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Chamorey E, Pujalte-Martin M, Ferrero JM, Mahammedi H, Gravis G, Roubaud G, Beuzeboc P, Largillier R, Borchiellini D, Linassier C, Bouges H, Etienne-Grimaldi MC, Schiappa R, Gal J, Milano G. Long-Term Pharmacokinetic Follow-Up of Abiraterone Acetate in Patients with Metastatic Castration-Resistant Prostate Cancer. Int J Mol Sci 2024; 25:6058. [PMID: 38892246 PMCID: PMC11172583 DOI: 10.3390/ijms25116058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
This ABIGENE pharmacokinetic (PK) study sought mainly to characterize the unchanged drug PK during long-term abiraterone acetate (AA) administration in advanced prostate cancer patients (81 patients). It was observed that individual AA concentrations remained constant over treatment time, with no noticeable changes during repeated long-term drug administration for up to 120 days. There was no correlation between AA concentrations and survival outcomes. However, a significant association between higher AA concentrations and better clinical benefit was observed (p = 0.041). The safety data did not correlate with the AA PK data. A significant positive correlation (r = 0.40, p < 0.001) was observed between mean AA concentration and patient age: the older the patient, the higher the AA concentration. Patient age was found to impact steady-state AA concentration: the older the patient, the higher the mean AA concentration. Altogether, these data may help to guide future research and clinical trials in order to maximize the benefits of AA metastatic castration-resistant prostate cancer patients.
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Affiliation(s)
- Emmanuel Chamorey
- Epidemiology and Biostatistics Department, Centre Antoine Lacassagne, University Côte d’Azur, 06000 Nice, France (J.G.)
| | - Marc Pujalte-Martin
- Medical Oncology Department, Centre Antoine Lacassagne, University Côte d’Azur, 06000 Nice, France
| | - Jean-Marc Ferrero
- Medical Oncology Department, Centre Antoine Lacassagne, University Côte d’Azur, 06000 Nice, France
| | - Hakim Mahammedi
- Medical Oncology Department, Centre Jean Perrin, 63000 Clermond Ferrand, France
| | - Gwenaelle Gravis
- Medical Oncology Department, Institut Paoli Calmette, 13009 Marseille, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, 33076 Bordeaux, France
| | | | - Remy Largillier
- Medical Oncology Department, Centre Azuréen de Cancérologie, 06250 Mougins, France
| | - Delphine Borchiellini
- Medical Oncology Department, Centre Antoine Lacassagne, University Côte d’Azur, 06000 Nice, France
- Clinical Research Department, Centre Antoine Lacassagne, University Côte d’Azur, 06000 Nice, France
| | - Claude Linassier
- Medical Oncology Department, Centre Hospitalier Régional Universitaire, 37000 Tours, France
| | - Hélène Bouges
- Oncopharmacology Unit, Centre Antoine Lacassagne, University Côte d’Azur, 06189 Nice, France
| | | | - Renaud Schiappa
- Epidemiology and Biostatistics Department, Centre Antoine Lacassagne, University Côte d’Azur, 06000 Nice, France (J.G.)
| | - Jocelyn Gal
- Epidemiology and Biostatistics Department, Centre Antoine Lacassagne, University Côte d’Azur, 06000 Nice, France (J.G.)
| | - Gérard Milano
- Oncopharmacology Unit, Centre Antoine Lacassagne, University Côte d’Azur, 06189 Nice, France
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2
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Shen J, Chowdhury S, Agarwal N, Karsh LI, Oudard S, Gartrell BA, Feyerabend S, Saad F, Pieczonka CM, Chi KN, Brookman-May SD, Rooney B, Bhaumik A, McCarthy SA, Bevans KB, Mundle SD, Small EJ, Smith MR, Graff JN. Apalutamide efficacy, safety and wellbeing in older patients with advanced prostate cancer from Phase 3 randomised clinical studies TITAN and SPARTAN. Br J Cancer 2024; 130:73-81. [PMID: 37951974 PMCID: PMC10781967 DOI: 10.1038/s41416-023-02492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Apalutamide plus androgen-deprivation therapy (ADT) improved outcomes in metastatic castration-sensitive prostate cancer (mCSPC) and non-metastatic castration-resistant PC (nmCRPC) in the Phase 3 randomised TITAN and SPARTAN studies, respectively, and maintained health-related quality of life (HRQoL). Apalutamide treatment effect by patient age requires assessment. METHODS Post-hoc analysis assessed patients receiving 240 mg/day apalutamide (525 TITAN and 806 SPARTAN) or placebo (527 TITAN and 401 SPARTAN) with ongoing ADT, stratified by age groups. Prostate-specific antigen declines, radiographic progression-free survival, metastasis-free survival, overall survival (OS), HRQoL and safety were assessed using descriptive statistics, Kaplan-Meier method, Cox proportional-hazards model and mixed-effects model for repeated measures. RESULTS Hazard ratios (95% confidence intervals) generally favoured apalutamide plus ADT versus ADT alone across all endpoints regardless of age; e.g., OS values were 0.57 (0.40-0.80), 0.70 (0.54-0.91) and 0.74 (0.40-1.39) (TITAN) and 0.39 (0.19-0.78), 0.89 (0.69-1.16) and 0.81 (0.58-1.15) (SPARTAN) in patients aged <65, 65-79 and ≥80 years. Regardless of age, apalutamide also maintained HRQoL and was tolerated well with a potential trend in rates of adverse events increasing with age. Limitations include post-hoc nature and variability in sample size of age groups. CONCLUSIONS Apalutamide plus ADT was an effective and well-tolerated option maintaining HRQoL in patients with mCSPC and nmCRPC regardless of age. CLINICAL TRIAL REGISTRATION TITAN (NCT02489318); SPARTAN (NCT01946204).
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Affiliation(s)
- John Shen
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA.
| | - Simon Chowdhury
- Guy's, King's, and St. Thomas' Hospitals, and Sarah Cannon Research Institute, London, UK
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Stéphane Oudard
- Georges Pompidou Hospital, University of Paris Cité, Paris, France
| | | | | | - Fred Saad
- Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | | | - Kim N Chi
- BC Cancer and Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Sabine D Brookman-May
- Ludwig-Maximilians-University (LMU), Munich, Germany
- Janssen Research & Development, Spring House, PA, USA
| | | | | | | | | | | | - Eric J Small
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew R Smith
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Julie N Graff
- VA Portland Health Care System, Portland, and Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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Fontes MS, Schutz FA, de Almeida Luz M, Bomfim G, Saturnino LTM, Goncalves SC, Soler R. Treatment Patterns Among Patients With Advanced Prostate Cancer in Brazil: An Analysis of a Private Healthcare System Database. World J Oncol 2022; 13:350-358. [PMID: 36660210 PMCID: PMC9822688 DOI: 10.14740/wjon1476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/01/2022] [Indexed: 12/26/2022] Open
Abstract
Background With the ongoing expansion of life-prolonging therapies approved to treat advanced prostate cancer, there is currently an unmet need to better understand real-world treatment patterns and identify optimal treatment sequencing for men with metastatic castration-resistant prostate cancer (mCRPC). Methods In this retrospective, observational cohort analysis, patients with confirmed mCRPC were identified in the Auditron claims database and used to describe mCRPC treatment patterns and trends in the Brazilian private healthcare system from 2014 to 2019. Demographics and clinical characteristics, prostate cancer stage at diagnosis, and type and number of treatment lines were evaluated. The primary endpoint was identification of the drugs used in first-line therapies in mCRPC, and the secondary endpoint included a description of sequential lines of therapy (second and third lines) in mCRPC. Results A total of 168 electronic patient records were reviewed. Docetaxel was the most frequently used first-line treatment (35.7%), followed by abiraterone (33.3%) and enzalutamide (13.1%). Docetaxel, abiraterone, and enzalutamide also accounted for 34.6%, 28.0%, and 15.0%, respectively, of second-line therapies. In third-line therapies, cabazitaxel (26.1%), enzalutamide (23.9%), docetaxel (15.2%), and abiraterone (15.2%) were most commonly prescribed. Irrespective of stage at diagnosis, treatment patterns were similar once the disease progressed to the metastatic castration-resistance stage. Conclusions Docetaxel was the most frequently utilized therapy for mCRPC treatment, followed by abiraterone and enzalutamide. Although the current analyses provide real-world insights into treatment patterns for patients with mCRPC in Brazil, additional real-world data are needed to further validate and expand on these findings.
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Affiliation(s)
| | - Fabio A. Schutz
- Medical Oncology, Beneficencia Portuguesa de Sao Paulo, Sao Paulo 01323-001, Brazil
| | | | - Giovanni Bomfim
- Medical Affairs, Astellas Pharma Brazil, Sao Paulo - SP 04583-110, Brazil
| | | | | | - Roberto Soler
- Medical Affairs, Astellas Pharma Brazil, Sao Paulo - SP 04583-110, Brazil,Corresponding Author: Roberto Soler, Medical Affairs, Astellas Pharma Brazil, Sao Paulo - SP 04583-110, Brazil.
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Fallah J, Zhang L, Amatya A, Gong Y, King-Kallimanis B, Bhatnagar V, Weinstock C, Suzman DL, Agrawal S, Chang E, Anscher MS, Chi DC, Xu JX, Brewer JR, Brave MH, Hadadi M, Theoret MR, Kluetz PG, Goldberg KB, Ibrahim A, Tang S, Pazdur R, Beaver JA, Amiri-Kordestani L, Singh H. Survival outcomes in older men with non-metastatic castration-resistant prostate cancer treated with androgen receptor inhibitors: a US Food and Drug Administration pooled analysis of patient-level data from three randomised trials. Lancet Oncol 2021; 22:1230-1239. [PMID: 34310904 DOI: 10.1016/s1470-2045(21)00334-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Little is known about the benefit-risk profile of second-generation androgen receptor inhibitors in older men with non-metastatic castration-resistant prostate cancer. We aimed to examine the efficacy and safety of second-generation androgen receptor inhibitors in men aged 80 years or older with non-metastatic castration-resistant prostate cancer. METHODS We searched for all randomised controlled clinical trials evaluating second-generation androgen receptor inhibitors in patients with non-metastatic castration-resistant prostate cancer submitted to the US Food and Drug Administration before Aug 15, 2020, and pooled data from three trials that met the selection criteria. All three trials enrolled patients who were aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0-1, castration-resistant prostate cancer, prostate-specific antigen (PSA) 2·0 μg/L or greater, PSA doubling time of 10 months or less, and no evidence of distant metastatic disease on conventional imaging per the investigator's assessment at the time of screening. All patients had histologically or cytologically confirmed adenocarcinoma of the prostate without neuroendocrine differentiation or small-cell features. All patients who were randomly assigned to androgen receptor inhibitor or placebo groups in these trials were considered assessable and were included in this pooled analysis. We evaluated the effect of age on metastasis-free survival and overall survival across age groups (<80 years vs ≥80 years) in the intention-to-treat population. Safety analyses were done in patients who received at least one dose of study treatment. FINDINGS Between Oct 14, 2013, and March 9, 2018, 4117 patients were assigned to androgen receptor inhibitor (apalutamide, enzalutamide, or daralutamide; n=2694) or placebo (n=1423) across three randomised trials. The median follow-up duration for metastasis-free survival was 18 months (IQR 11-26) and for overall survival was 44 months (32-55). In patients aged 80 years or older (n=1023), the estimated median metastasis-free survival was 40 months (95% CI 36-41) in the androgen receptor inhibitor groups and 22 months (18-29) in the placebo groups (adjusted hazard ratio [HR] 0·37 [95% CI 0·28-0·47]), and the median overall survival was 54 months (50-61) versus 49 months (43-58), respectively (adjusted HR 0·79 [0·64-0·98]). In patients younger than 80 years of age (n=3094), the estimated median metastasis-free survival was 41 months (95% CI 36-not estimable [NE]) in the androgen receptor inhibitor groups and 16 months (15-18) in the placebo groups (adjusted HR 0·31 [95% CI 0·27-0·35]), and the median overall survival was 74 months (74-NE) versus 61 months (56-NE), respectively (adjusted HR 0·69 [0·60-0·80]). In patients aged 80 years or older, grade 3 or worse adverse events were reported in 371 (55%) of 672 patients in the androgen receptor inhibitor groups and 140 (41%) of 344 patients in the placebo groups, compared with 878 (44%) of 2015 patients in the androgen receptor inhibitor groups and 321 (30%) of 1073 patients in the placebo groups among patients younger than 80 years. The most common grade 3-4 adverse events were hypertension (168 [8%] of 2015 patients aged <80 years and 51 [8%] of 672 patients aged ≥80 years in the androgen receptor inhibitor groups vs 53 [5%] of 1073 patients aged <80 years and 22 [6%] of 344 patients aged ≥80 years in the placebo groups) and fracture (61 [3%] and 36 [5%] in the androgen receptor inhibitor groups vs 15 [1%] and 11 [3%] in the placebo groups). INTERPRETATION The findings of this pooled analysis support the use of androgen receptor inhibitors in older men with non-metastatic castration-resistant prostate cancer. Incorporating geriatric assessment tools in the care of older adults with non-metastatic castration-resistant prostate cancer might help clinicians to offer individualised treatment to each patient. FUNDING None.
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Affiliation(s)
- Jaleh Fallah
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA.
| | - Lijun Zhang
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Anup Amatya
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Yutao Gong
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Bellinda King-Kallimanis
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Vishal Bhatnagar
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Chana Weinstock
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Daniel L Suzman
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Sundeep Agrawal
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Elaine Chang
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Mitchell S Anscher
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Dow-Chung Chi
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - James X Xu
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Jamie R Brewer
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Michael H Brave
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Mehrnoosh Hadadi
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Marc R Theoret
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA; Oncology Center of Excellence, Food and Drug Administration, Silver Spring, MD, USA
| | - Paul G Kluetz
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA; Oncology Center of Excellence, Food and Drug Administration, Silver Spring, MD, USA
| | - Kirsten B Goldberg
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA; Oncology Center of Excellence, Food and Drug Administration, Silver Spring, MD, USA
| | - Amna Ibrahim
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Shenghui Tang
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Richard Pazdur
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA; Oncology Center of Excellence, Food and Drug Administration, Silver Spring, MD, USA
| | - Julia A Beaver
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA; Oncology Center of Excellence, Food and Drug Administration, Silver Spring, MD, USA
| | - Laleh Amiri-Kordestani
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA
| | - Harpreet Singh
- Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Food and Drug Administration, Silver Spring, MD, USA; Oncology Center of Excellence, Food and Drug Administration, Silver Spring, MD, USA
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Efficacy and Safety of Cabazitaxel Versus Abiraterone or Enzalutamide in Older Patients with Metastatic Castration-resistant Prostate Cancer in the CARD Study. Eur Urol 2021; 80:497-506. [PMID: 34274136 DOI: 10.1016/j.eururo.2021.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/28/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND In the CARD study (NCT02485691), cabazitaxel significantly improved median radiographic progression-free survival (rPFS) and overall survival (OS) versus abiraterone/enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) who had previously received docetaxel and progressed ≤12 mo on the alternative agent (abiraterone/enzalutamide). OBJECTIVE To assess cabazitaxel versus abiraterone/enzalutamide in older (≥70 yr) and younger (<70 yr) patients in CARD. DESIGN, SETTING, AND PARTICIPANTS Patients with mCRPC were randomized 1:1 to cabazitaxel (25 mg/m2 plus prednisone and granulocyte colony-stimulating factor) versus abiraterone (1000 mg plus prednisone) or enzalutamide (160 mg). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Analyses of rPFS (primary endpoint) and safety by age were prespecified; others were post hoc. Treatment groups were compared using stratified log-rank or Cochran-Mantel-Haenszel tests. RESULTS AND LIMITATIONS Of the 255 patients randomized, 135 were aged ≥70 yr (median 76 yr). Cabazitaxel, compared with abiraterone/enzalutamide, significantly improved median rPFS in older (8.2 vs 4.5 mo; hazard ratio [HR] = 0.58; 95% confidence interval [CI] = 0.38-0.89; p = 0.012) and younger (7.4 vs 3.2 mo; HR = 0.47; 95% CI = 0.30-0.74; p < 0.001) patients. The median OS of cabazitaxel versus abiraterone/enzalutamide was 13.9 versus 9.4 mo in older patients (HR = 0.66; 95% CI = 0.41-1.06; p = 0.084), and it was 13.6 versus 11.8 mo in younger patients (HR = 0.66; 95% CI = 0.41-1.08; p = 0.093). Progression-free survival, prostate-specific antigen, and tumor and pain responses favored cabazitaxel, regardless of age. Grade ≥3 treatment-emergent adverse events (TEAEs) occurred in 58% versus 49% of older patients receiving cabazitaxel versus abiraterone/enzalutamide and 48% versus 42% of younger patients. In older patients, cardiac adverse events were more frequent with abiraterone/enzalutamide; asthenia and diarrhea were more frequent with cabazitaxel. CONCLUSIONS Cabazitaxel improved efficacy outcomes versus abiraterone/enzalutamide in patients with mCRPC after prior docetaxel and abiraterone/enzalutamide, regardless of age. TEAEs were more frequent among older patients. The cabazitaxel safety profile was manageable across age groups. PATIENT SUMMARY Clinical trial data showed that cabazitaxel improved survival versus abiraterone/enzalutamide with manageable side effects in patients with metastatic castration-resistant prostate cancer who had previously received docetaxel and the alternative agent (abiraterone/enzalutamide), irrespective of age.
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6
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Feng Z, Graff JN. Next-Generation Androgen Receptor-Signaling Inhibitors for Prostate Cancer: Considerations for Older Patients. Drugs Aging 2021; 38:111-123. [DOI: 10.1007/s40266-020-00809-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 12/22/2022]
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Malik Z, Di Lorenzo G, Pichler A, De Giorgi U, Hitier S, Ecstein-Fraisse E, Ozatilgan A, Carles J. Effect of Baseline Characteristics on Cabazitaxel Treatment Duration in Patients with Metastatic Castration-Resistant Prostate Cancer: A Post Hoc Analysis of the Compassionate Use/Expanded Access Programs and CAPRISTANA Registry. Cancers (Basel) 2020; 12:cancers12040995. [PMID: 32316580 PMCID: PMC7226228 DOI: 10.3390/cancers12040995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023] Open
Abstract
We examined factors that may impact cabazitaxel treatment duration in a real-life setting in a compassionate use program, expanded access program, and prospective observational study in metastatic castration-resistant prostate cancer (mCRPC). Patients with mCRPC previously treated with docetaxel (N = 1,621) received cabazitaxel 25 mg/m2 intravenously every 3 weeks until disease progression, death, unacceptable toxicity or physician/patient decision. The median number of cabazitaxel cycles was six (range, 1-49); 708 patients (43.7%) received >6 cycles. Patients receiving >6 cycles tended to have a better Eastern Cooperative Oncology Group performance status of 0-1 (p = 0.0017 for ≤6 vs. >6 cycles). Overall, 348 patients (21.5%) were ≥75 years of age; 139 (39.9%) received >6 cycles. The main reason for discontinuation was disease progression; however, in patients receiving 1-2 cycles, the main reason for discontinuation was adverse events. Only 52 patients (3.2%) progressed during cycles 1-2. Cabazitaxel was well tolerated in these studies, which included some elderly and frail patients, offering clinicians an important treatment option in the management of mCRPC. Proactive management of adverse events may allow patients to receive a higher number of cabazitaxel cycles and derive greater benefit.
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Affiliation(s)
- Zafar Malik
- Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral CH63 4JY, UK
- Correspondence:
| | - Giuseppe Di Lorenzo
- Department of Medicine and Health Sciences ‘Vincenzo Tiberio’, University of Molise, 86100 Campobasso, Italy
- Medical Oncology, Tortora Hospital, 84016 Pagani, Salerno, Italy
| | - Angelika Pichler
- Department of Hematology and Oncology, Regional Hospital Hochsteiermark, 8700 Leoben, Austria
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - Simon Hitier
- Department of Biostatistics, Sanofi, 91380 Chilly-Mazarin, France
| | | | - Ayse Ozatilgan
- Global Medical Affairs Oncology, Sanofi, Cambridge, MA 02142, USA
| | - Joan Carles
- Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
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8
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Nieder C, Dalhaug A, Haukland E. Feasibility and efficacy of sequential systemic therapy for metastatic castration-resistant prostate cancer in a rural health care setting. Scand J Urol 2020; 54:110-114. [PMID: 32091322 DOI: 10.1080/21681805.2020.1730435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: The aim of this study was to evaluate the feasibility and efficacy, in terms of overall survival, of sequential systemic therapy in patients with metastatic castration-resistant prostate cancer (MCRPC) who lived in Nordland County, Norway, a large region with a challenging geography, yet only one department of oncology located in the main city, Bodø.Patients and methods: Overall 77 patients who had received at least 2 lines of treatment were included in this retrospective study.Results: Management included docetaxel in 69 patients (90%), often prescribed in first line. Only 12 patients (16%) started their treatment with a sequence of two endocrine drugs (enzalutamide or abiraterone acetate). Thirty-two patients (42%) were not eligible for treatment beyond second line, while 31 (40%) received 3 lines, and 14 (18%) more than 3 lines (for example cabazitaxel or Ra-223). Distance to the department of oncology did not predict for treatment with more than 2 lines. Only two factors were statistically significant: age <75 years and not initiating treatment with two lines of endocrine drugs. Survival increased with increasing number of lines of treatment. None of the five individual drugs available to these patients was significantly associated with survival.Conclusions: There was no indication toward under-treatment with systemic therapy among patients from the distant regions. Sequential treatment was feasible and survival increased with each additional line.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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Halwani AS, Rasmussen KM, Patil V, Li CC, Yong CM, Burningham Z, Gupta S, Narayanan S, Lin SW, Carroll S, Mhatre SK, Graff JN, Dreicer R, Sauer BC. Real-world practice patterns in veterans with metastatic castration-resistant prostate cancer. Urol Oncol 2019; 38:1.e1-1.e10. [PMID: 31704142 DOI: 10.1016/j.urolonc.2019.09.027] [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] [Received: 09/19/2018] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Metastatic castration-resistant prostate cancer (mCRPC) is incurable, with most patients surviving less than 3 years. However, many treatments that extend survival have been approved in the past decade. OBJECTIVE To describe the patient demographics, disease characteristics, treatment patterns, and outcomes in a cohort of Veterans diagnosed with mCRPC in the Veterans Health Administration. DESIGN We identified 3,637 Veterans diagnosed with prostate cancer between January 2006 and August 2015 with evidence of mCRPC through December 2016. We described the most commonly used systemic mCRPC treatments according to mCRPC diagnosis era: Epoch 1 (2006-2010) or Epoch 2 (2011-2016). Patient demographics, disease characteristics, and treatment patterns were examined using descriptive statistics. An unadjusted Kaplan-Meier method was used to estimate the median time to biochemical progression and overall survival (OS) with 95% confidence intervals. RESULTS The median age at initial prostate cancer diagnosis was 68 years. Approximately 67% of patients were non-Hispanic white, 29% were black, and 4% were other/unknown. A high-risk Gleason score (8-10) was reported in 748 (67%) of patients in Epoch 1 and 1578 (63%) of patients in Epoch 2, and the median prostate-specific antigen level at initial prostate cancer diagnosis was higher in Epoch 1 patients than in Epoch 2 patients (68 vs. 35 ng/ml). Following mCRPC diagnosis, the most common first-line therapies in Epoch 1 patients were docetaxel (83%) and abiraterone (9%), whereas Epoch 2 patients mainly received abiraterone (47%), docetaxel (36%), and enzalutamide (15%). In Epoch 1 and Epoch 2 patients, the median time to biochemical progression (unadjusted) was 9 and 13 months, respectively, and the median OS (unadjusted) was 15 and 23 months, respectively. CONCLUSIONS The introduction of new therapies has resulted in increased use of the noncytotoxic agents abiraterone and enzalutamide as first-line treatment in lieu of docetaxel. Our results suggest that more recently diagnosed patients (Epoch 2) have a delayed time to biochemical progression and longer OS (unadjusted) compared with patients diagnosed earlier (Epoch 1).
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Affiliation(s)
- Ahmad S Halwani
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - Kelli M Rasmussen
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT.
| | - Vikas Patil
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | - Catherine C Li
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | - Christina M Yong
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | - Zachary Burningham
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT
| | - Sumati Gupta
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Shih-Wen Lin
- Genentech, Inc, South San Francisco, California, FL
| | | | | | - Julie N Graff
- Oregon Health & Science University, Knight Cancer Center, Portland, OR
| | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, VA
| | - Brian C Sauer
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT; University of Utah, Salt Lake City, UT
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