1
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Shore ND, Laliberté F, Ionescu-Ittu R, Yang L, Mahendran M, Lejeune D, Yu LH, Burgents J, Duh MS, Ghate SR. Real-World Treatment Patterns and Overall Survival of Patients with Metastatic Castration-Resistant Prostate Cancer in the US Prior to PARP Inhibitors. Adv Ther 2021; 38:4520-4540. [PMID: 34282527 PMCID: PMC8342357 DOI: 10.1007/s12325-021-01823-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/08/2021] [Indexed: 12/19/2022]
Abstract
Introduction Therapeutic options for metastatic castration-resistant prostate cancer (mCRPC) patients are continuously advancing. We described mCRPC treatment patterns in the US from 2013 to 2019. Methods Patients with a confirmed mCRPC diagnosis and adenocarcinoma histology were included in the US Flatiron Health Electronic Health Record-derived de-identified database. Treatment patterns [including treatment per lines of therapies (LOTs), LOT sequences, and time on treatment] and overall survival (OS) have been described in mCRPC settings. Results Of 5213 patients (mean age: 72.6 years), 4374 (83.9%) were treated with ≥ 1 LOT post-mCRPC diagnosis (among those with ≥ 1 LOT, 55.3%, 29.5%, 14.7%, and 6.7% had ≥ 2, 3, 4, and 5 LOTs, respectively). In first line (1L), the main treatment class was next-generation hormonal agents (NHA; 62.5% of patients with ≥ 1 LOT), while the shortest and longest time on 1L were observed for chemotherapy (median 2.8 months) and NHA (median 5.1 months), respectively. The most common LOT sequences were NHA → NHA (29.4% of patients with ≥ 2 LOTs) and NHA → NHA → chemotherapy (16.7% of patients with ≥ 3 LOTs). In Kaplan–Meier analyses, the median OS was 19.4, 14.6, and 11.1 months post-1L, 2L, and 3L start, respectively. Patients who moved rapidly through LOTs had an increased risk of death. Conclusions NHA were widely used as 1L therapy in mCRPC patients from 2013 to 2019, but time on 1L NHA treatment was on average < 6 months. While NHA → NHA was the most observed 1L → 2L LOT sequence, a plethora of other LOT sequences were observed. OS was poor, highlighting an unmet need for life-prolonging treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01823-6.
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Affiliation(s)
- Neal D Shore
- Carolina Urologic Research Center, 823 82nd Pkwy Suite b, Myrtle Beach, SC, 29572, USA
| | - François Laliberté
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Raluca Ionescu-Ittu
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC, H3B 0G7, Canada.
| | - Lingfeng Yang
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | - Malena Mahendran
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Dominique Lejeune
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Louise H Yu
- Analysis Group, Inc, 111 Huntington Ave 14th Floor, Boston, MA, 02199, USA
| | - Joseph Burgents
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | - Mei Sheng Duh
- Analysis Group, Inc, 111 Huntington Ave 14th Floor, Boston, MA, 02199, USA
| | - Sameer R Ghate
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
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2
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Liu Y, Gu Y, Fu Z, Xu Y, Wu X, Chen J. T7-Functionalized Cationic Peptide as a Nanovehicle for Co-delivering Paclitaxel and siR-MeCP2 to Target Androgen-Dependent and Androgen Independent Prostate Cancer. ACS APPLIED BIO MATERIALS 2021. [DOI: 10.1021/acsabm.0c01350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ying Liu
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai 200030, P. R. China
| | - Yongwei Gu
- Department of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350108, P. R. China
- Shanghai Wei Er Biopharmaceutical Technology Co., Ltd., Shanghai 201799, P. R. China
| | - Zhiqin Fu
- Department of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350108, P. R. China
- Shanghai Wei Er Biopharmaceutical Technology Co., Ltd., Shanghai 201799, P. R. China
| | - Youfa Xu
- Department of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350108, P. R. China
- Shanghai Wei Er Biopharmaceutical Technology Co., Ltd., Shanghai 201799, P. R. China
| | - Xin Wu
- Department of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350108, P. R. China
- Shanghai Wei Er Biopharmaceutical Technology Co., Ltd., Shanghai 201799, P. R. China
| | - Jianming Chen
- Department of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350108, P. R. China
- Shanghai Wei Er Biopharmaceutical Technology Co., Ltd., Shanghai 201799, P. R. China
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3
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Barber TW, Singh A, Kulkarni HR, Niepsch K, Billah B, Baum RP. Clinical Outcomes of 177Lu-PSMA Radioligand Therapy in Earlier and Later Phases of Metastatic Castration-Resistant Prostate Cancer Grouped by Previous Taxane Chemotherapy. J Nucl Med 2019; 60:955-962. [PMID: 30683770 DOI: 10.2967/jnumed.118.216820] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/28/2018] [Indexed: 11/16/2022] Open
Abstract
177Lu-labeled prostate-specific membrane antigen (PSMA) radioligand therapy using PSMA-617 and PSMA-I&T ligands (177Lu-PRLT) is an emerging treatment in metastatic castration-resistant prostate cancer (mCRPC). This retrospective study evaluates clinical outcomes of 177Lu-PRLT in earlier and later phases of mCRPC grouped by previous taxane chemotherapy. Methods: A retrospective analysis was performed on 167 patients with mCRPC who underwent 177Lu-PRLT between March 2013 and December 2016. Patients were classified as either taxane chemotherapy pretreated (T-pretreated) or naïve (T-naïve) depending on whether they had received taxane-based chemotherapy prior to 177Lu-PRLT. Clinical outcome for T-pretreated and T-naïve patients was assessed by overall survival (OS), radiographic progression-free survival, and prostate-specific antigen (PSA) response rate. Univariate and multivariable analyses were performed for both T-pretreated and T-naïve patients to determine predictors of outcome. Toxicity was categorized by the Common Terminology Criteria for Adverse Events (version 4.03). Results: Of the 167 patients treated with 177Lu-PRLT, 83 were T-pretreated and 84 were T-naïve. At baseline, T-pretreated patients had overall poorer performance status, a higher prevalence of bone metastases, higher PSA levels, lower hemoglobin levels, higher alkaline phosphatase (ALP) levels and had received more additional therapies compared with T-naïve patients. Median OS was 10.7 mo for T-pretreated patients and 27.1 mo for T-naïve patients. Median radiographic progression-free survival was 6.0 mo for T-pretreated patients and 8.8 mo for T-naïve patients. PSA response assessment was evaluable in 132 patients and seen in 25 of 62 (40%) T-pretreated patients and 40 of 70 (57%) T-naïve patients. Significant determinates of inferior OS in multivariable analysis for T-pretreated patients were poorer performance status, lower cumulative administered activity, and lower baseline hemoglobin. Higher baseline alkaline phosphatase was the only significant determinate of inferior OS in multivariable analysis for T-naïve patients. Overall 177Lu-PRLT was safe, with minimal adverse effects evident during follow-up in both T-pretreated and T-naïve patients. Conclusion: 177Lu-PRLT is a promising therapy in mCRPC, with encouraging outcomes and minimal associated toxicity seen in both our T-naïve and heavily pretreated patient cohorts.
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Affiliation(s)
- Thomas W Barber
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Australia .,Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, Australia
| | - Aviral Singh
- Theranostics Center for Molecular Radiotherapy and Precision Oncology, Zentralklinik Bad Berka, Bad Berka, Germany.,GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands; and
| | - Harshad R Kulkarni
- Theranostics Center for Molecular Radiotherapy and Precision Oncology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Karin Niepsch
- Theranostics Center for Molecular Radiotherapy and Precision Oncology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital Campus, Melbourne, Australia
| | - Richard P Baum
- Theranostics Center for Molecular Radiotherapy and Precision Oncology, Zentralklinik Bad Berka, Bad Berka, Germany
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4
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Liu Y, Uemura H, Ye D, Lee JY, Chiong E, Pu YS, Razack AHA, Pripatnanont C, Rawal S, Low GKM, Qiu H, Chow WH, Van Kooten Losio M. Prostate cancer in Asia: design of a patient registry to inform real-world treatments, outcomes, and quality of life. Prostate Int 2018; 7:108-113. [PMID: 31485435 PMCID: PMC6713796 DOI: 10.1016/j.prnil.2018.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/14/2018] [Accepted: 12/08/2018] [Indexed: 11/26/2022] Open
Abstract
Background The incidence of prostate cancer (PC) in Asian countries is increasing for reasons that are not clear. Data describing how PC is diagnosed and treated are fragmented across Asia, with marked intercountry and intracountry differences in outcome and knowledge gaps in clinical diagnostic and treatment practices. To address these knowledge gaps, we have established a PC disease registry with the aim of providing a comprehensive picture of PC diagnosis, prognosis, treatment and outcome, population characteristics, and comorbidities in real-world clinical practice in Asia. Methods This is a multinational, multicenter, longitudinal, and observational registry of PC patients presenting to participating tertiary-care hospitals in eight Asian countries (www.clinicaltrials.gov NCT02546908. Registry Identifier: NOPRODPCR4001). Approximately 3500-4000 eligible patients with existing or newly diagnosed high-risk localized PC (cohort 1), nonmetastatic biochemically recurrent PC (cohort 2), or metastatic PC (cohort 3) will be consecutively enrolled and followed-up for 5 years. An enrollment cap of 600 patients each will be applied to cohorts 1 and 2. Disease status is collected at enrollment, and outcome variables captured at 3-monthly intervals include diagnostic/staging, treatments including reason for change, laboratory results, comorbidities, and concomitant medications. Treatments and survival outcomes will be captured real time until study end. Patient-reported quality-of-life will be measured every 6 months, and medical resource utilization summarized at study end. Data analysis will include exploratory analyses of potential associations between multiple risk factors and socioeconomic variables with disease progression and evaluation of various treatments for PC including novel therapies on clinical outcome and health-related quality-of-life outcomes. Results 3636 men with PC were enrolled until July 2018; 416 in cohort 1, 399 in cohort 2 and 2821 in cohort 3. Discussion A total of 3636 patients were enrolled until July 2018. The prospective disease registry will provide comprehensive and wide-ranging real-world information on how PC is diagnosed and treated in Asia. Such information can be used to inform policy development for best practice and direct clinical study design evaluating new treatments.
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Affiliation(s)
- Yanfang Liu
- Janssen Research and Development, Titusville, NJ 08560, United States
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Hospital, Osaka 589-8511, Japan
| | - Dingwei Ye
- Fudan University Shang Hai Cancer Center, Xuhui District, 200032, China
| | - Ji Y Lee
- The Catholic University of Korea, Seoul St.Mary's Hospital, 06591 Seoul, Korea
| | - Edmund Chiong
- Department of Urology, National University Health System, Singapore
| | - Yeong-S Pu
- Department of Urology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Azad H A Razack
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603 Malaysia
| | - Choosak Pripatnanont
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand
| | - Sudhir Rawal
- Rajeev Gandhi Cancer Institutes, 110085, New Delhi, India
| | - Grace K M Low
- Janssen Research and Development, Epidemiology, Ascent, 118222, Singapore
| | - Hong Qiu
- Janssen Research and Development, Titusville, NJ 08560, United States
| | - Weng H Chow
- Janssen Research and Development, Epidemiology, Ascent, 118222, Singapore
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5
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Quality of Health Information on the Internet for Prostate Cancer. Adv Urol 2018; 2018:6705152. [PMID: 30627152 PMCID: PMC6305048 DOI: 10.1155/2018/6705152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction To compare (1) the quality of prostate cancer health information on the Internet, (2) the difference in quality between websites appearing earlier or later in the search, and (3) the sources of sponsorship for each of these websites. Materials and methods The top 150 listed websites on the Google search engine for each of the 11 search terms related to prostate cancer were analysed. Quality was assessed on whether the website conforms to the principles of the Health On the Net Foundation. Each of these websites was then reviewed to determine the main source of sponsorship. Statistical analysis was performed to determine if the proportion of HON accreditation varied among the different cohorts of listed websites and among the 11 search terms used. Results In total, 1650 websites were analysed. Among these, 10.5% websites were HON-accredited. The proportion of HON-accredited websites for individual search terms ranged from 3.3% to 19.3%. In comparison with the search term of "Prostate cancer," four search terms had statistically significant odds ratio of the rate of HON accreditation. Websites 51-150 were statistically less likely to have HON accreditation than websites 1-50. The top three website sponsors were journal/universities (28.8%), commercial (28.1%), and physician/surgeon (26.9%). Conclusions The lack of validated and unbiased websites for prostate cancer is concerning especially with increasing use of the Internet for health information. Websites sponsored or managed by the government and national departments were most likely to provide impartial health information for prostate cancer. We need to help our patients identify valid and unbiased online health resources.
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6
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Abdallah AO, Coleman H, Kamel M, Davis R, Landrum T, Spencer H, Mackintosh S, Mahmoud FA, Milojkovic N, Wicker C, Arnaoutakis K, Nakagawa M. A novel prostate cancer immunotherapy using prostate-specific antigen peptides and Candida skin test reagent as an adjuvant. SAGE Open Med 2018; 6:2050312118800202. [PMID: 30245818 PMCID: PMC6144584 DOI: 10.1177/2050312118800202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/21/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Our group developed the use of the Candida skin test reagent as an adjuvant of cell-mediated immunity in designing a human papillomavirus therapeutic vaccine. Here, this technology is being applied for designing a prostate cancer immunotherapy. METHODS Peptides based on the prostate-specific antigen amino acid sequences were selected, synthesized, and evaluated in terms of their (1) solubility, (2) maturation effects on Langerhans cells by fluorescence-activated cell sorter analysis, and (3) recognition by peripheral immune cells from prostate cancer patients using interferon-γ enzyme-linked immunospot assay. RESULTS The peptides were soluble in 10 mM succinate at pH of 5 with 5% glycine, and they demonstrated no maturation effects on Langerhans cells from healthy donors. On the other hand, peripheral immune cells from 4 of 10 prostate cancer patients examined had positive responses in enzyme-linked immunospot assay to one or more prostate-specific antigen peptides. CONCLUSION In summary, a design and a formulation of a novel prostate cancer immunotherapy are described. The immunogenicity of prostate-specific antigen peptides in some prostate cancer patients supports further development of this immunotherapy.
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Affiliation(s)
- Al-Ola Abdallah
- Department of Internal Medicine, College
of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Division of Hematologic Malignancies and
Cellular Therapeutics, Department of Internal Medicine, School of Medicine, Kansas
University Medical Center, Kansas City, KS, USA
| | - Hannah Coleman
- Department of Pathology, College of
Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mohamed Kamel
- Department of Urology, College of
Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Urology, Ain Shams
University, Cairo, Egypt
| | - Rodney Davis
- Department of Urology, College of
Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Teri Landrum
- Division of Hematology and Oncology,
Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical
Sciences, Little Rock, AR, USA
| | - Horace Spencer
- Department of Biostatistics, College of
Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sam Mackintosh
- Department of Biochemistry and Molecular
Biology, College of Medicine, University of Arkansas for Medical Sciences, Little
Rock, AR, USA
| | - Fade A Mahmoud
- Department of Internal Medicine, College
of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Natasa Milojkovic
- Department of Internal Medicine, College
of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Chester Wicker
- Division of Hematology and Oncology,
Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical
Sciences, Little Rock, AR, USA
| | - Konstantinos Arnaoutakis
- Department of Internal Medicine, College
of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mayumi Nakagawa
- Department of Pathology, College of
Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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7
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Eckert F, Schaedle P, Zips D, Schmid-Horch B, Rammensee HG, Gani C, Gouttefangeas C. Impact of curative radiotherapy on the immune status of patients with localized prostate cancer. Oncoimmunology 2018; 7:e1496881. [PMID: 30393582 PMCID: PMC6208674 DOI: 10.1080/2162402x.2018.1496881] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 12/30/2022] Open
Abstract
Combination of radiotherapy with immunotherapy has become an attractive concept for the treatment of cancer. The objective of this study was to assess the effect of curative, normofractionated radiotherapy on peripheral immune lymphocytes in prostate cancer patients, in order to propose a rationale for scheduling of normofractionated radiotherapy with T-cell based immunotherapy. In a prospective study (clinicaltrials.gov: NCT01376674), eighteen patients with localized prostate cancer were treated with radiotherapy with or without hormonal therapy. Irradiation volumes encompassed prostate and, in select cases, elective pelvic nodal regions. Blood samples were collected from all patients before, during, and after radiotherapy, as well as from 6 healthy individuals as control. Normofractionated radiotherapy of prostate cancer over eight weeks had a significant influence on the systemic immune status of patients compared to healthy controls. Absolute leukocyte and lymphocyte counts decreased during treatment as did peripheral blood immune subsets (T cells, CD8+ and naïve CD4+ T cells, B cells). Regulatory T cells and NK cells increased. Proliferation of all immune cells except regulatory T cells increased during RT. Most of these changes were transient. Importantly, the functionality of T lymphocytes and the frequency of antigen-specific CD8+ T cells were not affected during therapy. Our data indicate that combination of normofractionated radiotherapy with immunotherapy might be feasible for patients with prostate cancer. Conceptually, beginning with immunotherapy early during the course of radiotherapy could be beneficial, as the percentage of T cells is highest, the percentage of regulatory T cells is lowest, and as the effects of radiotherapy did not completely subside 3 months after end of radiotherapy.
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Affiliation(s)
- Franziska Eckert
- Department of Radiation Oncology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Partner Site Tuebingen, Tuebingen, Germany
| | - Philipp Schaedle
- Department of Radiation Oncology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
- Interfaculty Institute for Cell Biology, Department of Immunology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
- Department for Internal Medicine I, Marienhospital Stuttgart, Stuttgart, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Partner Site Tuebingen, Tuebingen, Germany
| | - Barbara Schmid-Horch
- Institute for Clinical and Experimental Transfusion Medicine, University Hospital Tuebingen, Eberhard-Karls-University, Tuebingen, Germany
| | - Hans-Georg Rammensee
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Partner Site Tuebingen, Tuebingen, Germany
- Interfaculty Institute for Cell Biology, Department of Immunology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Partner Site Tuebingen, Tuebingen, Germany
| | - Cécile Gouttefangeas
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Partner Site Tuebingen, Tuebingen, Germany
- Interfaculty Institute for Cell Biology, Department of Immunology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
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8
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Riva G, Marvaso G, Augugliaro M, Zerini D, Fodor C, Musi G, De Cobelli O, Orecchia R, Jereczek-Fossa BA. Cytoreductive prostate radiotherapy in oligometastatic prostate cancer: a single centre analysis of toxicity and clinical outcome. Ecancermedicalscience 2017; 11:786. [PMID: 29225693 PMCID: PMC5718249 DOI: 10.3332/ecancer.2017.786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Indexed: 12/30/2022] Open
Abstract
Objectives The current standard of care for patients with metastatic prostate cancer (mPCa) at diagnosis is androgen deprivation therapy (ADT) with or without anti-androgen and chemotherapy. The aim of this study was to define the role of a local radiotherapy (RT) treatment in the mPCa setting. Methods We retrospectively reviewed data of patients with PCa and bone oligometastases at diagnosis treated in our institution with ADT followed by cytoreductive prostate-RT with or without RT on metastases. Biochemical and clinical failure (BF, CF), overall survival (OS) and RT-toxicity were assessed. Results We identified 22 patients treated with ADT and external-beam RT on primary between June 2008 and March 2016. All of them but four were also treated for bone metastases. RT on primary with moderately and extremely hypofractionated regimes started after 10.3 months (3.9–51.7) from ADT. After a median follow-up of 26.4 months (10.3–55.5), 20 patients are alive. Twelve patients showed BF after a median time of 23 months (14.5–104) and CF after a median of 23.6 months (15.3–106.1) from the start of ADT. Three patients became castration resistant, starting a new therapy; median time to castration resistance was 31.03 months (range: 29.9–31.5 months). According to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC), only one patient developed acute grade 3 genitourinary toxicity. No late grade >2 adverse events were observed. Conclusion Prostate RT in oligometastatic patients is safe and offers long-lasting local control. When compared to ADT alone, RT on primary seems to improve biochemical control and long-term survival; however, this hypothesis should be investigated in prospective studies. Further research is warranted.
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Affiliation(s)
- Giulia Riva
- Department of Radiotherapy, European Institute of Oncology, 20141 Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giulia Marvaso
- Department of Radiotherapy, European Institute of Oncology, 20141 Milan, Italy
| | - Matteo Augugliaro
- Department of Radiotherapy, European Institute of Oncology, 20141 Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Dario Zerini
- Department of Radiotherapy, European Institute of Oncology, 20141 Milan, Italy
| | - Cristiana Fodor
- Department of Radiotherapy, European Institute of Oncology, 20141 Milan, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Roberto Orecchia
- Scientific Direction, European Institute of Oncology, 20141 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, 20141 Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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9
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Porter LH, Hashimoto K, Lawrence MG, Pezaro C, Clouston D, Wang H, Papargiris M, Thorne H, Li J, Ryan A, Norden S, Moon D, Bolton DM, Sengupta S, Frydenberg M, Murphy DG, Risbridger GP, Taylor RA. Intraductal carcinoma of the prostate can evade androgen deprivation, with emergence of castrate-tolerant cells. BJU Int 2017; 121:971-978. [DOI: 10.1111/bju.14043] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Laura H. Porter
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Prostate Cancer Research Program; Cancer Research Division; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Kohei Hashimoto
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Hokkaido Japan
| | - Mitchell G. Lawrence
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Prostate Cancer Research Program; Cancer Research Division; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Carmel Pezaro
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Eastern Health Clinical School; Monash University; Melbourne Vic. Australia
| | | | - Hong Wang
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
| | - Melissa Papargiris
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Australian Prostate Cancer Bioresource; Victorian Node; Monash University; Melbourne Vic. Australia
| | - Heather Thorne
- kConFab, Research Department; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Vic. Australia
| | - Jason Li
- Bioinformatics Core; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | | | - Sam Norden
- TissuPath; Mount Waverley Vic. Australia
| | - Daniel Moon
- Epworth Healthcare; Richmond Vic. Australia
- Central Clinical School; Monash University; Melbourne Vic. Australia
| | - Damien M. Bolton
- Department of Urology; Austin Hospital, Melbourne; Heidelberg Vic. Australia
- Department of Surgery; University of Melbourne; Melbourne Vic. Australia
| | - Shomik Sengupta
- Department of Urology; Austin Hospital, Melbourne; Heidelberg Vic. Australia
- Department of Surgery; University of Melbourne; Melbourne Vic. Australia
| | - Mark Frydenberg
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Department of Surgery; Monash University; Melbourne Vic. Australia
| | - Declan G. Murphy
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Vic. Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Gail P. Risbridger
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Prostate Cancer Research Program; Cancer Research Division; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Renea A. Taylor
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Department of Physiology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
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10
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Hegde JV, Demanes DJ, Veruttipong D, Raince J, Park SJ, Raman SS, Nickols NG, King CR, Kishan AU, Steinberg ML, Kamrava M. Pretreatment 3T multiparametric MRI staging predicts for biochemical failure in high-risk prostate cancer treated with combination high-dose-rate brachytherapy and external beam radiotherapy. Brachytherapy 2017; 16:1106-1112. [PMID: 28807747 DOI: 10.1016/j.brachy.2017.07.008] [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: 06/05/2017] [Revised: 07/02/2017] [Accepted: 07/13/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether pretreatment 3T multiparametric MRI (mpMRI) staging impacts biochemical recurrence-free survival (BRFS) or distant metastasis-free survival (DMFS) for men with high-risk prostate cancer treated with combination high-dose-rate (HDR) brachytherapy and external beam radiation therapy (EBRT). MATERIALS AND METHODS This institutional review board-approved retrospective study included a cohort of 37 men with high-risk prostate cancer treated with HDR brachytherapy and EBRT after 3T mpMRI. Kaplan-Meier analysis was used to evaluate whether mpMRI evidence of extracapsular extension or seminal vesicle invasion (SVI) resulted in differences in BRFS or DMFS. Pretreatment and treatment-related variables were evaluated for association with biochemical failure (Phoenix definition) and distant metastatic failure using univariate Cox regression analysis. RESULTS The median prostate-specific antigen at diagnosis was 9 ng/mL (range 2-100). Biopsy Gleason score (bGS) was ≤8 in 38% and nine in 62%. Clinical T-category was T1-T2 in 89%, T3a in 8%, and T3b in 3%. With a median followup of 30.6 months, actuarial 3-year BRFS and DMFS were 76% and 86%, respectively. Kaplan-Meier analysis revealed that mpMRI evidence of extracapsular extension or SVI resulted in significantly higher rates of both biochemical recurrence and distant failure. Using Cox regression analysis, only mpMRI evidence of SVI vs. no SVI predicted for biochemical failure (hazard ratio 13.98, p = 0.0055). CONCLUSIONS For high-risk prostate cancer treated with combination HDR brachytherapy and EBRT, mpMRI evidence of SVI predicted for biochemical failure, whereas traditional pretreatment variables did not. Therefore, pretreatment 3T mpMRI appears useful for identifying men who may benefit from treatment intensification.
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Affiliation(s)
- John V Hegde
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
| | - D Jeffrey Demanes
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Darlene Veruttipong
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Jagdeep Raince
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Sang-June Park
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Steven S Raman
- Departments of Radiology, Urology, and Surgery, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Nicholas G Nickols
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Christopher R King
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA
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11
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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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