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Armstrong AJ, Sartor O, de Bono J, Chi K, Fizazi K, Krause BJ, Herrmann K, Rahbar K, Tagawa ST, Saad F, Beer TM, Wu J, Mirante O, Morris MJ. Association of Declining Prostate-specific Antigen Levels with Clinical Outcomes in Patients with Metastatic Castration-resistant Prostate Cancer Receiving [ 177Lu]Lu-PSMA-617 in the Phase 3 VISION Trial. Eur Urol 2024:S0302-2838(24)02560-0. [PMID: 39242323 DOI: 10.1016/j.eururo.2024.08.021] [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: 02/13/2024] [Revised: 07/11/2024] [Accepted: 08/10/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND AND OBJECTIVE The prognostic value of declining prostate-specific antigen (PSA) levels is under investigation in patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) receiving PSMA-targeted radioligand therapy with [177Lu]Lu-PSMA-617 (177Lu-PSMA-617). This post hoc analysis of the phase 3 VISION trial aimed to evaluate associations between PSA decline and clinical and patient-reported outcomes in patients receiving 177Lu-PSMA-617. METHODS Of 831 enrolled patients with PSMA-positive progressive mCRPC treated previously with one or more androgen receptor pathway inhibitors and one to two taxanes, 551 were randomised to 177Lu-PSMA-617 plus protocol-permitted standard of care (SoC). Radiographic progression-free survival, overall survival, radiographic objective response rate, and patient-reported health-related quality of life (HRQoL) and pain were analysed in subgroups of patients categorised by the magnitude of unconfirmed PSA decline from baseline. KEY FINDINGS AND LIMITATIONS Patients randomised to 177Lu-PSMA-617 with the best PSA declines of ≥0-<50% (96/551 [17%]), ≥50-<90% (152/551 [28%]), and ≥90% (83/551 [15%]) up to and including week 12 had 61%, 72%, and 88% reduced risks of radiographic disease progression or death, and 51%, 70%, and 87% reduced risks of death, respectively, versus those with increased PSA levels (160/551 [29%]), based on hazard ratios in a multivariate Cox proportional hazard model. In patients with greater PSA declines, radiographic responses were more frequent and median time to worsening in HRQoL and pain scores were longer. CONCLUSIONS AND CLINICAL IMPLICATIONS The magnitude of PSA decline was associated with improvement in clinical and patient-reported outcomes in patients with mCRPC receiving 177Lu-PSMA-617 plus SoC in VISION. PSA decline therefore appears to have a prognostic value during 177Lu-PSMA-617 treatment in this population.
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Affiliation(s)
- Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Departments of Medicine, Surgery, Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
| | - Oliver Sartor
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Johann de Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, UK
| | - Kim Chi
- Division of Medical Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Karim Fizazi
- Cancer Medicine Department, Gustave Roussy Institute, University of Paris Saclay, Villejuif, France
| | - Bernd J Krause
- Department of Nuclear Medicine, Rostock University Medical Center, Rostock, Germany
| | - Ken Herrmann
- Clinic for Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Scott T Tagawa
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Fred Saad
- Urology Department, University of Montreal Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Tomasz M Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Jiwen Wu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Osvaldo Mirante
- Advanced Accelerator Applications, a Novartis company, Geneva, Switzerland
| | - Michael J Morris
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Luo L, Wang Z, Wang X, Gao J, Zheng A, Duan X. Fluorine-18 prostate-specific membrane antigen-1007-avid indeterminate bone lesions in prostate cancer: clinical and PET/CT features to predict outcomes and prognosis. Clin Radiol 2024; 79:346-353. [PMID: 38216370 DOI: 10.1016/j.crad.2023.12.008] [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: 09/05/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 01/14/2024]
Abstract
AIM To determine clinical and fluorine-18 prostate-specific membrane antigen-1007 (18F-PSMA-1007) integrated positron-emission tomography (PET)/computed tomography (CT) features that could be used to interpret indeterminate bone lesions (IBLs) and assess the prognosis of prostate cancer (PCa) in patients with IBLs. MATERIALS AND METHODS Consecutive patients who underwent PSMA PET/CT were analysed retrospectively. IBLs were identified as benign or malignant based on follow-up imaging and clinical management. Lesion- and patient-based assessments were performed to define features predictive of bone lesion results and determine clinical risk. Patients' prognosis was analysed based on clinical characteristics, including prostate-specific antigen (PSA) and alkaline phosphatase (ALP), respectively. RESULTS A total of 105 patients (mean age ± SD, 72.1 ± 8 years) were evaluated and 158 IBLs were identified. Fifty-three (33.5%), 36 (22.8%), and 69 (43.7%) IBLs were benign, malignant, and equivocal, respectively. Variables including location, maximum standard uptake value (SUVmax), and lymph node metastases (LNM) were related to the benignancy or malignancy of IBLs (p=0.046, p<0.001 and p<0.001, respectively). Regression analysis indicated that LNM, SUVmax, and location of IBLs could be predictors of lesion interpretation (p<0.001, p=0.002 and p=0.035). Patients with benign IBLs experienced the most considerable decreases in PSA and ALP levels. CONCLUSIONS LNM, SUVmax, and location may contribute to IBL interpretation. A rapid decrease in PSA and ALP levels might suggest a better prognosis for patients with benign IBLs.
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Affiliation(s)
- L Luo
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Z Wang
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - X Wang
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - J Gao
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - A Zheng
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - X Duan
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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3
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Sidhu A, Khan N, Phillips C, Briones J, Kapoor A, Zalewski P, Fleshner NE, Chow E, Emmenegger U. Prevalence and Prognostic Implications of PSA Flares during Radium-223 Treatment among Men with Metastatic Castration Resistant Prostate Cancer. J Clin Med 2023; 12:5604. [PMID: 37685670 PMCID: PMC10488545 DOI: 10.3390/jcm12175604] [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: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Radium-223 (Ra233) prolongs the survival of men with symptomatic bone-predominant metastatic castration-resistant prostate cancer (mCRPC). However, prostate-specific antigen (PSA) response patterns are not closely associated with Ra223 therapy outcomes. Herein, we sought to analyze the impact of Ra223-induced PSA flares on patient outcome. Using a retrospective cohort study of Ra223 treatment in four Ontario/Canada cancer centres, we identified 134 patients grouped into sub-cohorts according to distinct PSA response patterns: (i) initial PSA flare followed by eventual PSA decline; (ii) PSA response (≥30% PSA decrease within 12 weeks of treatment); and (iii) PSA non-response. We analyzed patient characteristics and outcome measures, including overall survival (OS), using the Kaplan-Meier method and log-rank testing. PSA flares were observed in 27 (20.2%), PSA responses in 11 (8.2%), and PSA non-responses in 96 (71.6%) patients. Amongst PSA flare patients, 12 presented with post-flare PSA decreases below baseline and 15 with PSA decreases below the flare peak but above baseline. Although only six flare patients achieved ≥30% PSA decreases below baseline, the median OS of all flare patients (16.8 months, 95% CI 14.9-18.7) was comparable to that of PSA responders and non-responders (p = 0.349). In summary, around 20% of mCRPC patients experience Ra223-induced PSA flares, whose outcome is similar to that of men with or without PSA responses. Further studies are needed regarding suitable biochemical surrogate markers of response to Ra223.
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Affiliation(s)
- Amanjot Sidhu
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada; (A.S.); (N.K.); (C.P.); (J.B.); (E.C.)
| | - Nabeeha Khan
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada; (A.S.); (N.K.); (C.P.); (J.B.); (E.C.)
| | - Cameron Phillips
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada; (A.S.); (N.K.); (C.P.); (J.B.); (E.C.)
| | - Juan Briones
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada; (A.S.); (N.K.); (C.P.); (J.B.); (E.C.)
| | - Anil Kapoor
- Juravinski Cancer Centre, Hamilton, ON L8V 5C2, Canada;
| | - Pawel Zalewski
- Durham Regional Cancer Centre, Oshawa, ON L1G 2B9, Canada;
| | | | - Edward Chow
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada; (A.S.); (N.K.); (C.P.); (J.B.); (E.C.)
| | - Urban Emmenegger
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada; (A.S.); (N.K.); (C.P.); (J.B.); (E.C.)
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4
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Gharzai LA, Jiang R, Jaworski EM, Morales Rivera K, Dess RT, Jackson WC, Hartman HE, Mehra R, Kishan AU, Solanki AA, Schaeffer EM, Feng FY, Zaorsky NG, Berlin A, Ponsky L, Shoag J, Sun Y, Schipper MJ, Garcia J, Spratt DE. Meta-Analysis of Candidate Surrogate End Points in Advanced Prostate Cancer. NEJM EVIDENCE 2023; 2:EVIDoa2200195. [PMID: 38320030 DOI: 10.1056/evidoa2200195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND: The Intermediate Clinical Endpoints in Cancer of the Prostate (ICECaP) working group identified metastasis-free survival as a valid surrogate end point for overall survival (OS) for patients with localized prostate cancer. No comparably validated surrogate end points exist in advanced prostate cancer. METHODS: We searched for trials in advanced prostate cancer, defined as node-positive, metastatic castration-sensitive, nonmetastatic, or metastatic castration-resistant prostate cancer. Eligible randomized trials reported OS and one or more intermediate clinical end points, including biochemical failure (BF), clinical failure, biochemical failure–free survival (BFS), progression-free survival (PFS), and radiographic PFS. Candidacy for surrogacy was assessed by using the second condition of the meta-analytic approach; R2 was weighted by the inverse variance of the log intermediate clinical end point hazard ratio and defined as R2>0.70. RESULTS: A total of 143 randomized trials (n=75,601 patients) were included. No candidate end points met the criteria for surrogacy (R2 BF [n=28,922], 0.42 [95% confidence interval (CI), 0.18 to 0.64]; BFS [n=25,741], 0.57 [95% CI, 0.37 to 0.73]; clinical failure [n=22,616], 0.31 [95% CI, 0.075 to 0.56]; PFS [n=52,639], 0.50 [95% CI, 0.35 to 0.63]; and radiographic PFS [n=52,548], 0.50 [95% CI, 0.35 to 0.63]). Within preplanned subgroups according to castration-sensitive or castration-resistant disease or according to treatment type, neither BFS nor PFS consistently met criteria for surrogacy. Sensitivity analyses showed that candidacy for surrogacy of all end points tested did not change over time. CONCLUSIONS: Our aggregate screening method for surrogate end points in advanced prostate cancer showed that commonly used clinical end points are not clear valid surrogate end points for OS. (Funded by the Prostate Cancer Foundation and the National Cancer Institute.)
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Affiliation(s)
- Laila A Gharzai
- Department of Radiation Oncology, Northwestern University, Chicago
| | - Ralph Jiang
- Department of Biostatistics, University of Michigan, Ann Arbor
| | | | | | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | | | - Holly E Hartman
- Department of Population and Quantitative Health Sciences, Case Western Reserve, Cleveland, OH
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles
| | - Abhishek A Solanki
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | | | - Felix Y Feng
- Department of Radiation Oncology, University of California, San Francisco, San Francisco
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve, Cleveland, OH
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - Lee Ponsky
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve, Cleveland, OH
| | - Jonathan Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve, Cleveland, OH
| | - Yilun Sun
- Department of Population and Quantitative Health Sciences, Case Western Reserve, Cleveland, OH
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Jorge Garcia
- Department of Medicine, University Hospitals Seidman Cancer Center, Case Western Reserve, Cleveland, OH
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve, Cleveland, OH
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5
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Sardinha M, Palma Dos Reis AF, Barreira JV, Fontes Sousa M, Pacey S, Luz R. Antibody-Drug Conjugates in Prostate Cancer: A Systematic Review. Cureus 2023; 15:e34490. [PMID: 36874351 PMCID: PMC9983052 DOI: 10.7759/cureus.34490] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
The prognosis in the setting of metastatic castration-resistant prostate cancer patients (mCRPC) remains limited. Therefore, novel treatment strategies remain an unmet need. Antibody-drug conjugates (ADC) emerged as a new drug concept with the potential to deliver a cytotoxic payload with limited off-target toxicity and potentially bystander effect. Following the success of ADCs in breast cancer and urothelial tumours, their activity in prostate cancer is now under investigation. Thus, the aim of this systematic review was to identify published and ongoing prospective clinical trials regarding ADC treatment in prostate cancer. A systematic search of PubMed, MEDLINE, and Web of Science was conducted as per PRISMA guidelines to identify prospective clinical trials of ADCin prostate cancer. Trials are currently ongoing on ClinicalTrials.gov and in the EU. The Clinical Trials Register was also identified. Abstracts, publications in languages other than English, review articles, retrospective analyses, and phase I trials were excluded. A total of six phase I/II prospective clinical trials already published were included. Seven ongoing trials were also identified. All studies were in the refractory/advanced tumour setting, and two included only mCRPC patients. The ADC targets were prostate-specific membrane antigen (PSMA), trophoblast cell surface antigen-2 (TROP-2), six-transmembrane epithelial antigen of prostate-1 (STEAP-1), tissue factor (TF), delta-like protein 3 (DLL-3), B7-H3 family of proteins (B7-H3), and human epidermal growth factor receptor 2 (HER2). Regarding the efficacy of PSMA ADC treatment in the second-line or beyond mCRPC setting, a PSA ≥ 50% decline rate in 14% of all treated patients was reported. One patient achieved a complete response with TROP-2 ADC. Overall, a wide range of safety issues were raised, particularly in connection with neuropathy and hematologic toxicity. Novel therapies have been changing the scope of treatment in mCRPC. ADCs seem to provide efficacy benefits, even with potential toxicity. The results of most prospective ongoing studies are still awaited, and a longer follow-up time is warranted to evaluate the real impact of ADCs in PCa.
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Affiliation(s)
- Mariana Sardinha
- Medical Oncology, Centro Hospitalar Universitário Central Lisboa, Lisbon, PRT
| | - Ana Filipa Palma Dos Reis
- Medical Oncology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, GBR
| | - João Vasco Barreira
- Medical Oncology, Hospital dos Serviços de Assistência Médico-Social, Lisbon, PRT
| | | | - Simon Pacey
- Medical Oncology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, GBR
| | - Ricardo Luz
- Medical Oncology, Centro Hospitalar Universitário Central Lisboa, Lisbon, PRT
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6
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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.
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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
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7
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Mahler M, Al-Ezzi E, Shrem NS, Zhang L, Winquist E, Canil C, Ong M, Hansen AR, Emmenegger U. UnCHAARTED territory: The role of docetaxel rechallenge following chemohormonal therapy for metastatic castration-sensitive prostate cancer. Urol Oncol 2022; 40:539.e17-539.e22. [PMID: 36272847 DOI: 10.1016/j.urolonc.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the effectiveness of docetaxel rechallenge (DR) for metastatic castration-resistant prostate cancer (mCRPC) following chemohormonal therapy for metastatic castrate-sensitive prostate cancer (mCSPC). Additionally, we sought to define clinical factors predicting treatment response. PATIENTS AND METHODS Retrospective analysis of men treated with docetaxel for mCSPC and then rechallenged in the mCRPC setting from four cancer centers in Ontario, Canada. Prostate specific antigen (PSA) response, progression-free survival (PFS), and overall survival (OS) following DR were evaluated. RESULTS Fifty five patients were identified between 2015 and 2020. Prior to DR, 94.5% of patients received androgen-receptor axis targeted therapy, 20% received radium-223, and 1.8% received cabazitaxel. Among 54 evaluable patients, 27.8% had a PSA decline ≥50%. Median PFS was 4.1 months (95% CI, 2.1-4.8) and median OS from androgen deprivation therapy initiation was 38.3 months (95% CI, 32.9-41.0). A Gleason Score of ≥8 was an independent predictor of prolonged PFS (HR 0.32, 95% CI, 0.12-0.81; P=0.02). CONCLUSIONS DR following chemohormonal therapy for mCSPC produced a meaningful PSA response in approximately one-quarter of patients, with relatively short PFS. The impact of Gleason Score on docetaxel response warrants further investigation.
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Affiliation(s)
- Mary Mahler
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Esmail Al-Ezzi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Noa Shani Shrem
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Liying Zhang
- Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric Winquist
- Department of Oncology, University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada
| | - Christina Canil
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Michael Ong
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Aaron R Hansen
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Division of Medical Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Urban Emmenegger
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
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8
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Price MJ, Vashistha V, Winski D, Kelley MJ, Bitting RL, Montgomery B. Homologous Recombination Repair Gene Variants and Outcomes Among Patients With Prostate Cancer Treated With Poly (ADP-ribose) Polymerase Inhibitors. JCO Precis Oncol 2022; 6:e2100461. [PMID: 35476551 PMCID: PMC9848572 DOI: 10.1200/po.21.00461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Poly ADP-ribose polymerase inhibitors (PARPi) are used for patients with advanced prostate cancer bearing alterations in homologous recombination repair (HRR) genes. We sought to characterize HRR gene variants and describe real-world outcomes for patients on PARPi. METHODS The US Department of Veterans Affairs' National Precision Oncology Program's database was reviewed to identify patients who underwent somatic DNA sequencing and were prescribed a PARPi before May 15, 2020. Somatic and germline variants within HRR genes were reported, and pathogenicity was reviewed via OncoKB. In patients treated with PARPi for > 4 weeks, the rate of those achieving a 30% decrease in prostate-specific antigen (PSA30) and composite progression-free survival (PFS) were compared between patients bearing pathogenic variants of BRCA2 and patients without these variants using Mann-Whitney and log-rank tests, respectively. RESULTS Forty-eight patients bearing 67 total HRR gene variants were prescribed PARPi for prostate cancer. Twenty-one patients (43.8%) were found to have at least one pathogenic HRR gene variant. Eight (16.6%) were referred to genetic counseling, and five (10.4%) were ultimately confirmed with germline variants. The median PFS was 4.0 months, and PSA30 was 25.6% (11 of 43) for all 43 evaluable patients. Patients with pathogenic BRCA2 variants (n = 13) had higher PSA30 (69.2% v 4.0%; P < .001) and longer PFS (7.2 v 2.8 months; P = .0291) than those without. CONCLUSION In a real-world setting, heavily pretreated patients with prostate cancer and pathogenic BRCA2 variants have a significant PSA response rate and a PFS > 7 months with PARPi. This work emphasizes the importance of determining pathogenicity and origin of HRR alterations to better inform clinical treatment decisions and highlights the need for provider education and other decision support tools.
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Affiliation(s)
- Meghan J. Price
- Department of Medicine, Duke University Health System, Durham, NC,Division of Hematology-Oncology, Durham Veterans Affairs Medical Center, Durham, NC
| | - Vishal Vashistha
- Raymond G. Murphy New Mexico Veterans Affairs Medical Center, Section of Hematology/Oncology, Albuquerque, NM,Vishal Vashistha, MD, Raymond G. Murphy New Mexico Veterans Affairs Medical Center, Section of Hematology/Oncology, 1501 San Pedro Dr SE, 6th Floor, Albuquerque, NM 87108; e-mail:
| | - David Winski
- National Oncology Program Office, Department of Veterans Affairs, Durham, NC,Veterans Affairs Boston Healthcare System, Jamaica Plain Campus, Boston, MA
| | - Michael J. Kelley
- Department of Medicine, Duke University Health System, Durham, NC,Division of Hematology-Oncology, Durham Veterans Affairs Medical Center, Durham, NC,National Oncology Program Office, Department of Veterans Affairs, Durham, NC,Duke University Health System, Divisions of Medical Oncology, Hematology and Cell Therapeutics, Durham, NC
| | - Rhonda L. Bitting
- Department of Medicine, Duke University Health System, Durham, NC,Division of Hematology-Oncology, Durham Veterans Affairs Medical Center, Durham, NC
| | - Bruce Montgomery
- Veterans Affairs Puget Sound Health Care System, Division of Hematology-Oncology, Seattle, WA,Department of Medicine, University of Washington, Seattle, WA
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9
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Grayling MJ, McMenamin M, Chandler R, Heer R, Wason JMS. Improving power in PSA response analyses of metastatic castration-resistant prostate cancer trials. BMC Cancer 2022; 22:111. [PMID: 35081926 PMCID: PMC8793251 DOI: 10.1186/s12885-022-09227-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/24/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To determine how much an augmented analysis approach could improve the efficiency of prostate-specific antigen (PSA) response analyses in clinical practice. PSA response rates are commonly used outcome measures in metastatic castration-resistant prostate cancer (mCRPC) trial reports. PSA response is evaluated by comparing continuous PSA data (e.g., change from baseline) to a threshold (e.g., 50% reduction). Consequently, information in the continuous data is discarded. Recent papers have proposed an augmented approach that retains the conventional response rate, but employs the continuous data to improve precision of estimation. METHODS A literature review identified published prostate cancer trials that included a waterfall plot of continuous PSA data. This continuous data was extracted to enable the conventional and augmented approaches to be compared. RESULTS Sixty-four articles, reporting results for 78 mCRPC treatment arms, were re-analysed. The median efficiency gain from using the augmented analysis, in terms of the implied increase to the sample size of the original study, was 103.2% (IQR [89.8,190.9%]). CONCLUSIONS Augmented PSA response analysis requires no additional data to be collected and can be performed easily using available software. It improves precision of estimation to a degree that is equivalent to a substantial sample size increase. The implication of this work is that prostate cancer trials using PSA response as a primary endpoint could be delivered with fewer participants and, therefore, more rapidly with reduced cost.
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Affiliation(s)
- Michael J. Grayling
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Martina McMenamin
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region China
| | | | - Rakesh Heer
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - James M. S. Wason
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
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Early PSA Change after [ 177Lu]PSMA-617 Radioligand Therapy as a Predicator of Biochemical Response and Overall Survival. Cancers (Basel) 2021; 14:cancers14010149. [PMID: 35008315 PMCID: PMC8750166 DOI: 10.3390/cancers14010149] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Radioligand therapy with [177Lu]PSMA-617 (PSMA-RLT) is a promising therapeutic option for metastatic castration-resistant prostate cancers (mCRPC), as its clinical relevance has recently been confirmed in the phase III VISION-trial. As prostate-specific antigen (PSA) plays an important role in the response evaluation of this therapy, and the aim of this study was to prospectively assess the prognostic value of early PSA measurements. We found PSA changes as early as four weeks after the first administration of PSMA-RLT to be predictive of both long-term biochemical and PET imaging response, as well as overall survival. We then evaluated relevant predictive thresholds in PSA change at that time point, as the early detection of long-term (non-)response to PSMA-RLT can be of great benefit in the clinical management of terminally ill mCRPC-patients. Abstract Purpose: Radioligand therapy with [177Lu]PSMA-617 (PSMA-RLT) is a promising therapeutic option for metastatic castration-resistant prostate cancer (mCPRP). This study assessed the prognostic value of early PSA measurements during PSMA-RLT. Methods: 27 patients with mCRPC scheduled for PSMA-RLT were prospectively enrolled for a serial short-interval PSA-assessment. Change in PSA (∆%PSA) during two treatment cycles was correlated with biochemical response (BR) and change in tumor volume on PET (TV) after 16 weeks (w16), as well as overall survival (OS). PCWG3 criteria and the recently recommended threshold of ∆%PSA ≤ −30% were assessed for their predictive value. Results: ∆%PSA first correlated with BR, TV and OS after 4 weeks (c1w4). At c1w4, ∆%PSA ≤ −30% was associated with the biochemical response at w16 (p = 0.003) and a longer median OS (p = 0.025), whereas the PCWG3-derived threshold of ∆%PSA ≤ −50% showed no such correlation. In contrast, ∆%PSA ≥ 25% at c1w4 was associated with biochemical progression at w16 (p = 0.003) and a shorter median OS (p < 0.001). Conclusion: PSA changes as early as four weeks after PSMA-RLT allow a significant prediction of later biochemical and PET-based imaging response, as well as OS. At this early time point, a more lenient threshold for a PSA decrease of at least 30% appears better-suited for the prediction of a positive biochemical response and longer OS. In contrast, the PCWG3-derived threshold for PSA increase (+25%) reliably anticipates biochemical progression and shorter OS.
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Mostaghel EA, Marck BT, Kolokythas O, Chew F, Yu EY, Schweizer MT, Cheng HH, Kantoff PW, Balk SP, Taplin ME, Sharifi N, Matsumoto AM, Nelson PS, Montgomery RB. Circulating and Intratumoral Adrenal Androgens Correlate with Response to Abiraterone in Men with Castration-Resistant Prostate Cancer. Clin Cancer Res 2021; 27:6001-6011. [PMID: 34407973 PMCID: PMC8563401 DOI: 10.1158/1078-0432.ccr-21-1819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/09/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE In metastatic castration-resistant prostate cancer (mCRPC) low serum androgens prior to starting abiraterone acetate (AA) is associated with more rapid progression. We evaluated the effect of AA on androgens in castration-resistant prostate cancer (CRPC) metastases and associations of intratumoral androgens with response. EXPERIMENTAL DESIGN We performed a phase II study of AA plus prednisone in mCRPC. The primary outcome was tissue testosterone at 4 weeks. Exploratory outcomes were association of steroid levels and genomic alterations with response, and escalating AA to 2,000 mg at progression. RESULTS Twenty-nine of 30 men were evaluable. Testosterone in metastatic biopsies became undetectable at 4 weeks (P < 0.001). Serum and tissue dehydroepiandrosterone sulfate (DHEAS) remained detectable in many patients and was not increased at progression. Serum and tissue DHEAS in the lowest quartile (pretreatment), serum DHEAS in the lowest quartile (4 weeks), and undetectable tissue DHEAS (on-therapy) associated with rapid progression (20 vs. 48 weeks, P = 0.0018; 20 vs. 52 weeks, P = 0.0003; 14 vs. 40 weeks, P = 0.0001; 20 vs. 56 weeks, P = 0.02, respectively). One of 16 men escalating to 2,000 mg had a 30% PSA decline; 13 developed radiographic progression by 12 weeks. Among patients with high serum DHEAS at baseline, wild-type (WT) PTEN status associated with longer response (61 vs. 33 weeks, P = 0.02). CONCLUSIONS Low-circulating adrenal androgen levels are strongly associated with an androgen-poor tumor microenvironment and with poor response to AA. Patients with CRPC with higher serum DHEAS levels may benefit from dual androgen receptor (AR)-pathway inhibition, while those in the lowest quartile may require combinations with non-AR-directed therapy.
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Affiliation(s)
- Elahe A Mostaghel
- Geriatric Research, Education and Clinical Center (GRECC), U.S. Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brett T Marck
- Geriatric Research, Education and Clinical Center (GRECC), U.S. Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | | | - Felix Chew
- Department of Radiology, University of Washington, Seattle, Washington
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Michael T Schweizer
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington
| | - Heather H Cheng
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington
| | | | - Steven P Balk
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mary-Ellen Taplin
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Nima Sharifi
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alvin M Matsumoto
- Geriatric Research, Education and Clinical Center (GRECC), U.S. Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Division of Gerontology & Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Peter S Nelson
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - R Bruce Montgomery
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington.
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Hematology and Oncology, VA Puget Sound Health Care System, Seattle, Washington
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12
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Giraud N, Buy X, Vuong NS, Gaston R, Cazeau AL, Catena V, Palussiere J, Roubaud G, Sargos P. Single-Center Experience of Focal Thermo-Ablative Therapy After Pelvic Radiotherapy for In-Field Prostate Cancer Oligo-Recurrence. Front Oncol 2021; 11:709779. [PMID: 34381730 PMCID: PMC8350731 DOI: 10.3389/fonc.2021.709779] [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: 05/14/2021] [Accepted: 07/05/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE In-field prostate cancer (PCa) oligo-recurrence after pelvic radiotherapy is a challenging situation for which metastasis-directed treatments may be beneficial, but options for focal therapies are scarce. METHODS We retrospectively reviewed data for patients with three or less in-field oligo-recurrent nodal, bone and/or locally recurrent (prostate, seminal vesicles, or prostatic bed) PCa lesions after radiation therapy, identified with molecular imaging (PET and/or MRI) and treated by focal ablative therapy (cryotherapy or radiofrequency) at the Institut Bergonié between 2012 and 2020. Chosen endpoints were the post-procedure PSA response (partially defined as a >50% reduction, complete as a PSA <0.05 ng/ml), progression-free survival (PFS) defined as either a biochemical relapse (defined as a rise >25% of the Nadir and above 2 ng/ml), radiological relapse (on any imaging technique), decision of treatment modification (hormonotherapy initiation or line change) or death, and tolerance. RESULTS Forty-three patients were included. Diagnostic imaging was mostly 18F-Choline positron emission tomography/computerized tomography (PET/CT) (75.0%), prostate specific membrane antigen (PSMA) PET/CT (9.1%) or a combination of pelvic magnetic resonance imaging (MRI), CT, and 99 mTc-bone scintigraphy (11.4%). PSA response was observed in 41.9% patients (partial in 30.3%, complete in 11.6%). In the hormone-sensitive exclusive focal ablation group (n = 31), partial and complete PSA responses were 32.3 and 12.9% respectively. Early local control (absence of visible residual active target) on the post-procedure imaging was achieved with 87.5% success. After a median follow-up of 30 months (IQR 13.3-56.8), the median PFS was 9 months overall (95% CI, 6-17), and 17 months (95% CI, 11-NA) for PSA responders. Complications occurred in 11.4% patients, with only one grade IIIb Dindo-Clavien event (uretral stenosis requiring endoscopic uretrotomy). CONCLUSION In PCa patients showing in-field oligo-recurrence after pelvic radiotherapy, focal ablative treatment is a feasible option, possibly delaying a systemic treatment initiation or modification. These invasive strategies should preferably be performed in expert centers and discussed along other available focal strategies in multi-disciplinary meetings.
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Affiliation(s)
- Nicolas Giraud
- Radiation Oncology Department, Institut Bergonié, Bordeaux, France
| | - Xavier Buy
- Oncologic Imaging Department, Institut Bergonié, Bordeaux, France
| | - Nam-Son Vuong
- Urology Department, Clinique Saint Augustin, Bordeaux, France
| | - Richard Gaston
- Urology Department, Clinique Saint Augustin, Bordeaux, France
| | | | - Vittorio Catena
- Oncologic Imaging Department, Institut Bergonié, Bordeaux, France
| | - Jean Palussiere
- Oncologic Imaging Department, Institut Bergonié, Bordeaux, France
| | - Guilhem Roubaud
- Medical Oncology Department, Institut Bergonié, Bordeaux, France
| | - Paul Sargos
- Radiation Oncology Department, Institut Bergonié, Bordeaux, France
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Maj-Hes A, Szarvas T, Sevcenco S, Kramer G. Multiple Docetaxel Retreatments Without Prednisone for Metastatic Castration-Resistant Prostate Cancer in the Docetaxel-Only Era: Effects on PSA Kinetics and Survival. Adv Ther 2021; 38:3831-3841. [PMID: 34043207 PMCID: PMC8280015 DOI: 10.1007/s12325-021-01778-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/06/2021] [Indexed: 01/10/2023]
Abstract
Introduction This study aimed to assess the effects of multiple docetaxel (DOC) treatments on prostate-specific antigen (PSA) kinetics and survival among patients with metastatic castration-resistant prostate cancer (mCRPC) who were sensitive to first-line DOC and received no other life-prolonging agents. To eliminate the effect of cortisone on serum PSA, only patients who were treated without prednisone were included. Methods This IRB-approved retrospective study evaluated 52 patients with mCRPC who were retreated using DOC after first-line DOC (without prednisone in both cases), based on a PSA response of > 50% and no radiographic progression. Twenty-three PSA-based factors, including static and kinetic PSA measures, were evaluate for their ability to predict overall survival (OS) Results The patients received 688 cycles of DOC in 143 series, including 91 courses of retreatments (1 cycle: 28 patients, 2 cycles: 14 patients, 3 cycles: 8 patients, 4 cycles: 1 patient, and 7 cycles: 1 patient). The median overall number of cycles per patient was 12 (range: 7–31). The median durations of the first, second, and third holidays were 18 weeks (6–60 weeks), 16 weeks (3–44 weeks), and 17 weeks (8–51 weeks), respectively. The median OSs were 22 months (10.5–70 months) after the first DOC treatment and 14 months (3–65 months) after the second DOC treatment. The > 50% PSA decline rate was 48% after retreatment. Short treatment holidays (< 3 months) were associated with shortened OS (p = 0.01). In the multivariate analysis, a 25% PSA increase over the nadir was the strongest predictor of survival (HR: 3.20, 95% CI: 1.47–6.99, p = 0.003). Conclusions DOC retreatment without prednisone had anti-tumor activity in a considerable proportion of mCRPC cases that were initially sensitive to first-line DOC. A 25% PSA increase over the nadir might predict acquired DOC resistance.
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Prognostic Association between Common Laboratory Tests and Overall Survival in Elderly Men with De Novo Metastatic Castration Sensitive Prostate Cancer: A Population-Based Study in Canada. Cancers (Basel) 2021; 13:cancers13112844. [PMID: 34200349 PMCID: PMC8200983 DOI: 10.3390/cancers13112844] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Despite significant advancements in the treatment of metastatic prostate cancer, a validated prognostic tool for patients with de novo metastatic castration-sensitive prostate cancer (mCSPC) is still lacking. Using population-based data from Ontario, Canada, we examined the prognostic association between common laboratory tests and survival for patients with mCSPC. These low-cost commonly available laboratory tests, including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, albumin, hemoglobin, PSA decrease and PSA nadir, were significantly associated with OS. They can provide important prognostic information and should be utilized more frequently among patients with newly diagnosed mCSPC. Abstract De novo cases of metastatic prostate cancer (mCSPC) are associated with poorer prognosis. To assist in clinical decision-making, we aimed to determine the prognostic utility of commonly available laboratory-based markers with overall survival (OS). In a retrospective population-based study, a cohort of 3556 men aged ≥66 years diagnosed with de novo mCSPC between 2014 and 2019 was identified in Ontario (Canada) administrative database. OS was assessed by using the Kaplan–Meier method. Multivariate Cox regression analysis was performed to evaluate the association between laboratory markers and OS adjusting for patient and disease characteristics. Laboratory markers that were assessed include neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), albumin, hemoglobin, serum testosterone and PSA kinetics. Among the 3556 older men with de novo mCSPC, their median age was 77 years (IQR: 71–83). The median survival was 18 months (IQR: 10–31). In multivariate analysis, a statistically significant association with OS was observed with all the markers (NLR, PLR, albumin, hemoglobin, PSA decrease, reaching PSA nadir and a 50% PSA decline), except for testosterone levels. Our findings support the use of markers of systemic inflammation (NLR, PLR and albumin), hemoglobin and PSA metrics as prognostic indicators for OS in de novo mCSPC.
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Early Prostate-Specific Antigen (PSA) Change at Four Weeks of the First-Line Treatment Using Abiraterone and Enzalutamide Could Predict Early/Primary Resistance in Metastatic Castration-Resistant Prostate Cancer. Cancers (Basel) 2021; 13:cancers13030526. [PMID: 33573172 PMCID: PMC7866532 DOI: 10.3390/cancers13030526] [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: 12/30/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 01/22/2023] Open
Abstract
Simple Summary Serum prostate-specific antigen (PSA) level is the most valuable biomarker in prostate cancer. This study investigates the predictive value of achieving >30% PSA decline at four weeks of first-line androgen signaling inhibitors (ASIs) using a multi-institutional cohort dataset of 254 mCRPC patients. The achievement of >30% PSA decline at four weeks is an independent predictor for overall survival (OS). Interestingly, in patients who did not achieve >30% PSA decline at four weeks—an achievement of the >30% PSA decline at 12 weeks is eventually observed in 30.9% of those patients. To identify the variables that discriminate the patient survival in 97 patients without achieving >30% PSA decline at four weeks of the first-line treatment, a multivariate analysis is conducted. The duration of androgen deprivation therapy before CRPC < 12 months and Eastern Cooperative Oncology Group Performance Status ≥ 1 are identified as independent predictors for shorter OS for those patients. Abstract The identification of early or primary resistance to androgen signaling inhibitors (ASIs) is of great value for the treatment of metastatic castration-resistant prostate cancer (mCRPC). This study evaluates the predictive value of prostate-specific antigen (PSA) response at dour weeks of first-line ASIs treatment for mCRPC patients. A total of 254 patients treated with ASIs (abiraterone acetate: AA and enzalutamide: Enz) at the first-line treatment are retrospectively analyzed. Patients are stratified according to the achievement of >30% PSA decline at 4 and 12 weeks from the treatment initiation. At four weeks of the treatment, 157 patients (61.8%) achieved >30% PSA decline from the baseline. Thereafter, 177 patients (69.7%) achieved >30% PSA decline at 12 weeks of the treatment. A multivariate analysis exhibits >30% PSA decline at four weeks as an independent predictor for overall survival (OS). We note that 30 of 97 (30.9%) patients who did not achieve >30% PSA decline at four weeks consequently achieved >30% PSA decline at 12 weeks, and had a comparable favorable three years OS rate as the 147 patients achieving >30% PSA decline at both 4 and 12 weeks. To identify the variables that discriminate the patient survival in 97 patients without achieving >30% PSA decline at four weeks, a multivariate analysis is performed. The duration of androgen deprivation therapy before CRPC ≤ 12 months and Eastern Cooperative Oncology Group Performance Status ≥ 1 are identified as independent predictors for shorter OS for those patients. These data offer a concept of early treatment switch after four weeks of first-line ASIs when not observing >30% PSA decline at four weeks—particularly in patients with a modest effect of ADT and poor performance status.
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Seurat J, Girard P, Goteti K, Mentré F. Comparison of Various Phase I Combination Therapy Designs in Oncology for Evaluation of Early Tumor Shrinkage Using Simulations. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2020; 9:686-694. [PMID: 33080100 PMCID: PMC7762808 DOI: 10.1002/psp4.12564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022]
Abstract
There is still a lack of efficient designs for identifying the dose response in oncology combination therapies in early clinical trials. The concentration response relationship can be identified using the early tumor shrinkage time course, which has been shown to be a good early response marker of clinical efficacy. The performance of various designs using an exposure–tumor growth inhibition model was explored using simulations. Different combination effects of new drug M and cetuximab (reference therapy) were explored first assuming no effect of M on cetuximab (to investigate the type I error (α)), and subsequently assuming additivity or synergy between cetuximab and M. One‐arm, two‐arm, and four‐arm designs were evaluated. In the one‐arm design, 60 patients received cetuximab + M. In the two‐arm design, 30 patients received cetuximab and 30 received cetuximab + M. In the four‐arm design, in addition to cetuximab and cetuximab + M as standard doses, combination arms with lower doses of cetuximab were evaluated (15 patients/arm). Model‐based predictions or “simulated observations” of early tumor shrinkage at week 8 (ETS8) were compared between the different arms. With the same number of individuals, the one‐arm design showed better statistical power than other designs but led to strong inflation of α in case of misestimated reference for ETS8 value. The two‐arm design protected against this misestimation and, with the same total number of subjects, would provide higher statistical power than a four‐arm design. However, a four‐arm design would be helpful for exploring more doses of cetuximab in combination with M to better understand the interaction.
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Affiliation(s)
- Jérémy Seurat
- Université de Paris, INSERM, IAME, F-75006 Paris, France
| | - Pascal Girard
- Merck Institute for Pharmacometrics, Merck Serono S.A, Lausanne, Switzerland
| | | | - France Mentré
- Université de Paris, INSERM, IAME, F-75006 Paris, France
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17
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España S, Ochoa de Olza M, Sala N, Piulats JM, Ferrandiz U, Etxaniz O, Heras L, Buisan O, Pardo JC, Suarez JF, Barretina P, Comet J, Garcia Del Muro X, Sumoy L, Font A. PSA Kinetics as Prognostic Markers of Overall Survival in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Abiraterone Acetate. Cancer Manag Res 2020; 12:10251-10260. [PMID: 33116879 PMCID: PMC7584507 DOI: 10.2147/cmar.s270392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background Abiraterone acetate (AA) is widely used in the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC). However, a significant percentage of patients will still progress, highlighting the need to identify patients more likely to benefit from AA. Parameters linked to prostate-specific antigen (PSA) kinetics are promising prognostic markers. We have examined clinical and PSA-related factors potentially associated with overall survival (OS) in patients treated with AA. Methods Between 2011 and 2014, 104 patients with mCRPC treated with AA after progression to docetaxel at centers of the Catalan Institute of Oncology were included in this retrospective study. Patients were assessed monthly. Baseline characteristics and variables related to PSA kinetics were included in univariate and multivariate analyses of OS. Results Median OS was 16.4 months (range 12.4-20.6) for all patients. The univariate analysis identified the following baseline characteristics as significantly associated with OS: ECOG PS, location of metastases, time between starting androgen deprivation therapy and starting AA, time between stopping docetaxel treatment and starting AA, neutrophil-lymphocyte ratio (NLR), alkaline phosphatase levels, and PSA levels. Factors related to PSA kinetics associated with longer OS were PSA response >50%, early PSA response (>30% decline at four weeks), PSA decline >50% at week 12, PSA nadir <2.4ng/mL, time to PSA nadir >140 days, the combination of PSA nadir and time to PSA nadir, and low end-of-treatment PSA levels. The multivariate analysis identified ECOG PS (HR 37.46; p<0.001), NLR (HR 3.7; p<0.001), early PSA response (HR 1.22; p=0.002), and time to PSA nadir (HR 0.39; p=0.002) as independent prognostic markers. Conclusion Our results indicate an association between PSA kinetics, especially early PSA response, and outcome to AA after progression to docetaxel. Taken together with other factors, lack of an early PSA response could identify patients who are unlikely to benefit from AA and who could be closely monitored with a view to offering alternative therapies.
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Affiliation(s)
- Sofia España
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Maria Ochoa de Olza
- Catalan Institute of Oncology, Medical Oncology Department, Bellvitge University Hospital, Hospitalet De Llobregat, Spain
| | - Nuria Sala
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Josep Trueta, Girona, Spain
| | - Josep Maria Piulats
- Catalan Institute of Oncology, Medical Oncology Department, Bellvitge University Hospital, Hospitalet De Llobregat, Spain
| | - Ulises Ferrandiz
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Olatz Etxaniz
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Lucia Heras
- Catalan Institute of Oncology, Medical Oncology Department, Bellvitge University Hospital, Hospitalet De Llobregat, Spain.,Medical Oncology Department, Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Oscar Buisan
- Urology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Juan Carlos Pardo
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - Jose F Suarez
- Urology Department, Bellvitge University Hospital, Hospitalet de LLobregat, Spain
| | - Pilar Barretina
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Josep Trueta, Girona, Spain
| | - Josep Comet
- Urology Department, University Hospital Josep Trueta, Girona, Spain
| | - Xavier Garcia Del Muro
- Catalan Institute of Oncology, Medical Oncology Department, Bellvitge University Hospital, Hospitalet De Llobregat, Spain
| | - Lauro Sumoy
- High Content Genomics & Bioinformatics Unit, Germans Trias I Pujol Research Institute (IGTP), Program of Predictive and Personalized Medicine of Cancer (PMPPC), Campus Can Ruti, Badalona, Spain
| | - Albert Font
- Catalan Institute of Oncology, Medical Oncology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
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Armstrong AJ, Lin P, Tombal B, Saad F, Higano CS, Joshua AM, Parli T, Rosbrook B, van Os S, Beer TM. Five-year Survival Prediction and Safety Outcomes with Enzalutamide in Men with Chemotherapy-naïve Metastatic Castration-resistant Prostate Cancer from the PREVAIL Trial. Eur Urol 2020; 78:347-357. [PMID: 32527692 DOI: 10.1016/j.eururo.2020.04.061] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the PREVAIL study, enzalutamide significantly improved clinical outcomes versus placebo in patients with chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC). OBJECTIVE To evaluate long-term benefits and risks of enzalutamide in the final prespecified PREVAIL analysis. DESIGN, SETTING, AND PARTICIPANTS We conducted a final 5-yr survival analysis of PREVAIL in men with chemotherapy-naïve mCRPC from the enzalutamide (n = 689) and placebo (n = 693) arms. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Predictors of the primary outcome of overall survival were estimated using the Kaplan-Meier method. Long-term adverse events over time were analyzed. RESULTS AND LIMITATIONS At the 5-yr data cutoff, 1382 of 1717 (80%) men had died. Enzalutamide reduced the hazard of death by 17% (hazard ratio 0.83; 95% confidence interval [CI] 0.75-0.93; p < 0.001), despite 65%, 54%, and 43% of placebo-treated patients receiving subsequent docetaxel, abiraterone, and enzalutamide, respectively. Median overall survival was 36 mo (95% CI 34-38) in the enzalutamide arm versus 31 mo (95% CI 29-34) in the placebo arm, with a median follow-up of 69 mo. Prognostic modeling showed 5-yr survival rates of 42%, 24%, and 5% for low-, intermediate-, and high-risk groups, respectively. Greater degrees of confirmed prostate-specific antigen declines (≤3 mo) were associated with greater 5-yr survival. A higher incidence of fatal treatment-emergent adverse events was observed with enzalutamide (6.9% vs 3.8%), with an increase in fatal cardiovascular events (1.6% vs 0.4%). CONCLUSIONS With >5 yr of follow-up, enzalutamide continued to demonstrate improved survival in patients with mCRPC despite crossover and multiple subsequent effective therapies, balanced against a slightly higher rate of fatal cardiovascular events. PREVAIL is registered on ClinicalTrials.gov as NCT01212991. PATIENT SUMMARY We report a maintained long-term survival benefit with enzalutamide and risks with >5 yr of enzalutamide treatment and follow-up in men with metastatic prostate cancer, and identify groups of men with widely different outcomes based on clinical factors.
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Affiliation(s)
- Andrew J Armstrong
- Division of Medical Oncology and Urology, Duke Cancer Institute, Duke University, Durham, NC, USA.
| | - Ping Lin
- Biostatistics, Pfizer Inc., San Francisco, CA, USA
| | - Bertrand Tombal
- Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Fred Saad
- Division of Urology and Urologic Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Celestia S Higano
- Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Anthony M Joshua
- Department of Medical Oncology, Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Teresa Parli
- Clinical Development, Pfizer Inc., San Francisco, CA, USA
| | | | - Steve van Os
- Biostatistics, Astellas Pharma Europe BV, Leiden, The Netherlands
| | - Tomasz M Beer
- Hematology/Medical Oncology, OHSU Knight Cancer Institute Oregon Health & Science University, Portland, OR, USA
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Zhou T, Xu W, Zhang W, Sun Y, Yan H, Gao X, Wang F, Zhou Q, Hou J, Ren S, Yang Q, Yang B, Xu C, Zhou Q, Wang M, Chen C, Sun Y. Preclinical profile and phase I clinical trial of a novel androgen receptor antagonist GT0918 in castration-resistant prostate cancer. Eur J Cancer 2020; 134:29-40. [PMID: 32460179 DOI: 10.1016/j.ejca.2020.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE We conducted preclinical experiments and phase I clinical trial to investigate the safety, pharmacokinetics (PK) and antitumour effects of GT0918 in castration-resistant prostate cancer (CRPC). EXPERIMENTAL DESIGN An androgen receptor (AR) competitive binding assay was performed, followed by evaluation of GT0918 on AR protein expression. The efficacy of GT0918 was investigated in a castration-resistant xenograft model. A phase I dose-escalation study of GT0918 in CRPC was also carried out to evaluate its safety, PK and antitumour efficacy. RESULTS GT0918 was demonstrated to inhibit the binding of androgen to AR more potently than MDV3100, and to effectively reduce the AR protein level. GT0918 inhibited the transcriptional activity of wild-type AR and AR with clinically relevant ligand-binding domain mutations. Furthermore, GT0918 significantly inhibited the growth of prostate cancer. A total of 16 patients was treated with GT0918 at five dose levels. Among these 16 patients, 10 and 2 patients, respectively, completed a three-cycle and six-cycle treatment, in which MTD was not reached. All the treatment-related adverse events were grade I, including hypercholesterolemia, hypertriglyceridemia, fatigue and anaemia. PK parameters showed that drug exposure increased with dose proportionally from 50 to 300 mg and a saturation was observed between 300 and 400 mg. PSA declines of ≥30% and ≥50% were, respectively, observed in six and two cases. All the 12 patients with metastatic soft tissue lesions confirmed stable disease. CONCLUSIONS GT0918, a full AR antagonist without agonist effect, has high binding affinity to AR with AR protein down-regulation activity. GT0918 is demonstrated to be well tolerated with a favourable PK profile and exhibits promising antitumour activity in CRPC. CLINICALTRIALS: gov identifier CTR20150501.
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Affiliation(s)
- Tie Zhou
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Weidong Xu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wei Zhang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ye Sun
- Suzhou Kintor Pharmaceuticals, Suzhou, Jiangsu, China
| | - Honghua Yan
- Suzhou Kintor Pharmaceuticals, Suzhou, Jiangsu, China
| | - Xu Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fubo Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | | | - Jianguo Hou
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shancheng Ren
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qing Yang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bo Yang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chuanliang Xu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qingqing Zhou
- Suzhou Kintor Pharmaceuticals, Suzhou, Jiangsu, China
| | - Meiyu Wang
- Suzhou Kintor Pharmaceuticals, Suzhou, Jiangsu, China
| | - Chunyun Chen
- Suzhou Kintor Pharmaceuticals, Suzhou, Jiangsu, China.
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
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20
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Noguchi M, Arai G, Egawa S, Ohyama C, Naito S, Matsumoto K, Uemura H, Nakagawa M, Nasu Y, Eto M, Suekane S, Sasada T, Shichijo S, Yamada A, Kakuma T, Itoh K. Mixed 20-peptide cancer vaccine in combination with docetaxel and dexamethasone for castration-resistant prostate cancer: a randomized phase II trial. Cancer Immunol Immunother 2020; 69:847-857. [PMID: 32025848 PMCID: PMC7183507 DOI: 10.1007/s00262-020-02498-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
Abstract
A novel cancer vaccine consisting of 20 mixed peptides (KRM-20) was designed to induce cytotoxic T lymphocytes (CTL) against twelve different tumor-associated antigens. The aim of this phase II trial was to examine whether KRM-20 in combination with docetaxel and dexamethasone enhances the antitumor effects in patients with castration-resistant prostate cancer (CRPC). In this double-blind, placebo-controlled, randomized phase II study, we enrolled chemotherapy-naïve patients with CRPC from ten medical centers in Japan. Eligible patients were randomly assigned 1:1 centrally to receive either KRM-20 combined with docetaxel and dexamethasone (n = 25) or placebo with docetaxel and dexamethasone (n = 26). The primary endpoint was the difference in prostate-specific antigen (PSA) decline between each treatment. The rates of > 50% PSA decline in the two arms were similar (56.5% versus 53.8%; P = 0.851). Human leukocyte antigen (HLA)-matched peptide-specific immunoglobulin G (P = 0.018) and CTL (P = 0.007) responses in the KRM-20 arm significantly increased after treatment. The addition of KRM-20 did not increase toxicity. There were no between-group differences in progression-free or overall survival (OS). The addition of KRM-20 was safe, and similar PSA decline and HLA-matched peptide-specific CTL and IgG responses increased in combination with docetaxel and dexamethasone in CRPC patients. Subgroup analysis suggested that this treatment is favorable for CRPC patients with ≥ 26% lymphocytes or PSA levels of < 11.2 ng/ml, but further clinical trials comparing OS are required.
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MESH Headings
- Administration, Oral
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Cancer Vaccines/administration & dosage
- Cancer Vaccines/adverse effects
- Cancer Vaccines/immunology
- Combined Modality Therapy/adverse effects
- Combined Modality Therapy/methods
- Dexamethasone/administration & dosage
- Dexamethasone/adverse effects
- Docetaxel/administration & dosage
- Docetaxel/adverse effects
- Double-Blind Method
- Drug Administration Schedule
- Humans
- Infusions, Intravenous
- Injections, Subcutaneous
- Kallikreins/blood
- Male
- Middle Aged
- Progression-Free Survival
- Prostate-Specific Antigen/blood
- Prostatic Neoplasms, Castration-Resistant/blood
- Prostatic Neoplasms, Castration-Resistant/immunology
- Prostatic Neoplasms, Castration-Resistant/mortality
- Prostatic Neoplasms, Castration-Resistant/therapy
- Response Evaluation Criteria in Solid Tumors
- T-Lymphocytes, Cytotoxic/immunology
- Vaccines, Subunit/administration & dosage
- Vaccines, Subunit/adverse effects
- Vaccines, Subunit/immunology
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Affiliation(s)
- Masanori Noguchi
- Canver Vaccine Center, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
- Department of Urology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Gaku Arai
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Chikara Ohyama
- Department of Urology, Graduate School of Medicine and School of Medicine, Hirosaki University, Hirosaki, Japan
| | | | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Masayuki Nakagawa
- Department of Urology, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, Japan
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, University of Kyushu, Fukuoka, Japan
| | - Shigetaka Suekane
- Department of Urology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Tetsuro Sasada
- Kanagawa Cancer Center Research Institute, Kanagawa, Japan
| | - Shigeki Shichijo
- Canver Vaccine Center, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Akira Yamada
- Cancer Vaccines, Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Japan
| | - Tatsuyuki Kakuma
- Biostatistics Center, Kurume University School of Medicine, Kurume, Japan
| | - Kyogo Itoh
- Canver Vaccine Center, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
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21
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Buttigliero C, Tucci M, Sonetto C, Vignani F, Di Stefano RF, Pisano C, Turco F, Lacidogna G, Guglielmini P, Numico G, Scagliotti GV, Di Maio M. Prognostic role of early PSA drop in castration resistant prostate cancer patients treated with abiraterone acetate or enzalutamide. MINERVA UROL NEFROL 2020; 72:737-745. [PMID: 32284527 DOI: 10.23736/s0393-2249.20.03708-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous studies demonstrated a predictive value of prostate-specific antigen (PSA) kinetics for treatment outcome. Our retrospective study evaluates the prognostic role of early PSA drop in metastatic castration resistant prostate cancer (mCRPC) patients receiving abiraterone acetate (AA) or enzalutamide (E). METHODS All mCRPC patients treated with AA or E at the San Luigi Hospital in Orbassano between 2010 and 2018 and at the Ordine Mauriziano Hospital in Turin between 2014 and 2018 were included in this retrospective study. Only patients with an early PSA (measured 28-60 days after the beginning of the treatment) were included in the analysis. Patients were divided in early responders and non-early responders according to early PSA response (drop≥50% from baseline). Univariate and multivariate analyses for progression free survival (PFS) and overall survival (OS) were performed. RESULTS Of 144 patients with early PSA value, 61 (42.4%) patients received E (docetaxel-naïve 42, post-docetaxel 19) and 83 (57.6%) received AA (docetaxel-naïve 44, post-docetaxel 39). Seventy-five (52.1%) patients achieved early PSA drop. In docetaxel-naïve setting (N.=86), median PFS was 14.9 (with early PSA drop) vs. 8.8 months (without early PSA drop, P=0.001). In post-docetaxel setting (N.=58) median PFS was 11.9 vs. 4.5 months (P<0.001). Globally, median PFS was 14.9 vs. 6.3 months in patients with and without early PSA drop, respectively (P<0.001). In docetaxel-naïve setting, patients with early PSA drop had a median OS of 39.5 vs. 18.8 months (P=0.12). In post-docetaxel setting median OS was 29.6 vs. 10.7 months (P=0.01). Comprehensively, median OS was 31.9 vs. 16.3 (P=0.002) in patients with and without early PSA drop, respectively. At multivariate analysis, early PSA drop confirmed an independent association with PFS (HR 0.21; 95% CI: 0.12-0.38, P<0.001) and OS (HR 0.25; 95% CI: 0.12-0.50, P<0.001). CONCLUSIONS mCRPC patients treated with AA or E, in docetaxel-naïve or post-docetaxel setting, with early PSA drop had significantly better OS and PFS.
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Affiliation(s)
- Consuelo Buttigliero
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Marcello Tucci
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Cristina Sonetto
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesca Vignani
- Division of Medical Oncology, Department of Oncology, Ordine Mauriziano Hospital, University of Turin, Turin, Italy
| | - Rosario F Di Stefano
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Chiara Pisano
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Fabio Turco
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Gaetano Lacidogna
- Division of Medical Oncology, Department of Oncology, Ordine Mauriziano Hospital, University of Turin, Turin, Italy
| | - Pamela Guglielmini
- Unit of Oncology, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Gianmauro Numico
- Unit of Oncology, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Giorgio V Scagliotti
- Division of Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Massimo Di Maio
- Division of Medical Oncology, Department of Oncology, Ordine Mauriziano Hospital, University of Turin, Turin, Italy
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22
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Rescigno P, Dolling D, Conteduca V, Rediti M, Bianchini D, Lolli C, Ong M, Li H, Omlin AG, Schmid S, Caffo O, Zivi A, Pezaro CJ, Morley C, Olmos D, Romero-Laorden N, Castro E, Saez MI, Mehra N, Smeenk S, Sideris S, Gil T, Banks P, Sandhu SK, Sternberg CN, De Giorgi U, De Bono JS. Early Post-treatment Prostate-specific Antigen at 4 Weeks and Abiraterone and Enzalutamide Treatment for Advanced Prostate Cancer: An International Collaborative Analysis. Eur Urol Oncol 2020; 3:176-182. [DOI: 10.1016/j.euo.2019.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
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23
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Gafita A, Heck MM, Rauscher I, Tauber R, Cala L, Franz C, D'Alessandria C, Retz M, Weber WA, Eiber M. Early Prostate-Specific Antigen Changes and Clinical Outcome After 177Lu-PSMA Radionuclide Treatment in Patients with Metastatic Castration-Resistant Prostate Cancer. J Nucl Med 2020; 61:1476-1483. [PMID: 32111687 DOI: 10.2967/jnumed.119.240242] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/06/2020] [Indexed: 11/16/2022] Open
Abstract
Prostate-specific antigen (PSA) is widely used to monitor treatment response in patients with metastatic castration-resistant prostate cancer. However, PSA measurements are considered only after 12 wk of treatment. We aimed to evaluate the prognostic value of early PSA changes after 177Lu-labeled prostate-specific membrane antigen (177Lu-PSMA) radionuclide treatment in metastatic castration-resistant prostate cancer patients. Methods: Men who were treated with 177Lu-PSMA under a compassionate-access program at our institution and had available PSA values at baseline and at 6 wk after treatment initiation were included in this retrospective analysis. Patients were assigned to 3 groups on the basis of PSA changes: response (≥30% decline), progression (≥25% increase), and stable (<30% decline and <25% increase). The coprimary endpoints were overall survival and imaging-based progression-free survival. The secondary endpoints were PSA changes at 12 wk and PSA flare-up. Results: We identified 124 eligible patients with PSA values at 6 wk. A greater than or equal to 30% decline in PSA at 6 wk was associated with longer overall survival (median, 16.7 mo; 95% CI, 14.4-19.0) than stable PSA (median, 11.8 mo; 95% CI, 8.6-15.1) (P = 0.007) or PSA progression (median, 6.5 mo; 95% CI, 5.2-7.8) (P < 0.001). Patients with a greater than or equal to 30% decline in PSA at 6 wk also had a lower risk of imaging-based progression than patients with stable PSA (hazard ratio, 0.60; 95% CI, 0.38-0.94) (P = 0.02), whereas patients with PSA progression had a higher risk of imaging-based progression than patients with stable PSA (hazard ratio, 3.18; 95% CI, 1.95-5.21) (P < 0.001). The percentage changes in PSA at 6 and 12 wk were highly associated (r = 0.90; P < 0.001). Of 31 patients who experienced early PSA progression at 6 wk, 29 (94%) showed biochemical progression at 12 wk. Overall, only 1 (3%) of 36 patients with PSA progression at 6 wk achieved any PSA decline at 12 wk (1% of the entire cohort). The limitations of the study included its retrospective nature and the single-center experience. Conclusion: PSA changes at 6 wk after 177Lu-PSMA initiation are an early indicator of long-term clinical outcome. Patients with PSA progression after 6 wk of treatment could benefit from a very early decision to switch treatment. PSA flare-up during 177Lu-PSMA treatment is very uncommon. Prospective studies are now warranted to validate our findings and potentially inform clinicians earlier on the effectiveness of 177Lu-PSMA.
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Affiliation(s)
- Andrei Gafita
- Department of Nuclear Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany; and
| | - Matthias M Heck
- Department of Urology, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany; and
| | - Robert Tauber
- Department of Urology, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Lisena Cala
- Department of Nuclear Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany; and
| | - Charlott Franz
- Department of Nuclear Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany; and
| | - Calogero D'Alessandria
- Department of Nuclear Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany; and
| | - Margitta Retz
- Department of Urology, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Wolfgang A Weber
- Department of Nuclear Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany; and
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany; and
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24
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Iacovelli R, Ciccarese C, Schinzari G, Rossi E, Maiorano BA, Astore S, D'Angelo T, Cannella A, Pirozzoli C, Teberino MA, Pierconti F, Martini M, Tortora G. Biomarkers of response to advanced prostate cancer therapy. Expert Rev Mol Diagn 2020; 20:195-205. [PMID: 31986925 DOI: 10.1080/14737159.2020.1707669] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Prostate cancer (PCa) is one of the most common adult malignancies worldwide, and a major leading cause of cancer-related death in men in Western societies. In the last years, the prognosis of advanced PCa patients has been impressively improved thanks to the development of different therapeutic agents, including taxanes (docetaxel and cabazitaxel), second-generation anti-hormonal agents (abiraterone and enzalutamide), and the radiopharmaceutical Radium-223. However, great efforts are still needed to properly select the most appropriate treatment for each single patient.Areas covered: Several prognostic or predictive biomarkers have been studied, none of which has an established validated role in daily clinical practice. This paper analyzed the major biomarkers (including PSA, androgen receptor (AR) splice variants, βIII-tubulin, ALP, circulating tumor cells, and DNA repair genes) with a potential prognostic and/or predictive role in advanced PCa patients.Expert commentary: Surrogate biomarkers - measurable, reproducible, closely associated with tumor behavior and linked to relevant clinical outcomes - are urgently needed to improve PCa patient management.
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Affiliation(s)
- Roberto Iacovelli
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Department of Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Chiara Ciccarese
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Department of Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Schinzari
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Department of Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Ernesto Rossi
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Brigida Anna Maiorano
- Department of Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Serena Astore
- Department of Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Tatiana D'Angelo
- Department of Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonella Cannella
- Department of Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Celeste Pirozzoli
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Maria Anna Teberino
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesco Pierconti
- Institute of Pathological Anatomy, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Martini
- Department of Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy.,Institute of Pathological Anatomy, Catholic University of the Sacred Heart, Rome, Italy
| | - Giampaolo Tortora
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Department of Medical Oncology, Catholic University of the Sacred Heart, Rome, Italy
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25
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Matsubara N, Chi KN, Özgüroğlu M, Rodriguez-Antolin A, Feyerabend S, Fein L, Alekseev BY, Sulur G, Protheroe A, Li S, Mundle S, De Porre P, Tran N, Fizazi K. Correlation of Prostate-specific Antigen Kinetics with Overall Survival and Radiological Progression-free Survival in Metastatic Castration-sensitive Prostate Cancer Treated with Abiraterone Acetate plus Prednisone or Placebos Added to Androgen Deprivation Therapy: Post Hoc Analysis of Phase 3 LATITUDE Study. Eur Urol 2019; 77:494-500. [PMID: 31843335 DOI: 10.1016/j.eururo.2019.11.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND LATITUDE, a randomized, double-blind trial, compared abiraterone acetate and prednisone (AAP) + androgen deprivation therapy (ADT) versus placebo (PBO) + ADT in high-risk metastatic castration-sensitive prostate cancer (mCSPC). OBJECTIVE To assess the correlation of prostate-specific antigen (PSA) kinetics with overall survival (OS) and radiological progression-free survival (rPFS). DESIGN, SETTING, AND PARTICIPANTS A post hoc analysis of data from 597 men receiving AAP + ADT and 602 receiving PBO + ADT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The associations of PSA-related outcomes (rates of confirmed 50% [PSA50] and 90% [PSA90] decline from baseline PSA [Prostate Cancer Working Group 2 criteria], rates of PSA < 0.2 ng/ml, median nadir PSA, time to PSA nadir [TPN], and time to PSA progression [TPP] with long-term outcomes [OS and rPFS]) were evaluated. Hazard ratios (HRs) were estimated using Cox proportional hazard model. Correlations of TPP with coprimary endpoints rPFS and OS were evaluated using Kendall's tau (KT). RESULTS AND LIMITATIONS AAP + ADT significantly delayed median TPP versus PBO + ADT (33.2 vs 7.4 mo; HR: 0.3, p < 0.001). TPP correlated with rPFS (KT = 0.921) and OS (KT = 0.666). In the AAP + ADT group, 91% had PSA50 and 79% had PSA90 responses (relative risk [RR]: 1.36 and 2.30, respectively; p < 0.001 for both comparisons vs PBO + ADT). Compared with nonresponders, PSA50 and PSA90 responders had reduced risk of death (RR: 0.44 and 0.12, respectively). At 6 mo, 40% receiving AAP + ADT and 6.5% receiving PBO + ADT achieved PSA ≤0.1 ng/ml, which was significantly associated with longer rPFS and OS. Median nadir PSA was 0.09 ng/ml with AAP + ADT versus 2.36 ng/ml with PBO + ADT. Median TPN (AAP + ADT, 6.4 mo; PBO + ADT, 3.8 mo) positively correlated with rPFS and OS. CONCLUSIONS Superior PSA response dynamics with AAP + ADT versus ADT + PBO strongly correlated with long-term outcomes of rPFS and OS in high-risk mCSPC. PATIENT SUMMARY We found that low prostate-specific antigen levels (≤0.1 ng/ml) after 6 mo may indicate a good long-term response to treatment. Our results need confirmation.
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Affiliation(s)
| | - Kim N Chi
- BC Cancer Agency, Vancouver, BC, Canada
| | - Mustafa Özgüroğlu
- Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | | | - Luis Fein
- Instituto de Oncologia de Rosário, Rosário, Argentina
| | - Boris Y Alekseev
- P.A. Hertsen Moscow Cancer Research Institute, Moscow, Russian Federation
| | - Giri Sulur
- Janssen Research & Development, Los Angeles, CA, USA
| | | | - Susan Li
- Janssen Research & Development, Spring House, PA, USA
| | | | | | | | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
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26
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Comparative assessment of docetaxel for safety and efficacy between hormone-sensitive and castration-resistant metastatic prostate cancer. Urol Oncol 2019; 37:999-1005. [PMID: 31377168 DOI: 10.1016/j.urolonc.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/04/2019] [Accepted: 07/08/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare toxicity and response of docetaxel chemotherapy between metastatic hormone-sensitive prostate cancer (mHSPC) and castration-resistant metastatic prostate cancer (mCRPC) patients of the same therapeutic era for assessing of upfront docetaxel against the benchmark of docetaxel in the castrate resistant stage in the setting outside of clinical trials. METHODS A prospectively collected database of real-world prostate cancer patients receiving docetaxel was divided in mHSPC and mCRPC cases and retrospectively analyzed. Principal objectives were toxicity measured by the common criteria of adverse events terminology and response characterized by Prostate specific antigen decline and radiographic progression-free disease at restaging. The prognostic value of suspected variables for grade 3 to 5 toxicity and response was investigated by logistic regression analysis. RESULTS Of 72 patients 34 (47%) were treated for mHSPC and 38 (53%) for mCRPC. Patients with mCRPC were older and had worse performance status (P< 0.01). In mHSPC total number of grade 3 to 5 adverse events (24, median 0, interquartile range 0-1) was significantly less than in mCRPC (46, median 1, interquartile range 1-2) (P = 0.01). Multivariable analysis revealed age as independent predictive variable for grade 3 to 5 toxicity (P = 0.03) but not disease stage, Prostate specific antigen predocetaxel, volume of disease, and Eastern Cooperative Oncology Group performance status (P > 0.05). Objective response was significantly higher in mHSPC compared to mCRPC patients (P < 0.01). Multivariable analysis confirmed mHSPC stage as independent prognostic factor for radiographic progression free disease at restaging (P < 0.01). CONCLUSIONS The association of age with toxicity and of mHSPC stage with response resulted in significantly fewer grade 3 to 5 adverse events but higher response rates for upfront docetaxel in mHSPC compared with docetaxel in the later mCRPC stage.
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Early platelet count kinetics has prognostic value in lower-risk myelodysplastic syndromes. Blood Adv 2019; 2:2079-2089. [PMID: 30126931 DOI: 10.1182/bloodadvances.2018020495] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/06/2018] [Indexed: 01/03/2023] Open
Abstract
Prognosis of lower-risk (International Prognostic Scoring System [IPSS] low/intermediate-1) myelodysplastic syndrome (MDS) is heterogeneous and relies on steady-state assessment of cytopenias. We analyzed relative drops in neutrophil and platelet counts during the first 6 months of follow-up of lower-risk MDS patients. We performed a landmark analysis of overall survival (OS) of lower-risk MDS patients prospectively included in the European LeukaemiaNet MDS registry having a visit at 6 ± 1 month from inclusion to assess the prognostic relevance of relative drops in neutrophils and platelets, defined as (count at landmark - count at inclusion)/count at inclusion. Of 2102 patients, 807 were eligible for the stringent 6-month landmark analysis. Median age was 73 years. Revised IPSS was very low, low, and intermediate/higher in 26%, 43%, and 31% of patients, respectively. A relative drop in platelets >25% at landmark predicted shorter OS (5-year OS, 21.9% vs 48.6% with platelet drop ≤25%, P < 10-4), regardless of baseline IPSS-revised or absolute platelet counts. Relative neutrophil drop >25% had no significant impact on OS. We built a classifier based on red blood cell transfusion dependence (RBC-TD) and relative platelet drop >25% at landmark. Patients with none (62%), either (27%), or both criteria (11%) had 5-year OS of 53.3%, 32.7%, and 9.0%, respectively (P < 10-4). This classifier was validated in an independent cohort of 335 patients. Combining relative platelet drop >25% and RBC-TD at 6 months from diagnosis provides an inexpensive and noninvasive way to predict outcome in lower-risk MDS. This study was registered at www.clinicaltrials.gov as #NCT00600860.
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Kohli M, Oberg AL, Mahoney DW, Riska SM, Sherwood R, Zhang Y, Zenka RM, Sahasrabudhe D, Qin R, Zhang S. Serum Proteomics on the Basis of Discovery of Predictive Biomarkers of Response to Androgen Deprivation Therapy in Advanced Prostate Cancer. Clin Genitourin Cancer 2019; 17:248-253.e7. [PMID: 31103340 DOI: 10.1016/j.clgc.2019.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND We investigated the serum proteome of hormone-sensitive prostate cancer patients to determine candidate biomarkers associated with androgen deprivation therapy (ADT) efficacy. PATIENTS AND METHODS Serum proteomes generated using isobaric mass tags for relative and absolute quantitation were analyzed using reverse-phase liquid chromatography coupled to tandem mass spectrometry. The advanced hormone-sensitive prostate cancer cohorts studied were: (1) untreated "paired" pre-ADT and 4-month post-ADT hormone-sensitive patients (n = 15); (2) "early ADT failure" patients (n = 10) in whom ADT treatment failed within a short period of time; and (3) "late ADT failure" patients (n = 10) in whom ADT treatment failed after a prolonged response time. Differential abundance was assessed, and ingenuity pathway analysis (IPA) was used to identify interaction networks in selected candidates from these comparisons. RESULTS Between "post-ADT" and combined "early" and "late" ADT failure groups 149 differentially detected candidates were observed, and between "early" and "late" ADT failure groups 98 candidates were observed; 47 candidates were common in both comparisons. IPA network enrichment analysis of the 47 candidates identified 3 interaction networks (P < .01) including 17-β-estradiol, nuclear factor kappa-light-chain enhancer of activated B cells complex, and P38 mitogen-activated protein kinases as pathways with potential markers of response to ADT. CONCLUSION A global proteomic analysis identified pathways with markers of ADT response, which will need validation in independent data sets.
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Affiliation(s)
- Manish Kohli
- Department of Medical Oncology, Mayo Clinic, Rochester, MN.
| | - Ann L Oberg
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Shaun M Riska
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Robert Sherwood
- Institute for Biotechnology and Life Science Technologies, Cornell University, Ithaca, NY
| | - Yuzi Zhang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Rui Qin
- Clinical Biostatistics, Janssen Pharmaceuticals, Raritan, NJ
| | - Sheng Zhang
- Institute for Biotechnology and Life Science Technologies, Cornell University, Ithaca, NY.
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Sternberg CN. Enzalutamide, an oral androgen receptor inhibitor for treatment of castration-resistant prostate cancer. Future Oncol 2019; 15:1437-1457. [PMID: 30848157 DOI: 10.2217/fon-2018-0940] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Androgen receptor (AR) signaling is a key pathway in prostate cancer, and patients are initially treated with androgen deprivation therapy. Patients who have stopped responding to androgen deprivation therapy are considered to have castration-resistant prostate cancer (CRPC), which is still dependent on AR signaling. Enzalutamide, an orally available AR inhibitor, was initially approved by the US FDA for the treatment of patients with metastatic CRPC who have previously received docetaxel. The indication was subsequently extended to include all patients with metastatic CRPC, and most recently to include patients with nonmetastatic CRPC. This review summarizes the body of evidence supporting enzalutamide efficacy and safety in CRPC.
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Affiliation(s)
- Cora N Sternberg
- Division of Medical Oncology, Weill Cornell Medical Center, New York, NY 10021, USA
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Prognostic Association of Prostate-specific Antigen Decline with Clinical Outcomes in Men with Metastatic Castration-resistant Prostate Cancer Treated with Enzalutamide in a Randomized Clinical Trial. Eur Urol Oncol 2018; 2:677-684. [PMID: 31274110 DOI: 10.1016/j.euo.2018.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/18/2018] [Accepted: 11/13/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the PREVAIL study, enzalutamide provided significant improvements versus placebo in clinical outcomes in chemotherapy-naïve men with metastatic castration-resistant prostate cancer (mCRPC). The association of post-treatment prostate-specific antigen (PSA) decline with clinical outcomes may provide important prognostic information. OBJECTIVE To evaluate associations between the magnitude of PSA decline from baseline to month 3 and clinical outcomes among enzalutamide recipients. DESIGN, SETTING, AND PARTICIPANTS This was a post hoc retrospective analysis of PREVAIL, an international, randomized, double-blind, placebo-controlled phase 3 study. Men with mCRPC and no prior chemotherapy from the enzalutamide arm were included (n=872). Patients were grouped by confirmed maximal PSA decline from baseline to month 3 of treatment (n=795 evaluable). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcomes were overall survival and radiographic progression-free survival. Secondary outcomes included PSA progression-free survival, radiographic response, and degradation of Functional Assessment of Cancer Therapy-Prostate score, which were estimated using the Kaplan-Meier method. RESULTS AND LIMITATIONS Following 3mo of enzalutamide treatment, 88% (701/795), 80% (639/795), and 39% (307/795) of patients had postbaseline confirmed maximal PSA declines of ≥30%, ≥50%, and ≥90%, respectively, whereas 12% (94/795) had no confirmed maximal PSA decline or a decline of <30%. Greater degrees of PSA decline within the first 3mo of enzalutamide treatment were increasingly associated with longer overall survival, time to PSA and radiographic progression, higher objective soft-tissue responses, and longer time to quality-of-life deterioration than no PSA decline or declines of <30% from baseline. PSA flares (rise followed by fall) after enzalutamide treatment were rare (<1%). CONCLUSIONS The magnitude of PSA decline after 3mo of enzalutamide therapy was strongly associated with better clinical and patient-reported outcomes. This updated prognostic information is of clinical value to this patient population and their health care providers. PATIENT SUMMARY We report that decreases in PSA levels are closely linked to better health and survival after 3mo of enzalutamide treatment in men with metastatic prostate cancer. The PREVAIL trial is registered at clinicaltrials.gov as NCT01212991.
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de Boer HR, Pool M, Joosten E, Everts M, Samplonius DF, Helfrich W, Groen HJM, van Cooten S, Fusetti F, Fehrmann RSN, de Vries EGE, van Vugt MATM. Quantitative proteomics analysis identifies MUC1 as an effect sensor of EGFR inhibition. Oncogene 2018; 38:1477-1488. [PMID: 30305724 DOI: 10.1038/s41388-018-0522-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/30/2018] [Accepted: 09/06/2018] [Indexed: 01/27/2023]
Abstract
Tumor responses to cancer therapeutics are generally monitored every 2-3 months based on changes in tumor size. Dynamic biomarkers that reflect effective engagement of targeted therapeutics to the targeted pathway, so-called "effect sensors", would fulfill a need for non-invasive, drug-specific indicators of early treatment effect. Using a proteomics approach to identify effect sensors, we demonstrated MUC1 upregulation in response to epidermal growth factor receptor (EGFR)-targeting treatments in breast and lung cancer models. To achieve this, using semi-quantitative mass spectrometry, we found MUC1 to be significantly and durably upregulated in response to erlotinib, an EGFR-targeting treatment. MUC1 upregulation was regulated transcriptionally, involving PI3K-signaling and STAT3. We validated these results in erlotinib-sensitive human breast and non-small lung cancer cell lines. Importantly, erlotinib treatment of mice bearing SUM149 xenografts resulted in increased MUC1 shedding into plasma. Analysis of MUC1 using serial blood sampling may therefore be a new, relatively non-invasive tool to monitor early and drug-specific effects of EGFR-targeting therapeutics.
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Affiliation(s)
- H Rudolf de Boer
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, Netherlands
| | - Martin Pool
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, Netherlands
| | - Esméé Joosten
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, Netherlands
| | - Marieke Everts
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, Netherlands
| | - Douwe F Samplonius
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, Netherlands
| | - Wijnand Helfrich
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, Netherlands
| | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, Netherlands
| | - Suzanne van Cooten
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, Netherlands
| | - Fabrizia Fusetti
- Department of Biochemistry, Groningen Biomolecular Sciences and Biotechnology Institute, Netherlands Proteomics Centre & Zernike Institute for Advanced Materials, University of Groningen, Groningen, Netherlands
| | - Rudolf S N Fehrmann
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, Netherlands
| | - Marcel A T M van Vugt
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, Netherlands.
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Romero-Laorden N, Lozano R, Jayaram A, López-Campos F, Saez MI, Montesa A, Gutierrez-Pecharoman A, Villatoro R, Herrera B, Correa R, Rosero A, Pacheco MI, Garcés T, Cendón Y, Nombela MP, Van de Poll F, Grau G, Rivera L, López PP, Cruz JJ, Lorente D, Attard G, Castro E, Olmos D. Phase II pilot study of the prednisone to dexamethasone switch in metastatic castration-resistant prostate cancer (mCRPC) patients with limited progression on abiraterone plus prednisone (SWITCH study). Br J Cancer 2018; 119:1052-1059. [PMID: 30131546 PMCID: PMC6219494 DOI: 10.1038/s41416-018-0123-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 04/17/2018] [Accepted: 04/25/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite most metastatic castration-resistant prostate cancer (mCRPC) patients benefit from abiraterone acetate plus prednisone 5 mg bid (AA + P), resistance eventually occurs. Long-term use of prednisone has been suggested as one of the mechanisms driving resistance, which may be reversed by switching to another steroid. METHODS SWITCH was a single-arm, open-label, single-stage phase II study. The primary objective was to evaluate the antitumour activity of abiraterone acetate plus dexamethasone 0.5 mg daily (AA + D) in mCRPC patients progressing to AA + P. Clinically stable mCRPC patients who had prostate-specific antigen (PSA) and/or limited radiographic progression after at least 12 weeks on AA + P, were eligible. The primary endpoint was measured as the proportion of patients achieving a PSA decline of ≥ 30% (PSA30) from baseline after 6 weeks on AA + D. Secondary endpoints included: PSA50 response rate at 12 weeks, time to biochemical and radiological progression, overall survival, safety profile evaluation, benefit from subsequent treatment lines and the identification of biomarkers of response (AR copy number, TMPRSS2-ERG status and PTEN expression). RESULTS Twenty-six patients were enrolled. PSA30 and PSA50 were 46.2% and 34.6%, respectively. Median time to biochemical and radiological progression were 5.3 and 11.8 months, respectively. Two radiological responses were observed. Median overall survival was 20.9 months. Patients with AR gain detected in plasma circulating tumour DNA did not respond to switch, whereas patients with AR normal status benefited the most. No significant toxicities were observed and PSA50 response rate to subsequent taxane was 50%. CONCLUSIONS In selected clinical stable mCRPC patients with limited disease progression on AA + P, a steroid switch from prednisone to dexamethasone can lead to PSA and radiological responses.
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Affiliation(s)
- Nuria Romero-Laorden
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Medical Oncology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Rebeca Lozano
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
| | - Anuradha Jayaram
- Division of Molecular Pathology, Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
- Academic Urology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Fernando López-Campos
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Radiation Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Maria I Saez
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
- Medical Oncology Department, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain
| | - Alvaro Montesa
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
- Medical Oncology Department, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain
| | - Ana Gutierrez-Pecharoman
- Medical Oncology Department, Hospital Universitario de La Princesa, Madrid, Spain
- Pathology Department, Hospital Universitario de Móstoles, Móstoles, Spain
| | - Rosa Villatoro
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
- Medical Oncology Department, Hospital Costa del Sol, Marbella, Spain
| | - Bernardo Herrera
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
- Urology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Raquel Correa
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Adriana Rosero
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Oncology Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - María I Pacheco
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
| | - Teresa Garcés
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
| | - Ylenia Cendón
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ma Paz Nombela
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Floortje Van de Poll
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Gala Grau
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
| | - Leticia Rivera
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
| | - Pedro P López
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Juan-Jesús Cruz
- Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - David Lorente
- Medical Oncology Department, Hospital Universitario La Fe, Valencia, Spain
| | - Gerhardt Attard
- Division of Molecular Pathology, Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
- Academic Urology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Elena Castro
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.
- Medical Oncology Department, Hospital Universitario Quirón, Madrid, Spain.
| | - David Olmos
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
- Medical Oncology Department, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain
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Brown LC, Sonpavde G, Armstrong AJ. Can RECIST response predict success in phase 3 trials in men with metastatic castration-resistant prostate cancer? Prostate Cancer Prostatic Dis 2018; 21:419-430. [PMID: 29858595 DOI: 10.1038/s41391-018-0049-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/11/2018] [Accepted: 03/19/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Intermediate endpoints are needed in early phase studies of men with metastatic castration-resistant prostate cancer (mCRPC) that can reliably predict success in phase 3 trials. Among men with measurable disease, objective response may provide information as to whether a treatment is likely to be successful. METHODS We conducted a systematic review of systemic agents that have proceeded to phase 3 trials in men with mCRPC and examined the relationship between improvements in measurable disease response in phase 2 trials and successful phase 3 trials leading to regulatory approval. Only trials that included men with radiographically measurable disease were included. RESULTS We examined 31 eligible mCRPC phase 3 trials between 1992 and 2017 and 29 of the preceding phase 2 trials for RECIST responses. Measurable tumor responses in phase 2 trials were higher for successful therapies in phase 3 trials in chemotherapy-naive men with mCRPC, but were less correlated with success in trials investigating docetaxel combination regimens or the post chemotherapy mCRPC setting. Many failed agents did not produce higher than expected response rates over control arms; however, several agents such as anti-angiogenic therapies or orteronel produced higher than expected responses without survival benefit. CONCLUSIONS Objective responses in men with mCRPC may be associated with prolonged survival, but this association is mechanism dependent and inconsistent across trials or disease states. These data support considering RECIST response as a supportive but not sole endpoint in phase 2 trials to support launching phase 3 trials.
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Affiliation(s)
- Landon C Brown
- Department of Medicine, School of Medicine, Duke University, Durham, NC, USA
| | | | - Andrew J Armstrong
- Department of Medicine, School of Medicine, Duke University, Durham, NC, USA. .,Duke Cancer Institute and the Duke Prostate and Urologic Cancer Center, Duke University, Durham, NC, USA.
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Sartor O, Coleman RE, Nilsson S, Heinrich D, Helle SI, O'Sullivan JM, Vogelzang NJ, Bruland Ø, Kobina S, Wilhelm S, Xu L, Shan M, Kattan MW, Parker C. An exploratory analysis of alkaline phosphatase, lactate dehydrogenase, and prostate-specific antigen dynamics in the phase 3 ALSYMPCA trial with radium-223. Ann Oncol 2018; 28:1090-1097. [PMID: 28453701 PMCID: PMC5406754 DOI: 10.1093/annonc/mdx044] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Baseline clinical variables are prognostic for overall survival (OS) in patients with castration-resistant prostate cancer (CRPC). Their prognostic and predictive value with agents targeting bone metastases, such as radium-223, is not established. Patients and methods The radium-223 ALSYMPCA trial enrolled patients with CRPC and symptomatic bone metastases. Prognostic potential of baseline variables was assessed using Cox models. Percentage changes in biomarker levels from baseline were evaluated during the trial period; changes from baseline to week 12 were evaluated for association with OS and surrogacy. Results Eastern Cooperative Oncology Group performance status, total alkaline phosphatase (tALP), lactate dehydrogenase (LDH), and prostate-specific antigen (PSA) at baseline were associated with OS (P ≤ 0.0003) in the intent-to-treat population (radium-223, N = 614; placebo, N = 307). tALP declined from baseline within 4 weeks after beginning radium-223, by week 12 declining in 87% of radium-223 and 23% of placebo patients (P < 0.001). LDH declined in 51% and 34% (P = 0.003), whereas PSA declined in 27% and 14% (P = 0.160). Mean tALP change from baseline was 32.2% decrease with radium-223 and 37.2% increase with placebo. Radium-223 patients with tALP decline from baseline to week 12 (confirmed ≥3 weeks from week 12) had 55% lower risk of death (hazard ratio = 0.45; 95% CI 0.34-0.61) versus those with no confirmed tALP decline. Proportional treatment effect (PTE) values for tALP, LDH, and PSA changes from baseline at week 12 as OS surrogate markers were 0.34 (95% CI: 0-0.746), 0.07 (95% CI: 0-0.211), and 0 (95% CI: 0-0.082), respectively. Conclusions Significant tALP declines (versus placebo) occurred as early as 4 weeks after beginning radium-223 therapy. tALP or LDH declines at 12 weeks correlated with longer OS, but did not meet statistical surrogacy requirements. Dynamic changes in tALP and LDH during radium-223 treatments may be useful to monitor, but do not serve as surrogates for survival.
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Affiliation(s)
- O Sartor
- Departments of Medicine and Urology, Tulane Cancer Center, New Orleans, USA
| | - R E Coleman
- Academic Unit of Clinical Oncology, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - S Nilsson
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - D Heinrich
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - S I Helle
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - J M O'Sullivan
- Department of Clinical Oncology, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
| | - N J Vogelzang
- Department of Medical Oncology, Comprehensive Cancer Centers of Nevada, Las Vegas, USA
| | - Ø Bruland
- Department of Medical Oncology and Radiotherapy, University of Oslo, Norwegian Radium Hospital, Oslo, Norway
| | - S Kobina
- Oncology Global Medical Affairs, Bayer HealthCare Pharmaceuticals, Whippany, USA
| | - S Wilhelm
- Oncology Global Medical Affairs, Bayer HealthCare Pharmaceuticals, Whippany, USA
| | - L Xu
- Infinity Analytics Group Inc, Madison
| | - M Shan
- Department of Statistics, Oncology, Bayer HealthCare Pharmaceuticals, Whippany, USA
| | - M W Kattan
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, USA
| | - C Parker
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK
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Sonpavde G, Pond GR, Plets M, Tangen CM, Hussain MHA, Lara PN, Goldkorn A, Garzotto MG, Mack PC, Higano CS, Vogelzang NJ, Thompson IM, Twardowski PW, Van Veldhuizen PJ, Agarwal N, Carducci MA, Monk JP, Quinn DI. Validation of the Association of RECIST Changes With Survival in Men With Metastatic Castration-Resistant Prostate Cancer Treated on SWOG Study S0421. Clin Genitourin Cancer 2017; 15:635-641. [PMID: 28579151 PMCID: PMC5734863 DOI: 10.1016/j.clgc.2017.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Phase 2 trials evaluating new agents for metastatic castration-resistant prostate cancer (mCRPC) have relied on bone scan and prostate-specific antigen changes to assess activity. Given the increasing detection of measurable disease, Response Evaluation Criteria in Solid Tumors (RECIST) changes warrant consideration to evaluate activity. We validated the association of RECIST 1.0 changes with survival in men with mCRPC receiving docetaxel. PATIENTS AND METHODS Data for men with measurable disease from the Southwest Oncology Group (SWOG) S0421, a phase 3 trial in men with mCRPC receiving docetaxel and prednisone plus placebo or atrasentan, were used. Cox proportional hazards regression was used to evaluate the association of RECIST 1.0 outcomes within 120 days, ie, unconfirmed partial response (uPR), stable disease, and progressive disease (PD), with overall survival (OS) from day 120, adjusted for prognostic factors. RESULTS Overall, 326 men were evaluable for landmark analysis, of whom 23 had PD, 230 stable disease, and 73 uPR. OS beyond day 120 was significantly different (P = .004) among these subgroups, with median (95% confidence interval) OS of 7.1 (3.5-8.8), 13.4 (11.4-15.6), and 16.3 (10.0-19.6) months for those with PD, stable disease, and uPR, respectively. In a multivariable model, the hazard ratio (95% confidence interval) for patients with PD was 2.47 (1.42-4.29) compared to patients with an uPR (P = .002). CONCLUSION The association of RECIST 1.0 changes with OS in men with mCRPC receiving docetaxel was validated. Given limitations of bone scan and prostate-specific antigen alterations, improvements in objective RECIST 1.0 changes should be reported in phase 2 trials before launching phase 3 trials.
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Affiliation(s)
- Guru Sonpavde
- University of Alabama at Birmingham, Birmingham, AL.
| | | | | | | | | | | | - Amir Goldkorn
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | | | - Ian M Thompson
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | | | | | | | | | - David I Quinn
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
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Cabazitaxel as second-line or third-line therapy in patients with metastatic castration-resistant prostate cancer. Anticancer Drugs 2017; 27:695-701. [PMID: 27148775 DOI: 10.1097/cad.0000000000000375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
To compare treatment outcomes in patients with metastatic castration-resistant prostate cancer treated with cabazitaxel (CA) as second-line or third-line therapy in the everyday clinical setting. Charts from 94 patients treated with CA as second-line (n=28) or third-line therapy (n=66) were evaluated. Common Terminology Criteria for Adverse Events were used to register grade 3-4 nonhematological toxicity during treatment with CA. Baseline metastatic castration-resistant prostate cancer-related prognostic factors, duration of therapy, and maximum prostate-specific antigen (PSA) percentage change were registered during treatment with CA and previous/subsequent novel androgen receptor targeting therapies. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. A median of 6 versus 5 treatment cycles was administered in patients treated with second-line and third-line CA (P=0.483). Events with grade 3-4 nonhematological toxicity were equally distributed in the two groups (32 vs. 35%, P=0.80). PSA responses were observed in 46 and 17% of patients treated with second-line and third-line CA (P=0.002). PFS (5.5 vs. 3.3 months, P=0.087, log rank) and OS (18.3 vs. 11.4 months, P=0.003, log rank) was longer in patients treated with second-line CA. OS measured from second-line abiraterone acetate/enzalutamide was similar (18.0 months) to second-line CA (P=0.883, log rank). Treatment-related toxicity was independent of CA being administered as second-line or third-line therapy. Although PFS and the frequency of PSA responders favored patients treated with second-line CA, one treatment sequence could not be considered superior to the other in this study.
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Zhang T, Armstrong AJ. The Who, What, and How of Cabazitaxel Treatment in Metastatic Castration-Resistant Prostate Cancer. J Clin Oncol 2017; 35:3175-3177. [PMID: 28809609 DOI: 10.1200/jco.2017.74.7931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tian Zhang
- Tian Zhang and Andrew J. Armstrong, Duke Cancer Institute, Durham NC
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38
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Clinical utility of emerging liquid biomarkers in advanced prostate cancer. Cancer Genet 2017; 228-229:151-158. [PMID: 28958406 DOI: 10.1016/j.cancergen.2017.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 08/21/2017] [Indexed: 01/04/2023]
Abstract
The therapeutic landscape of advanced prostate cancer (PCa) has rapidly expanded in recent years. Despite significant improvements in patient overall survival, it remains challenging to determine the optimal therapy and sequence of therapies for individual patients. The development of molecular biomarkers will be key for patient stratification, and for monitoring response and resistance to therapy. In this context, minimally-invasive blood-based "liquid" biopsies are attractive as a practical surrogate for solid tumor tissue, providing a window into metastatic disease. Circulating tumor cells and circulating cell-free tumor DNA in particular have demonstrated remarkable potential to inform on PCa patient outcomes through the detection of specific genomic and transcriptomic alterations. This review covers recent advances in the development of clinically-informative liquid biomarkers for advanced PCa.
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Petrylak DP, Crawford ED. Biomarkers for the Management of Castration-Resistant Prostate Cancer: We Are Not There Yet. Target Oncol 2017; 12:401-412. [DOI: 10.1007/s11523-017-0500-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Nielsen TK, Højgaard M, Andersen JT, Jørgensen NR, Zerahn B, Kristensen B, Henriksen T, Lykkesfeldt J, Mikines KJ, Poulsen HE. Weekly ascorbic acid infusion in castration-resistant prostate cancer patients: a single-arm phase II trial. Transl Androl Urol 2017; 6:517-528. [PMID: 28725594 PMCID: PMC5503969 DOI: 10.21037/tau.2017.04.42] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Ascorbic acid (AA) has in vivo cytotoxic properties at concentrations that can only be achieved through intravenous (IV) administration in humans. Treatment with intravenous AA is widely and increasingly used in complementary medicine despite a lack of clinical evidence for the efficacy of this treatment. METHODS This non-comparative, single-center, phase II trial included patients with chemotherapy-naïve, metastatic castration-resistant prostate cancer (mCRPC) from an outpatient clinic to evaluate the efficacy and safety of IV AA therapy. Patients received weekly infusions of AA (week 1, 5 g; week 2, 30 g; and weeks 3-12, 60 g) followed by efficacy evaluation at 12 weeks. The primary endpoint for efficacy was a 50% reduction in the prostate-specific antigen (PSA) level. The secondary endpoints included changes in health-related quality of life (HRQoL), biomarkers of bone metabolism, inflammation and bone scans. Clinicaltrials.gov identifier: NCT01080352. RESULTS Twenty-three patients were enrolled in this study, and 20 completed the efficacy evaluation at 12 weeks. The mean baseline PSA level was 43 µg/L. No patient achieved a 50% PSA reduction; instead, a median increase in PSA of 17 µg/L was recorded at week 12. Among the secondary endpoints, no signs of disease remission were observed. In total, 53 adverse events (AEs) were recorded. Eleven were graded as "serious". Three AEs were directly related to AA, and all of which were related to fluid load. CONCLUSIONS Infusion with 60 g of AA did not result in disease remission. This study does not support the use of intravenous AA outside clinical trials.
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Affiliation(s)
- Torben K Nielsen
- Department of Urology, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Højgaard
- Department of Urology, Copenhagen University Hospital, Herlev, Denmark
| | - Jon T Andersen
- Laboratory of Clinical Pharmacology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg, Frederiksberg, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Herlev, Denmark
| | - Bent Kristensen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Herlev, Denmark
| | - Trine Henriksen
- Laboratory of Clinical Pharmacology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg, Frederiksberg, Denmark
| | - Jens Lykkesfeldt
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kári J Mikines
- Department of Urology, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik E Poulsen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Laboratory of Clinical Pharmacology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg, Frederiksberg, Denmark
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41
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Ballas LK, de Castro Abreu AL, Quinn DI. What Medical, Urologic, and Radiation Oncologists Want from Molecular Imaging of Prostate Cancer. J Nucl Med 2017; 57:6S-12S. [PMID: 27694176 DOI: 10.2967/jnumed.115.170142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/15/2016] [Indexed: 12/25/2022] Open
Abstract
As molecular imaging better delineates the state of prostate cancer, clinical management will evolve. The currently licensed imaging modalities are limited by lack of specificity or sensitivity for the extent of cancer and for predicting outcome in response to therapy. Clinicians want molecular imaging that-by being more reliable in tailoring treatment and monitoring response for each patient-will become a key facet of precision medicine, surgery, and radiation therapy. Identifying patients who are candidates for specific or novel treatments is important, but equally important is the finding that a given patient may not be a good candidate for single-modality therapy. This article presents prostate cancer scenarios in which managing clinicians would welcome molecular imaging innovations to help with decision making. The potential role of newer techniques that may help fill this wish list is discussed.
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Affiliation(s)
- Leslie K Ballas
- Department of Radiation Oncology, Keck School of Medicine at USC, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, California
| | - Andre Luis de Castro Abreu
- Department of Urology, Keck School of Medicine at USC, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, California; and
| | - David I Quinn
- Division of Medical Oncology, Department of Medicine, Keck School of Medicine at USC, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, California
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Armstrong AJ, Saad F, Phung D, Dmuchowski C, Shore ND, Fizazi K, Hirmand M, Forer D, Scher HI, Bono JD. Clinical outcomes and survival surrogacy studies of prostate-specific antigen declines following enzalutamide in men with metastatic castration-resistant prostate cancer previously treated with docetaxel. Cancer 2017; 123:2303-2311. [PMID: 28171710 PMCID: PMC5484320 DOI: 10.1002/cncr.30587] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/15/2016] [Accepted: 12/23/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND In the AFFIRM trial, enzalutamide significantly increased overall survival (OS) for men with metastatic castration‐resistant prostate cancer (mCRPC) after chemotherapy versus placebo and significantly decreased prostate‐specific antigen (PSA) levels. The goal of this post hoc analysis was to associate levels of PSA decline from baseline after enzalutamide with clinical outcomes in the postchemotherapy mCRPC setting. METHODS Men in the AFFIRM trial (n = 1199) were grouped by maximal PSA decline in the first 90 days of treatment. Kaplan‐Meier estimates evaluated the association of defined PSA changes from baseline with OS, progression‐free survival (PFS), radiographic PFS (rPFS), and pain response. Each PSA decline category was assessed for OS surrogacy using Prentice criteria, proportion of treatment effect explained (PTE), and proportion of variation explained. RESULTS Men treated with enzalutamide had improved OS (hazard ratio, 0.63; P < .001) and higher rates of PSA decline (odds ratio, >19.0; P < .001) versus placebo. PSA declines of any, ≥30%, ≥50%, and ≥90% with enzalutamide were strongly associated with greater OS, PSA PFS, rPFS (P < .001), and pain response (P < .026) versus PSA increase/no decline. Any, ≥30%, and ≥50% declines in PSA resulted in the PTE range of 1.07‐1.29, where treatment was no longer significant after adjustment for decline measures (P > .20). CONCLUSIONS PSA declines of any, ≥30%, and ≥50% following enzalutamide were associated with greater clinical and pain response and improvements in PFS and OS. Surrogacy of PSA decline for OS was not fully established, possibly due to lack of PSA declines with placebo, and discordant results between PSA and imaging responses over time, and because some declines were not durable due to rapid resistance development. However, a lack of PSA decline by 90 days following enzalutamide treatment was a poor prognosis indicator in this setting. Conclusions from sensitivity analyses of maximal PSA decline from baseline over the entire treatment period are consistent with PSA declines restricted to the first 90 days. Cancer 2017;123:2303–2311. © 2017 American Cancer Society. A post hoc analysis of the randomized, double‐blind AFFIRM trial revealed that postenzalutamide prostate‐specific antigen declines of any, ≥30%, and ≥50% are associated with greater clinical and pain response. The decline criteria explain a large proportion of treatment effect on survival improvements but do not fulfill the criteria for surrogacy.
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Affiliation(s)
| | - Fred Saad
- Centre Hospitalier de l'Université de Montréal and CRCHUM, Montreal, Quebec, Canada
| | - De Phung
- Astellas Pharma, Inc., Leiden, Netherlands
| | | | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, South Carolina
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Paris, France
| | | | | | - Howard I Scher
- Sidney Kimmel Center for Prostate and Urologic Cancers and Memorial Sloan-Kettering Cancer Center, New York, New York
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43
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Rescigno P, Lorente D, Bianchini D, Ferraldeschi R, Kolinsky MP, Sideris S, Zafeiriou Z, Sumanasuriya S, Smith AD, Mehra N, Jayaram A, Perez-Lopez R, Mateo J, Parker C, Dearnaley DP, Tunariu N, Reid A, Attard G, de Bono JS. Prostate-specific Antigen Decline After 4 Weeks of Treatment with Abiraterone Acetate and Overall Survival in Patients with Metastatic Castration-resistant Prostate Cancer. Eur Urol 2016; 70:724-731. [PMID: 26965561 DOI: 10.1016/j.eururo.2016.02.055] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/21/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The availability of multiple new treatments for metastatic castration-resistant prostate cancer (mCRPC) mandates earlier treatment switches in the absence of a response. A decline in prostate-specific antigen (PSA) is widely used to monitor treatment response, but is not validated as an intermediate endpoint for overall survival (OS). OBJECTIVE To evaluate the association between early PSA decline and OS following abiraterone acetate (AA) treatment. DESIGN, SETTING, AND PARTICIPANTS We identified mCRPC patients treated with AA before or after docetaxel at the Royal Marsden NHS Foundation Trust between 2006 and 2014. Early PSA decline was defined as a 30% decrease in PSA at 4 wk relative to baseline, and early PSA rise as a 25% increase. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Association with OS was analyzed using multivariate Cox regression and log-rank analyses. Spearman's rho correlation coefficient (r) was calculated to evaluate the association between PSA changes at 4 wk and 12 wk. RESULTS AND LIMITATIONS There were 274 patients eligible for this analysis. A 30% PSA decline at 4 wk was associated with longer OS (25.8 vs 15.1 mo; hazard ratio [HR] 0.47, p<0.001), and a 25% PSA rise at 4 wk with shorter OS (15.1 vs 23.8 mo; HR 1.7, p=0.001) in both univariate and multivariable models. The percentage PSA decline at 4 wk was significantly correlated with the percentage PSA change at 12 wk (r=0.82; p<0.001). Patients achieving a 30% PSA decline at 4 wk were 11.7 times more likely to achieve a 50% PSA decrease at 12 wk (sensitivity 90.9%, specificity 79.4%). Limitations include the retrospective design of this analysis. CONCLUSIONS Patients not achieving 30% PSA decline after 4 wk of AA have a lower likelihood of achieving PSA response at 12 wk and significantly inferior OS. Prospective multicentre validation studies are needed to confirm these findings. PATIENT SUMMARY Prostate-specific antigen (PSA) is commonly used to evaluate response to treatment in metastatic castration-resistant prostate cancer. Expert recommendations discourage reliance on PSA changes earlier than 12 wk after treatment initiation. Our data suggest that early PSA changes are associated with survival in patients receiving abiraterone acetate.
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Affiliation(s)
- Pasquale Rescigno
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - David Lorente
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Diletta Bianchini
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Roberta Ferraldeschi
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Michael P Kolinsky
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Spyridon Sideris
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Zafeiris Zafeiriou
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Semini Sumanasuriya
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Alan D Smith
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Niven Mehra
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Anuradha Jayaram
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Raquel Perez-Lopez
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Joaquin Mateo
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Chris Parker
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - David P Dearnaley
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Nina Tunariu
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Alison Reid
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Gerhardt Attard
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Johann S de Bono
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK.
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44
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Maughan BL, Eisenberger MA. A Potential Predictive Role for Prostate-specific Antigen Changes at 4 Weeks? Eur Urol 2016; 70:732-733. [DOI: 10.1016/j.eururo.2016.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/22/2016] [Indexed: 11/25/2022]
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45
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Miyamoto DT, Lee RJ. Cell-free and circulating tumor cell-based biomarkers in men with metastatic prostate cancer: Tools for real-time precision medicine? Urol Oncol 2016; 34:490-501. [PMID: 27771279 DOI: 10.1016/j.urolonc.2016.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 09/03/2016] [Accepted: 09/07/2016] [Indexed: 12/28/2022]
Abstract
The recent expansion of therapeutic options for the treatment of metastatic prostate cancer highlights the need for precision medicine approaches to enable the rational selection of appropriate therapies for individual patients. In this context, circulating biomarkers in the peripheral blood are attractive as readily accessible tools for predicting and monitoring therapeutic response. In the case of circulating tumor cells and circulating tumor DNA, they may also serve as a noninvasive means of assessing molecular aberrations in tumors at multiple time points before and during therapy. These so-called "liquid biopsies" can provide a snapshot view of tumor molecular architecture and may enable clinicians to monitor the molecular status of tumors as they evolve during treatment, thus allowing for individualized precision therapeutic decisions for patients over time. In this review, we outline recent progress in the field of circulating biomarkers in metastatic prostate cancer and evaluate their potential for enabling this vision of real-time precision medicine.
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Affiliation(s)
- David T Miyamoto
- Massachusetts General Hospital Cancer Center, Boston, MA; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Richard J Lee
- Massachusetts General Hospital Cancer Center, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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46
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Lohiya V, Aragon-Ching JB, Sonpavde G. Role of Chemotherapy and Mechanisms of Resistance to Chemotherapy in Metastatic Castration-Resistant Prostate Cancer. Clin Med Insights Oncol 2016; 10:57-66. [PMID: 27773999 PMCID: PMC5065075 DOI: 10.4137/cmo.s34535] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/30/2016] [Accepted: 09/03/2016] [Indexed: 12/13/2022] Open
Abstract
Chemotherapy using the taxanes, docetaxel and cabazitaxel, remains an important therapeutic option in metastatic castration-resistant prostate cancer (CRPC). However, despite the survival benefits afforded by these agents, the survival increments are modest and resistance occurs universally. Efforts to overcome resistance to docetaxel by combining with biologic agents have heretofore been unsuccessful. Indeed, resistance to these taxanes is also associated with cross-resistance to the antiandrogen drugs, abiraterone and enzalutamide. Here, we discuss the various mechanisms of resistance to chemotherapy in metastatic CRPC and the potential role of emerging regimens and agents in varying clinical phases of development.
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Affiliation(s)
- Vipin Lohiya
- Division of Hematology-Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Guru Sonpavde
- Division of Hematology-Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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47
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Trial Level Analysis of Prostate-Specific Antigen-Related Versus Unrelated Endpoints in Phase III Trials of First-Line and Second-Line Medical Treatments of Patients With Metastatic Castration-Resistant Prostate Cancer. Clin Genitourin Cancer 2016; 14:389-397. [DOI: 10.1016/j.clgc.2016.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 03/07/2016] [Accepted: 03/19/2016] [Indexed: 11/21/2022]
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48
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Heck MM, Thalgott M, Schmid SC, Oh WK, Gong Y, Wang L, Zhu J, Seitz AK, Porst D, Höppner M, Retz M, Gschwend JE, Nawroth R. A 2-Gene Panel Derived From Prostate Cancer-Enhanced Transcripts in Whole Blood Is Prognostic for Survival and Predicts Treatment Benefit in Metastatic Castration-Resistant Prostate Cancer. Prostate 2016; 76:1160-8. [PMID: 27198487 DOI: 10.1002/pros.23202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/26/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND To determine a prognostic model derived from prostate cancer-enhanced transcripts in whole blood of castration-resistant prostate cancer (CRPC) patients and explore its applicability as a surrogate of treatment response. METHODS Six out of twenty-three selected transcripts were identified as specific for detection of metastatic prostate cancer cells in peripheral blood using quantitative polymerase chain reaction (qPCR). Their prognostic value was explored in whole blood samples of a training cohort (n = 22 CRPC patients, New York, USA). A resulting 2-gene panel (2GP) including KLK2 and TMPRSS2 was validated in an independent cohort with pre- and post-treatment blood draws after 9-16 weeks of systemic treament (n = 86 CRPC patients, Munich, Germany). Overall survival (OS), prostate-specific antigen progression-free survival (PSA-PFS), and clinical PFS were analyzed. Kaplan-Meier and cox regression analyses were performed. RESULTS An unfavorable 2GP (≥1 marker positive) identified patients with poor survival (median OS 10.0 months [95%CI 5.7-14.2] vs. not reached; P = 0.023). This was validated in an independent cohort at pre-treatment (median OS 7.8 [95%CI 6.5-9.2] vs. 17.3 months [95%CI 10.7-23.8]; P = 0.004) and post-treatment blood draw (median OS 5.0 [95%CI 0.0-10.0] vs. 18.0 months [95%CI 9.5-26.6]; P = 0.003). The 2GP independently predicted OS on multivariate analysis (hazard ratio 2.1 [95%CI 1.1-4.0]; P = 0.034) and performed better than PSA decline at correlation with OS. Conversion to favorable 2GP during treatment correlated with improved OS (7.8 to 20.9 months), PSA-PFS (2.8 to 12.0 months), and clinical PFS (4.6 to 8.0 months). CONCLUSIONS The established 2GP is prognostic for survival at pre- and post-treatment blood draw in CRPC patients and conversion to favorable 2GP predicts treatment benefit. Prostate 76:1160-1168, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Matthias M Heck
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Mark Thalgott
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Sebastian C Schmid
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - William K Oh
- Department of Hematology/Oncology, Mount Sinai Hospital, The Tisch Cancer Institute, New York, New York
| | - Yixuan Gong
- Department of Hematology/Oncology, Mount Sinai Hospital, The Tisch Cancer Institute, New York, New York
| | - Li Wang
- Genetic and Genomic Sciences, The Tisch Cancer Institute, New York, New York
| | - Jun Zhu
- Genetic and Genomic Sciences, The Tisch Cancer Institute, New York, New York
| | - Anna-Katharina Seitz
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Desiree Porst
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Michael Höppner
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Margitta Retz
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Roman Nawroth
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, München, Germany
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49
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Kapoor A, Hotte SJ. Chemotherapy research for metastatic prostate cancer. Can Urol Assoc J 2016; 10:S140-S143. [PMID: 27895810 DOI: 10.5489/cuaj.4055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Anil Kapoor
- Professor of Surgery (Urology), McMaster University, Associate Editor (Oncology), Canadian Urological Association Journal ( CUAJ ), Hamilton, ON, Canada
| | - Sebastien J Hotte
- Associate Professor, Department of Oncology, Division of Medical Oncology, McMaster University; Medical Oncologist, Juravinski Cancer Centre, Hamilton, ON, Canada
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50
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Damodaran C, Das TP, Papu John AMS, Suman S, Kolluru V, Morris TJ, Faber EN, Rai SN, Messer JC, Alatassi H, Ankem MK. miR-301a expression: A prognostic marker for prostate cancer. Urol Oncol 2016; 34:336.e13-20. [PMID: 27133223 PMCID: PMC4967401 DOI: 10.1016/j.urolonc.2016.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/10/2016] [Accepted: 03/14/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE The diagnosis and treatment of prostate cancer (CaP) continues to be challenging, as prostate-specific antigen (PSA) appears to be overly sensitive and biopsy is the only reliable method for confirmation. Hence, the goal of the study is to identify a biomarker that could distinguish malignant cancer from benign prostatic hyperplasia (BPH) during the early diagnosis of the disease. MATERIALS AND METHODS A total of 75 formalin fixed paraffin embedded (FFPE) with matching controls, 4 paired metastatic tumors, 6 fresh tumor tissues and BPH (13 cases) with their clinical diagnosis were selected for this study. Prostate cancer cell lines and normal prostate epithelial cell lines were obtained from ATCC and subjected to phenotypic analysis. RESULTS We observed significant differential expression of miR-301a in CaP samples in comparison to BPH and adjacent benign samples. The overexpression of miR-301a activates the invasion/migration of CaP cells. In contrast, silencing miR-301a expression inhibited the colony-forming ability, adhesion, invasion and migration of CaP cells. Similarly, the overexpression of miR-301a increased cell motility in normal RWPE-1 prostate epithelial cells. Our results suggest that miR-301a is differentially expressed between BPH and CaP specimens and that the expression of miR-301a correlates with biochemical recurrence and/or metastasis in CaP patients. CONCLUSIONS The expression of miR-301a could be a potential marker for metastasis in CaP patients. Detecting miR-301a expression during diagnosis will avoid wait and watch timelines, thus preventing morbidity.
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Affiliation(s)
| | - Trinath P Das
- Department of Urology, University of Louisville, Louisville, KY
| | | | - Suman Suman
- Department of Urology, University of Louisville, Louisville, KY
| | | | | | - Erin N Faber
- Department of Pathology, University of Louisville, Louisville, KY
| | - Shesh N Rai
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY
| | - Jamie C Messer
- Department of Urology, University of Louisville, Louisville, KY
| | - Houda Alatassi
- Department of Pathology, University of Louisville, Louisville, KY
| | - Murali K Ankem
- Department of Urology, University of Louisville, Louisville, KY.
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