
Collapse
|
40
|
De Giorgi U, Hussain M, Shore N, Fizazi K, Tombal B, Penson D, Saad F, Efstathiou E, Madziarska K, Steinberg J, Sugg J, Lin X, Shen Q, Sternberg CN. Consistent survival benefit of enzalutamide plus androgen deprivation therapy in men with nonmetastatic castration-resistant prostate cancer: PROSPER subgroup analysis by age and region. Eur J Cancer 2021; 159:237-246. [PMID: 34784577 DOI: 10.1016/j.ejca.2021.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Enzalutamide combined with androgen deprivation therapy (ADT) significantly prolonged metastasis-free survival and overall survival (OS) versus ADT alone in patients with non-metastatic castration-resistant prostate cancer (nmCRPC) with rapidly rising prostate-specific antigen (PSA). The objective of this post hoc analysis of the PROSPER trial is to evaluate OS benefit and safety of enzalutamide in patients across age and regional subgroups. PATIENTS AND METHODS Eligible men with nmCRPC, PSA doubling time ≤10 months and PSA ≥2 ng/mL with continued ADT use were randomised 2:1 to enzalutamide 160 mg or placebo. OS and safety were examined by age (<70 vs ≥70 years) and region (North America, Europe, Asia or the rest of the world). The impact of prior and subsequent therapy was also examined. RESULTS In total, 1401 men were enrolled (median age, 74 years). Enzalutamide plus ADT reduced the risk of death, independent of age or region. Multivariate analyses identified Eastern Cooperative Oncology Group (ECOG) status (P < 0.0001), log (PSA; P = 0.0002) and subsequent therapy (P < 0.0001) as statistically significant factors impacting OS. Safety was consistent across age and regional subgroups. Any grade treatment-emergent adverse events were similar across age groups, were more common in the placebo group and had regional variation. CONCLUSIONS In men with nmCRPC and rapidly rising PSA, the benefit and safety of enzalutamide were consistent across age and regional subgroups. Variables impacting OS included ECOG status, log (PSA) and subsequent therapy. CLINICALTRIALS. GOV IDENTIFIER NCT02003924.
Collapse
Affiliation(s)
- Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| | - Maha Hussain
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | | | - David Penson
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fred Saad
- Division of Urology and Urologic Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | | | | | | | - Xun Lin
- Pfizer Inc., San Diego, CA, USA
| | - Qi Shen
- Pfizer Inc., San Francisco, CA, USA
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine, Meyer Cancer Center, New York, NY, USA.
| |
Collapse
|
41
|
Management of Patients with Nonmetastatic Castration-Resistant Prostate Cancer: Recommendations of a Multidisciplinary Panel of Experts from South America. Prostate Cancer 2021. [DOI: 10.1155/2021/3334333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Most prostate cancer patients who undergo androgen-deprivation therapy or orchiectomy will eventually develop castration-resistant prostate cancer (CRPC), often preceded by a nonmetastatic CRPC state known as M0CRPC. The recent development of second-generation antiandrogens provides clinicians with efficacious and safe treatments for M0CRPC. However, the complexity of these patients, who typically have to deal with underlying comorbidities and polypharmacy, often challenges therapeutic decisions in this setting. The recent development of novel imaging techniques also provides clinicians with tools for detecting metastases with high sensitivity and specificity. However, the lack of evidence on the early detection of metastases and the corresponding impact on therapeutic decisions makes these techniques a double-edged sword that must be managed appropriately. Here, we present the expert view of the rapidly evolving concept of M0CRPC and provide recommendations for the identification of these patients, the appropriate use of the emerging imaging modalities, and patients’ management, particularly considering their clinical complexity and the recent development of next-generation antiandrogens.
Collapse
|
42
|
Penson DF, Armstrong AJ, Concepcion RS, Agarwal N, Olsson CA, Karsh LI, Dunshee CJ, Duggan W, Shen Q, Sugg J, Haas GP, Higano CS. Enzalutamide versus bicalutamide in patients with nonmetastatic castration-resistant prostate cancer: a prespecified subgroup analysis of the STRIVE trial. Prostate Cancer Prostatic Dis 2021; 25:363-365. [PMID: 34621011 PMCID: PMC9184266 DOI: 10.1038/s41391-021-00465-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND In the phase 2, randomized, double-blind STRIVE trial, enzalutamide significantly reduced the risk of prostate cancer progression or death versus bicalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) and nonmetastatic CRPC (nmCRPC). The objective of this protocol-specified subgroup analysis of STRIVE was to investigate the benefit of enzalutamide versus bicalutamide specifically in patients with nmCRPC. METHODS Patients (N = 139) were stratified by disease stage and randomized to enzalutamide 160 mg/day plus androgen deprivation therapy (ADT; n = 70) or bicalutamide 50 mg/day plus ADT (n = 69). RESULTS Baseline characteristics of patients with nmCRPC were comparable between groups. At a median of 17 months follow-up, enzalutamide reduced the risk of progression or death by 76% versus bicalutamide in patients with nmCRPC (hazard ratio [HR], 0.24; 95% CI 0.14-0.42). Enzalutamide reduced risk of prostate-specific antigen progression by 82% versus bicalutamide in patients with nmCRPC (HR, 0.18; 95% CI 0.10-0.34). The most frequently reported adverse events by patients receiving enzalutamide were fatigue (36.2%), hot flush (20.3%), decreased appetite (17.4%), dizziness (17.4%), and nausea (17.4%). CONCLUSIONS This STRIVE subgroup analysis of patients with nmCRPC illustrates the benefit of enzalutamide in reducing the risk of progression or death versus bicalutamide in patients with nmCRPC. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01664923.
Collapse
Affiliation(s)
- David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Andrew J Armstrong
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC, USA
| | | | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - William Duggan
- Global Product Development, Pfizer Inc., Groton, CT, USA
| | - Qi Shen
- Global Product Development, Pfizer Inc., Collegeville, PA, USA
| | - Jennifer Sugg
- Biostatistics, Astellas Pharma, Inc., Northbrook, IL, USA
| | - Gabriel P Haas
- Global Development, Astellas Pharma, Inc., Northbrook, IL, USA
| | - Celestia S Higano
- Department of Medicine, Division of Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
43
|
Iacovelli R, Astore S, Ciccarese C, Cannella MA, Bove P, Iacovelli V, Tortora G. Inside prostate cancer news from the 2021 ASCO Genitourinary Cancers Symposium. Expert Rev Anticancer Ther 2021; 21:1207-1210. [PMID: 34493147 DOI: 10.1080/14737140.2021.1976148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prostate cancer (PC) is a heterogeneous disease that requires a personalized treatment approach for proper patient management. AIM We analyzed a selected overview of the most important news recently presented at the 2021 ASCO genitourinary cancer symposium. RESULTS In particular, we focused on the identification of predictive biomarkers as potential targets for therapy. Molecular signatures of increased T cell activity, proliferation, and hormone dependence were associated with greater probability of response to apalutamide in non-metastatic CRPC. Pathogenic variants of DDR genes mutations detected with circulating tumor DNA (ctDNA) analysis, which had a high concordance with tumor tissue analysis, might represent a useful way for selecting mutated patients for poly (adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitors therapy. Loss of PTEN could be a target for ipatasertib (a pan-AKT inhibitor) associated with abiraterone in mCRPC patients. CONCLUSIONS The 2021 ASCO Genitourinary Cancers Symposium significantly contributed to the complex research goal of intimately understanding PC carcinogenesis with the ultimate aim of improving patient outcomes.
Collapse
Affiliation(s)
- Roberto Iacovelli
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Irccs, Rome, Italy
| | - Serena Astore
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Irccs, Rome, Italy
| | - Chiara Ciccarese
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Irccs, Rome, Italy.,Department of Medical Oncology, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Maria Antonella Cannella
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Irccs, Rome, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | | | - Giampaolo Tortora
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Irccs, Rome, Italy.,Department of Medical Oncology, Università Cattolica Del Sacro Cuore, Rome, Italy
| |
Collapse
|
44
|
Health-related Quality of Life at the SPARTAN Final Analysis of Apalutamide for Nonmetastatic Castration-resistant Prostate Cancer Patients Receiving Androgen Deprivation Therapy. Eur Urol Focus 2021; 8:958-967. [PMID: 34479838 DOI: 10.1016/j.euf.2021.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/14/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND In SPARTAN, apalutamide improved metastasis-free and overall survival for patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) with a prostate-specific antigen doubling time of ≤10 mo. OBJECTIVE We evaluated health-related quality of life (HRQoL) at the final analysis of the SPARTAN study. INTERVENTION Patients received apalutamide (240 mg/d) or placebo in 28-d cycles. All patients continued androgen deprivation therapy (ADT). DESIGN, SETTING, AND PARTICIPANTS A total of 1207 patients with nmCRPC were randomized 2:1 to apalutamide or placebo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS HRQoL was assessed using Functional Assessment of Cancer Therapy-Prostate (FACT-P) and EQ-5D-3L questionnaires at day 1 of cycle 1 (predose/baseline), cycles 2-6, every two cycles during cycles 7-13, every four cycles thereafter, at the end of treatment, and every 4 mo after progression to 1 yr. Results are presented using descriptive statistics. A mixed model for repeated measures was fitted to estimate the mean scores at each scheduled visit during treatment. RESULTS At final analysis, with 52 mo follow-up for survival, the median treatment duration was 32.9 mo for apalutamide and 11.5 mo for placebo. Patients had good baseline HRQoL. At each scheduled collection during treatment, >90% per group completed the questionnaires. The change in FACT-P total score from baseline to cycles 21 and 25 significantly favored apalutamide over placebo (p = 0.0138 and 0.0009, respectively). The apalutamide group generally maintained favorable FACT-P (total and subscales) and EQ-5D-3L scores, while placebo scores tended to decline over time (starting in cycles 11-13 and pronounced by cycles 21-25). Notably, patient-reported fatigue did not worsen with apalutamide. Most patients reported being "not at all bothered" by side effects, and bother did not increase over time with apalutamide or placebo. Patients receiving apalutamide had minimal change in side-effect bother following symptomatic adverse events. CONCLUSIONS Final analysis of SPARTAN confirms that HRQoL is preserved in patients with nmCRPC receiving apalutamide plus ADT, but declines in patients receiving placebo plus ADT after approximately 1 yr. PATIENT SUMMARY Responses from patients with prostate cancer who were included in the SPARTAN study indicated that treatment with apalutamide, even after the most extensive follow-up time possible, did not reduce their quality of life. These results, along with improved survival and longer time to the development of metastases (reported separately), confirm the benefits of apalutamide for patients with nonmetastatic castration-resistant prostate cancer.
Collapse
|
45
|
Xiong K, Wang G, Peng T, Zhou F, Chen S, Liu W, Ju L, Xiao Y, Qian K, Wang X. The cholesterol esterification inhibitor avasimibe suppresses tumour proliferation and metastasis via the E2F-1 signalling pathway in prostate cancer. Cancer Cell Int 2021; 21:461. [PMID: 34461908 PMCID: PMC8407011 DOI: 10.1186/s12935-021-02175-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/24/2021] [Indexed: 02/08/2023] Open
Abstract
Background New effective drugs for prostate cancer (PCa) treatment are urgently needed. Avasimibe was recently identified as a promising drug for anticancer therapies. The main purpose of this study was to explore the effects and the underlying mechanisms of avasimibe in prostate cancer. Methods In this study, MTT and clonogenic survival assays were performed to detect cell proliferation after avasimibe treatment. The effect of avasimibe on cell migration was measured by wound healing and transwell migration assays. Cell cycle distribution and apoptosis were detected by flow cytometry. Immunofluorescence staining and western blot analysis were used to detect the expression of cell cycle-related proteins and epithelial-mesenchymal transition (EMT)-related proteins. In vivo, the antitumour effects of avasimibe were evaluated using a xenograft model and pulmonary metastasis model. Results The study found that avasimibe suppresses tumour growth and triggers G1 phase arrest. Moreover, the expression of the cell cycle-related proteins CDK2/4/6, Cyclin D1 and Cyclin A1 + A2 was significantly increased and p21 expression was decreased after avasimibe treatment. The migration of PCa cells was attenuated after treatment with avasimibe, followed by the downregulation of the expression of the EMT-related proteins N-cadherin, β-catenin, vimentin, Snail and MMP9 and upregulation of E-cadherin expression. Moreover, E2F-1 was elevated after treatment with avasimibe. After knockdown of E2F-1 expression, the inhibition of cell proliferation and migration caused by avasimibe was significantly recovered. The results of the xenograft model showed that avasimibe suppressed tumour growth in vivo. Immunofluorescence staining revealed lower levels of Ki67 and higher levels of E2F-1 in tumour tissues of the avasimibe group than those of the control group. A pulmonary metastasis model also confirmed the inhibition of PCa metastasis by avasimibe. The number of lung metastatic foci in the avasimibe group was significantly decreased compared with that in the control group. Conclusions Our results suggest that avasimibe can suppress tumour proliferation and metastasis via the E2F-1 signalling pathway. These findings demonstrate the potential of avasimibe as a new effective drug for PCa treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12935-021-02175-5.
Collapse
Affiliation(s)
- Kangping Xiong
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Gang Wang
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China.,Human Genetic Resource Preservation Center of Hubei Province, Wuhan, China.,Human Genetic Resource Preservation Center of Wuhan University, Wuhan, China.,Laboratory of Precision Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
| | - Tianchen Peng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fenfang Zhou
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Siming Chen
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lingao Ju
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China.,Human Genetic Resource Preservation Center of Hubei Province, Wuhan, China.,Human Genetic Resource Preservation Center of Wuhan University, Wuhan, China.,Laboratory of Precision Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
| | - Yu Xiao
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China.,Human Genetic Resource Preservation Center of Hubei Province, Wuhan, China.,Human Genetic Resource Preservation Center of Wuhan University, Wuhan, China.,Laboratory of Precision Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
| | - Kaiyu Qian
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China. .,Human Genetic Resource Preservation Center of Hubei Province, Wuhan, China. .,Human Genetic Resource Preservation Center of Wuhan University, Wuhan, China. .,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China.
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China. .,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China. .,Medical Research Institute, Wuhan University, Wuhan, China.
| |
Collapse
|
46
|
Singh R, Alsayadi YMMA, Singh V, Chawla P, Rawal RK. Prospects of Treating Prostate Cancer through Apalutamide: A Mini-Review. Anticancer Agents Med Chem 2021; 22:1056-1067. [PMID: 34431470 DOI: 10.2174/1871520621666210824113736] [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: 02/10/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prostate cancer is considered the second most diagnosed cancer, and one of the most common causes of death from cancer in men. Apalutamide is an effective, safe, and well-tolerated agent used for the treatment of men with non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic hormone-naive prostate cancer (mHNPC). Androgen receptor signaling is a leading factor that drives these prostate tumors. USFDA has approved apalutamide on 14 February 2018 as an agent that targets androgen receptor signaling through inhibition causing significant improvement in metastasis-free survival in patients with prostate cancer. <P> Objective: In this review, various aspects related to apalutamide have been summarized which involve the mechanism of action, chemistry, synthesis, pharmacokinetics, pharmacodynamics, adverse reactions, and safety parameters. <P> Methods: The literature was thoroughly searched in the relevant databases to identify studies published in this field during recent years. Special attention has been given to apalutamide clinical trials phases and its promising future as one of the first-line agents for the treatment of patients with advanced prostate cancer. <P> Results: Ongoing trials are progressing for apalutamide monotherapy and also for its combinations in other disease settings. The expected results of such trials will shape the future scenario of prostate cancer therapy. <P> Conclusion: This review article has highlighted different aspects of Apalutamide like its mechanism of action, adverse effects, pharmacokinetics, pharmacodynamics, clinical trials among others. The contents of this article should make an excellent read for prospective researchers in this field.
Collapse
Affiliation(s)
- Ranapartap Singh
- Department of Pharmaceutical Chemistry & Analysis, ISF College of Pharmacy, GT Road, Moga-142001, Punjab. India
| | - Yunes M M A Alsayadi
- Department of Pharmaceutical Chemistry & Analysis, ISF College of Pharmacy, GT Road, Moga-142001, Punjab. India
| | - VikramJeet Singh
- Department of Pharmaceutical Chemistry & Analysis, ISF College of Pharmacy, GT Road, Moga-142001, Punjab. India
| | - Pooja Chawla
- Department of Pharmaceutical Chemistry & Analysis, ISF College of Pharmacy, GT Road, Moga-142001, Punjab. India
| | - Ravindra Kumar Rawal
- Department of Chemistry, Maharishi Markandeshwar (Deemed to be University), Mullana-133207, Haryana. India
| |
Collapse
|
47
|
Westaby D, Maza MDLDFDL, Paschalis A, Jimenez-Vacas JM, Welti J, de Bono J, Sharp A. A New Old Target: Androgen Receptor Signaling and Advanced Prostate Cancer. Annu Rev Pharmacol Toxicol 2021; 62:131-153. [PMID: 34449248 DOI: 10.1146/annurev-pharmtox-052220-015912] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Owing to the development of multiple novel therapies, there has been major progress in the treatment of advanced prostate cancer over the last two decades; however, the disease remains invariably fatal. Androgens and the androgen receptor (AR) play a critical role in prostate carcinogenesis, and targeting the AR signaling axis with abiraterone, enzalutamide, darolutamide, and apalutamide has improved outcomes for men with this lethal disease. Targeting the AR and elucidating mechanisms of resistance to these agents remains central to drug development efforts. This review provides an overview of the evolution and current approaches for targeting the AR in advanced prostate cancer. It describes the biology of AR signaling, explores AR-targeting resistance mechanisms, and discusses future perspectives and promising novel therapeutic strategies. Expected final online publication date for the Annual Review of Pharmacology and Toxicology, Volume 62 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Collapse
Affiliation(s)
- Daniel Westaby
- The Institute of Cancer Research, London SM2 5NG, United Kingdom; .,The Royal Marsden Hospital, London SM2 5PT, United Kingdom
| | | | - Alec Paschalis
- The Institute of Cancer Research, London SM2 5NG, United Kingdom; .,The Royal Marsden Hospital, London SM2 5PT, United Kingdom
| | | | - Jon Welti
- The Institute of Cancer Research, London SM2 5NG, United Kingdom;
| | - Johann de Bono
- The Institute of Cancer Research, London SM2 5NG, United Kingdom; .,The Royal Marsden Hospital, London SM2 5PT, United Kingdom
| | - Adam Sharp
- The Institute of Cancer Research, London SM2 5NG, United Kingdom; .,The Royal Marsden Hospital, London SM2 5PT, United Kingdom
| |
Collapse
|
48
|
Rizzo A, Merler S, Sorgentoni G, Oderda M, Mollica V, Gadaleta-Caldarola G, Santoni M, Massari F. Risk of cardiovascular toxicities and hypertension in nonmetastatic castration-resistant prostate cancer patients treated with novel hormonal agents: a systematic review and meta-analysis. Expert Opin Drug Metab Toxicol 2021; 17:1237-1243. [PMID: 34407702 DOI: 10.1080/17425255.2021.1970745] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: With hormonal agents quickly expanding as novel therapeutic options in nonmetastatic castration-resistant prostate cancer (nmCRPC), the toxicity profile of enzalutamide, apalutamide, and darolutamide should be kept in mind.Methods: We performed an updated meta-analysis with the aim to analyze the risk of treatment-related cardiovascular (CV) events, any grade, and grade 3-4 (G3-4) hypertension in nmCRPC patients treated with enzalutamide, apalutamide, and darolutamide plus androgen deprivation therapy (ADT) versus ADT plus placebo in randomized controlled trials (RCTs). Results were compared by calculating Relative Risk (RR) with 95% confidence intervals (CIs); RRs were combined with Mantel-Haenszel method.Results: Three RCTs involving 4110 patients were available for the meta-analysis. According to our results, the addition of novel hormonal agents was associated with a significantly increased risk of CV events (RR = 1.71; 95% CI 1.29-2.27) and G3-4 hypertension (RR = 1.53; 95% CI 1.19-1.97). In addition, a trend toward a higher risk of any grade hypertension was reported in the experimental arm.Conclusions: The use of enzalutamide, apalutamide, and darolutamide in nmCRPC patients implies a careful benefit-risk assessment. Real-world, large-cohort studies are warranted to confirm the findings of our meta-analysis.
Collapse
Affiliation(s)
- Alessandro Rizzo
- Medical Oncology, Irccs Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italia.,Medical Oncology Unit, "Mons. R. Dimiccoli" Hospital, Barletta (BT), ASL BT, Italy
| | - Sara Merler
- U.o.c. Oncology, Azienda Ospedaliera Universitaria IntegrataUniversity and Hospital Trust of Verona, Verona, Italy
| | | | - Marco Oderda
- Department of Urology, San Giovanni Battista Hospital, Città Della Salute E Della Scienza, University of Turin, Turin, Italy
| | - Veronica Mollica
- Medical Oncology, Irccs Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italia
| | | | | | - Francesco Massari
- Medical Oncology, Irccs Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italia
| |
Collapse
|
49
|
Mori K, Quhal F, Katayama S, Mostafaei H, Laukhtina E, Schuettfort VM, Sari Motlagh R, Grossmann NC, Rajwa P, Ploussard G, Briganti A, Kimura T, Egawa S, Papalia R, Carrion DM, Fiori C, Shariat SF, Esperto F, Pradere B. Androgen receptor axis-targeted agents for non-metastatic castration-resistant prostate cancer impact on overall survival and safety profile: an updated systematic review and meta-analysis. Minerva Urol Nephrol 2021; 74:292-301. [PMID: 34308608 DOI: 10.23736/s2724-6051.21.04431-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The management of non-metastatic castration-resistant prostate cancer (nmCRPC) has undergone a paradigm shift with the development of androgen receptor axis-targeted (ARAT) agents. The updated results with final overall survival (OS) data of the phase III PROSPER, SPARTAN, and ARAMIS trials have recently been reported. Therefore, we performed an updated meta-analysis and network meta-analysis to indirectly compare the efficacy and safety of currently available treatments. EVIDENCE ACQUISITION Multiple databases were searched for articles published before January 2021. Studies that compared OS and adverse events (AEs) in patients with nmCRPC were considered eligible. EVIDENCE SYNTHESIS Three studies (n=4,117) met our eligibility criteria. Formal network meta-analyses were conducted. ARAT agent is associated with significantly longer OS compared to placebo (pooled hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.65-0.83, P<0.001), with similar results shown for patients with both N1 and N0 disease (pooled HR 0.61 and pooled HR 0.76, respectively). In the network meta-analysis, apalutamide, darolutamide, and enzalutamide were more effective than placebo, with similar efficacies in terms of OS. For AEs (including any AEs, grade 3 or grade 4 AEs, grade 5 AEs, serious AEs, and AEs leading to treatment discontinuation), darolutamide was shown to be likely well tolerated. Quality-of-life was preserved in treatment arms irrespective of the drug. CONCLUSIONS All three ARAT agents are efficacious options for the treatment of nmCRPC, whereas darolutamide appears to have the most favorable tolerability profile. These findings may facilitate individualized treatment strategies and inform future direct comparative trials.
Collapse
Affiliation(s)
- Keiichiro Mori
- Department of Urology, Medical University of Vienna, Vienna, Austria - .,Department of Urology, The Jikei University School of Medicine, Tokyo, Japan -
| | - Fahad Quhal
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Satoshi Katayama
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hadi Mostafaei
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ekaterina Laukhtina
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Victor M Schuettfort
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reza Sari Motlagh
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nico C Grossmann
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Pawel Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Medical University of Silesia, Zabrze, Poland
| | | | - Alberto Briganti
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Diego M Carrion
- Department of Urology, La Paz University Hospital, Madrid, Spain.,European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Hospital, School of Medicine, University of Turin, Orbassano, Turin, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy.,European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
50
|
Yu A, Erba M, Hazra A. Pharmacokinetics and Use-Testing of Apalutamide Prepared in Aqueous Food Vehicles for Alternative Administration. Clin Pharmacol Drug Dev 2021; 10:1375-1384. [PMID: 34273257 PMCID: PMC8596416 DOI: 10.1002/cpdd.1001] [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: 02/22/2021] [Accepted: 06/21/2021] [Indexed: 11/09/2022]
Abstract
Patients may have difficulty swallowing a whole daily dose of 240 mg (4 × 60-mg tablets) of apalutamide. One of the unique properties of apalutamide tablets is easy disintegration and dispersion when mixed into aqueous vehicles, avoiding the need to crush/split the tablets. To evaluate whether this method of apalutamide tablet administration would be conducive in a patient setting, different variations in preparation were evaluated, and one preparation was tested in humans. In vitro compatibility studies evaluated purity, dose, or stability of different variations of apalutamide in applesauce/yogurt/orange juice/green tea. An open-label, randomized, crossover phase 1 study in healthy men determined the bioavailability of an apalutamide-applesauce mixture versus whole tablets based on maximum plasma analyte concentration (Cmax ), area under the plasma analyte concentration-time curve: AUC0-72h and AUC0-168h . Different amounts of applesauce/yogurt/orange juice/green tea as well as durations (up to 6 hours) did not affect the total apalutamide content available. The phase 1 study (n = 12) showed increased total exposure of 5% and peak exposure of 27.6% when comparing the apalutamide-applesauce mixture with whole-tablet administration. Variations in preparation times and total content for applesauce/yogurt/orange juice/green tea did not affect the purity, dose, or stability of apalutamide. An apalutamide-applesauce mixture is a suitable alternative administration method to whole tablets.
Collapse
Affiliation(s)
- Alex Yu
- Clinical Pharmacology & Pharmacometrics, Janssen Research & Development, Spring House, Pennsylvania, USA
| | - Maura Erba
- CMC Leadership SMPD, Janssen Research & Development, Latina, Italy
| | - Anasuya Hazra
- Clinical Pharmacology & Pharmacometrics, Janssen Research & Development, Spring House, Pennsylvania, USA
| |
Collapse
|