1
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Scher HI, Armstrong AJ, Schonhoft JD, Gill A, Zhao JL, Barnett E, Carbone E, Lu J, Antonarakis ES, Luo J, Tagawa S, Dos Anjos CH, Yang Q, George D, Szmulewitz R, Danila DC, Wenstrup R, Gonen M, Halabi S. Development and validation of circulating tumour cell enumeration (Epic Sciences) as a prognostic biomarker in men with metastatic castration-resistant prostate cancer. Eur J Cancer 2021; 150:83-94. [PMID: 33894633 DOI: 10.1016/j.ejca.2021.02.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/09/2021] [Accepted: 02/20/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the prognostic significance of circulating tumour cell (CTC) number determined on the Epic Sciences platform in men with metastatic castration-resistant prostate cancer (mCRPC) treated with an androgen receptor signalling inhibitor (ARSI). PATIENTS AND METHODS A pre-treatment blood sample was collected from men with progressing mCRPC starting either abiraterone or enzalutamide as a first-, second- or third-line systemic therapy at Memorial Sloan Kettering Cancer Center (Discovery cohort, N = 171) or as a first- or second-line therapy as part of the multicenter PROPHECY trial (NCT02269982) (Validation cohort, N = 107). The measured CTC number was then associated with overall survival (OS) in the Discovery cohort, and progression-free survival (PFS) and OS in the Validation cohort. CTC enumeration was also performed on a concurrently obtained blood sample using the CellSearch® Circulating Tumor Cell Kit. RESULTS In the MSKCC Discovery cohort, CTC count was a statistically significant prognostic factor of OS as a dichotomous (<3 CTCs/mL versus ≥ 3 CTCs/mL; hazard ratio [HR] = 1.8 [95% confidence interval {CI} 1.3-3.0]) and a continuous variable when adjusting for line of therapy, presence of visceral metastases, prostate-specific antigen, lactate dehydrogenase and alkaline phosphatase. The findings were validated in an independent datas et from PROPHECY (HR [95% CI] = 1.8 [1.1-3.0] for OS and 1.7 [1.1-2.9] for PFS). A strong correlation was also observed between CTC counts determined in matched samples on the CellSearch® and Epic platforms (r = 0.84). CONCLUSION The findings validate the prognostic significance of pretreatment CTC number determined on the Epic Sciences platform for predicting OS in men with progressing mCRPC starting an ARSI.
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Affiliation(s)
- H I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - A J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC, USA.
| | | | - A Gill
- Epic Sciences, San Diego, CA, USA
| | - J L Zhao
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E Barnett
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E Carbone
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Lu
- Epic Sciences, San Diego, CA, USA
| | | | - J Luo
- Johns Hopkins University, Baltimore, MD, USA
| | - S Tagawa
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - C H Dos Anjos
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Q Yang
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - D George
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC, USA
| | - R Szmulewitz
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA; University of Chicago, Chicago, IL, USA
| | - D C Danila
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | - M Gonen
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Halabi
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
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2
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Armstrong AJ, Antonarakis ES, Taplin ME, Kelly WK, Beltran H, Fizazi K, Dahut WL, Shore N, Slovin S, George D, Carducci MA, Corn P, Danila D, Dreicer R, Heath E, Rathkopf D, Liu G, Nanus D, Stein M, Smith MR, Sternberg C, Wilding G, Nelson PS, Halabi S, Kantoff P, Clarke NW, Evans CP, Heidenreich A, Mottet N, Gleave M, Morris MJ, Scher HI. Naming disease states for clinical utility in prostate cancer: a rose by any other name might not smell as sweet. Ann Oncol 2019; 29:23-25. [PMID: 29088323 DOI: 10.1093/annonc/mdx648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- A J Armstrong
- Department of Medicine, Duke Cancer Institute, Durham, New York, USA
| | - E S Antonarakis
- Department of Oncology, Johns Hopkins University, Baltimore, USA
| | - M-E Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - W K Kelly
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, USA
| | - H Beltran
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - K Fizazi
- Department of Medical Oncology, Gustave Roussy Institute, Villejuif, France
| | - W L Dahut
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, USA
| | - N Shore
- Carolina Urologic Research Center, Myrtle Beach, USA
| | - S Slovin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, New York, USA
| | - D George
- Department of Medicine, Duke Cancer Institute, Durham, New York, USA
| | - M A Carducci
- Department of Oncology, Johns Hopkins University, Baltimore, USA
| | - P Corn
- Department of Medicine, MD Anderson Cancer Center, Houston, USA
| | - D Danila
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, New York, USA
| | - R Dreicer
- School of Medicine, University of Virginia, Charlottesville, USA
| | - E Heath
- Division of Hematology/Oncology, Wayne State University, Detroit, USA
| | - D Rathkopf
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, New York, USA
| | - G Liu
- Division of Hematology/Oncology, University of Wisconsin, Madison, USA
| | - D Nanus
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - M Stein
- Department of Medicine, Rutgers Cancer Institute of New Jersey, Newark, USA
| | - M R Smith
- Massachusetts General Hospital, Cancer Center, Boston, USA
| | - C Sternberg
- Department of Medical Oncology, San Camillo-Forlanini Hospital, Rome, Italy
| | - G Wilding
- Department of Medicine, MD Anderson Cancer Center, Houston, USA
| | - P S Nelson
- Division of Human Biology, University of Washington, Seattle, USA.,Fred Hutchinson Cancer Center, Seattle, USA
| | - S Halabi
- Department of Medicine, Duke Cancer Institute, Durham, New York, USA
| | - P Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, New York, USA
| | - N W Clarke
- Department of Urology, The Christie Clinic, National Health Service, Manchester, UK
| | - C P Evans
- Department of Urology, UC Davis, Sacramento, USA
| | - A Heidenreich
- Department of Oncology, University Hospital Aschen, Cologne, Germany
| | - N Mottet
- Department of Urology, University Hospital St. Etienne, Saint-Etienne, France
| | - M Gleave
- Department of Urologic Sciences, Vancouver Prostate Centre, Vancouver, Canada
| | - M J Morris
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, New York, USA
| | - H I Scher
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, New York, USA
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3
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Rathkopf DE, Smith MR, Ryan CJ, Berry WR, Shore ND, Liu G, Higano CS, Alumkal JJ, Hauke R, Tutrone RF, Saleh M, Chow Maneval E, Thomas S, Ricci DS, Yu MK, de Boer CJ, Trinh A, Kheoh T, Bandekar R, Scher HI, Antonarakis ES. Androgen receptor mutations in patients with castration-resistant prostate cancer treated with apalutamide. Ann Oncol 2018. [PMID: 28633425 DOI: 10.1093/annonc/mdx283] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Mutations in the androgen receptor (AR) ligand-binding domain (LBD), such as F877L and T878A, have been associated with resistance to next-generation AR-directed therapies. ARN-509-001 was a phase I/II study that evaluated apalutamide activity in castration-resistant prostate cancer (CRPC). Here, we evaluated the type and frequency of 11 relevant AR-LBD mutations in apalutamide-treated CRPC patients. Patients and methods Blood samples from men with nonmetastatic CRPC (nmCRPC) and metastatic CRPC (mCRPC) pre- or post-abiraterone acetate and prednisone (AAP) treatment (≥6 months' exposure) were evaluated at baseline and disease progression in trial ARN-509-001. Mutations were detected in circulating tumor DNA using a digital polymerase chain reaction-based method known as BEAMing (beads, emulsification, amplification and magnetics) (Sysmex Inostics' GmbH). Results Of the 97 total patients, 51 had nmCRPC, 25 had AAP-naïve mCRPC, and 21 had post-AAP mCRPC. Ninety-three were assessable for the mutation analysis at baseline and 82 of the 93 at progression. The overall frequency of detected AR mutations at baseline was 7/93 (7.5%) and at progression was 6/82 (7.3%). Three of the 82 (3.7%) mCRPC patients (2 AAP-naïve and 1 post-AAP) acquired AR F877L during apalutamide treatment. At baseline, 3 of the 93 (3.2%) post-AAP patients had detectable AR T878A, which was lost after apalutamide treatment in 1 patient who continued apalutamide treatment for 12 months. Conclusions The overall frequency of detected mutations at baseline (7.5%) and progression (7.3%) using the sensitive BEAMing assay was low, suggesting that, based on this assay, AR-LBD mutations such as F877L and T878A are not common contributors to de novo or acquired resistance to apalutamide. ClinicalTrials.gov identifier NCT01171898.
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Affiliation(s)
- D E Rathkopf
- Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York
| | - M R Smith
- Massachusetts General Hospital and Harvard Medical School, Boston
| | - C J Ryan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco
| | - W R Berry
- Cancer Centers of North Carolina, Raleigh
| | - N D Shore
- Carolina Urologic Research Center, Myrtle Beach
| | - G Liu
- University of Wisconsin Carbone Cancer Center, Madison
| | - C S Higano
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle
| | - J J Alumkal
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | - R Hauke
- Nebraska Cancer Specialists, Omaha
| | - R F Tutrone
- Chesapeake Urologic Research Associates, Baltimore
| | - M Saleh
- University of Alabama Comprehensive Cancer Center, Birmingham
| | | | - S Thomas
- Janssen Research & Development, Spring House
| | - D S Ricci
- Janssen Research & Development, Spring House
| | - M K Yu
- Janssen Research & Development, Los Angeles
| | - C J de Boer
- Janssen Biologics, B. V., Leiden, the Netherlands
| | - A Trinh
- Janssen Research & Development, Los Angeles
| | - T Kheoh
- Janssen Research & Development, San Diego
| | - R Bandekar
- Janssen Research & Development, Spring House
| | - H I Scher
- Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York
| | - E S Antonarakis
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, USA
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4
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Antonarakis ES, Armstrong AJ, Dehm SM, Luo J. Androgen receptor variant-driven prostate cancer: clinical implications and therapeutic targeting. Prostate Cancer Prostatic Dis 2016; 19:231-41. [PMID: 27184811 PMCID: PMC5493501 DOI: 10.1038/pcan.2016.17] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 12/13/2022]
Abstract
While there are myriad mechanisms of primary and acquired resistance to conventional and next-generation hormonal therapies in prostate cancer, the potential role of androgen receptor splice variants (AR-Vs) has recently gained momentum. AR-Vs are abnormally truncated isoforms of the androgen receptor (AR) protein that lack the COOH-terminal domain but retain the NH2-terminal domain and DNA-binding domain and are thus constitutively active even in the absence of ligands. Although multiple preclinical studies have previously implicated AR-Vs in the development of castration resistance as well as resistance to abiraterone and enzalutamide, recent technological advances have made it possible to reliably detect and quantify AR-Vs from human clinical tumor specimens including blood samples. Initial clinical studies have now shown that certain AR-Vs, in particular AR-V7, may be associated with resistance to abiraterone and enzalutamide but not taxane chemotherapies when detected in circulating tumor cells. Efforts are now underway to clinically validate AR-V7 as a relevant treatment-selection biomarker in the context of other key genomic aberrations in men with metastatic castration-resistant prostate cancer. Additional efforts are underway to therapeutically target both AR and AR-Vs either directly or indirectly. Whether AR-Vs represent drivers of castration-resistant prostate cancer, or whether they are simply passenger events associated with aggressive disease or clonal heterogeneity, will ultimately be answered only through these types of clinical trials.
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MESH Headings
- Alternative Splicing
- Androgen Receptor Antagonists/therapeutic use
- Androgens/metabolism
- Animals
- Antineoplastic Agents, Hormonal/therapeutic use
- Biomarkers, Tumor
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/metabolism
- Clinical Trials as Topic
- Drug Evaluation, Preclinical
- Drug Resistance, Neoplasm/drug effects
- Epithelium/metabolism
- Epithelium/pathology
- Gene Expression Regulation, Neoplastic
- Genetic Variation
- Humans
- Male
- Molecular Targeted Therapy
- Prostatic Neoplasms/drug therapy
- Prostatic Neoplasms/genetics
- Prostatic Neoplasms/metabolism
- Prostatic Neoplasms/pathology
- Protein Binding
- Protein Interaction Domains and Motifs
- Protein Multimerization
- Receptors, Androgen/chemistry
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Research
- Signal Transduction/drug effects
- Transcription, Genetic
- Treatment Outcome
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Affiliation(s)
- ES Antonarakis
- Departments of Oncology and Urology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - AJ Armstrong
- Departments of Medicine, Surgery, and Pharmacology and Cancer Biology, Divisions of Medical Oncology and Urology, Duke Cancer Institute, Durham, NC, USA
| | - SM Dehm
- Masonic Cancer Center and Departments of Laboratory Medicine and Pathology and Urology, University of Minnesota, Minneapolis, MN, USA
| | - J Luo
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
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5
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Teply BA, Luber B, Denmeade SR, Antonarakis ES. The influence of prednisone on the efficacy of docetaxel in men with metastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis 2015; 19:72-8. [PMID: 26857146 PMCID: PMC4748735 DOI: 10.1038/pcan.2015.53] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 07/28/2015] [Accepted: 08/25/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prednisone and other corticosteroids can provide palliation and tumor responses in patients with prostate cancer. The combination of docetaxel and prednisone was the first treatment shown to prolong survival in men with metastatic castration-resistant prostate cancer (mCRPC). Since the approval of docetaxel in 2004, additional treatments are available, including abiraterone, which is also administered with prednisone. Therefore, patients are increasingly likely to have prednisone therapy several times throughout their disease course, and the contribution of prednisone to the efficacy of docetaxel is unknown. METHODS We conducted a retrospective study of patients with mCPRC treated with docetaxel at our institution between 2004–2014. Patients were divided into 2 cohorts based upon whether prednisone was co-administered with docetaxel. Cohorts were further stratified based upon prior prednisone (with abiraterone) or hydrocortisone (with ketoconazole) use. The primary endpoint was clinical/radiographic progression-free survival (PFS). The secondary endpoints were >50% PSA response rate and PSA progression-free survival (PSA-PFS). A multivariable cox regression model was constructed to determine if prednisone use was independently predictive of PFS. RESULTS We identified 200 consecutive patients for inclusion in the study: 131 men received docetaxel with prednisone and 69 received docetaxel alone. The docetaxel-prednisone cohort had superior PFS compared to the docetaxel-alone cohort (median PFS: 7.8 vs 6.2 months, HR 0.68 [95% CI 0.48–0.97], p=0.03). Prednisone was associated with a reduced risk of progression on docetaxel in the propensity score-weighted multivariable Cox model (p=0.002). Among abiraterone- or ketoconazole-pretreated patients, no difference in PFS was observed between prednisone-containing and non-prednisone containing cohorts (median PFS: 7.1 vs 6.3 months, HR 0.96 [95% CI 0.59–1.57], p=0.87). CONCLUSIONS The incorporation of prednisone potentially augments the efficacy of docetaxel in patients with mCRPC. We hypothesize that this advantage is limited to patients who have not previously received corticosteroids. Prospective confirmation is needed.
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Affiliation(s)
- B A Teply
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - B Luber
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S R Denmeade
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E S Antonarakis
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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Nakazawa M, Lu C, Chen Y, Paller CJ, Carducci MA, Eisenberger MA, Luo J, Antonarakis ES. Serial blood-based analysis of AR-V7 in men with advanced prostate cancer. Ann Oncol 2015; 26:1859-1865. [PMID: 26117829 DOI: 10.1093/annonc/mdv282] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/18/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We previously showed that pretreatment detection of androgen receptor splice variant-7 (AR-V7) in circulating tumor cells (CTCs) from men with castration-resistant prostate cancer is associated with resistance to abiraterone and enzalutamide, but not to taxane chemotherapies. Here, we conducted serial measurements of AR-V7 and evaluated patterns of longitudinal AR-V7 dynamics over the course of multiple sequential therapies. PATIENTS AND METHODS Metastatic prostate cancer patients treated at Johns Hopkins with AR-directed therapies or taxane chemotherapies underwent serial liquid biopsies for CTC-based AR-V7 analysis at baseline, during therapy, and at progression. We used a CTC enrichment platform followed by multiplexed reverse-transcription polymerase chain reaction analysis to detect full-length androgen receptor and AR-V7 transcripts. Patients selected for inclusion in this report were those who provided ≥4 CTC samples, at least one of which was AR-V7 positive, over the course of ≥2 consecutive therapies. RESULTS We identified 14 patients who received a total of 37 therapies and contributed 70 CTC samples for AR-V7 analysis during a median follow-up period of 11 months. Three patients remained AR-V7 positive during the entire course of therapy. The remainder underwent transitions in AR-V7 status: there were eight instances of 'conversions' from AR-V7-negative to -positive status (during treatment with first-line androgen deprivation therapy, abiraterone, enzalutamide, and docetaxel), and six instances of 'reversions' from AR-V7-positive to -negative status (during treatment with docetaxel and cabazitaxel). CONCLUSIONS AR-V7 is a dynamic marker, and transitions in AR-V7 status may reflect selective pressures on the tumor exerted by therapeutic interventions. While 'conversions' to AR-V7-positive status were observed with both AR-directed therapies and taxane chemotherapies, 'reversions' to AR-V7-negative status only occurred during taxane therapies. Serial blood-based AR-V7 testing is feasible in routine clinical practice, and may provide insights into temporal changes in tumor evolution.
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Affiliation(s)
- M Nakazawa
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - C Lu
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Y Chen
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - C J Paller
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - M A Carducci
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - M A Eisenberger
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - J Luo
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - E S Antonarakis
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, USA
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7
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Cheng HH, Gulati R, Azad A, Nadal R, Twardowski P, Vaishampayan UN, Agarwal N, Heath EI, Pal SK, Rehman HT, Leiter A, Batten JA, Montgomery RB, Galsky MD, Antonarakis ES, Chi KN, Yu EY. Activity of enzalutamide in men with metastatic castration-resistant prostate cancer is affected by prior treatment with abiraterone and/or docetaxel. Prostate Cancer Prostatic Dis 2015; 18:122-7. [PMID: 25600186 PMCID: PMC4430366 DOI: 10.1038/pcan.2014.53] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/03/2014] [Accepted: 11/20/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Enzalutamide and abiraterone are new androgen-axis disrupting treatments for metastatic castration resistant prostate cancer (mCRPC). We examined response and outcomes of enzalutamide-treated mCRPC patients in the real-world context of prior treatments of abiraterone and/or docetaxel. METHODS We conducted a seven-institution retrospective study of mCRPC patients treated with enzalutamide between January 2009 and February 2014. We compared baseline characteristics, PSA declines, PSA progression-free survival (PSA-PFS), duration on enzalutamide, and overall survival (OS) across subgroups defined by prior abiraterone and/or docetaxel. RESULTS Of 310 patients who received enzalutamide, 36 (12%) received neither prior abiraterone nor prior docetaxel, 79 (25%) received prior abiraterone, 30 (10%) received prior docetaxel, and 165 (53%) received both prior abiraterone and prior docetaxel. Within these groups, respectively, ≥30% PSA decline was achieved among 67%, 28%, 43%, and 24% of patients; PSA-PFS was 5.5 (95% CI 4.2–9.1), 4.0 (3.2–4.8), 4.1 (2.9–5.4), and 2.8 (2.5–3.2) months; median duration of enzalutamide was 9.1 (7.3-not reached), 4.7 (3.7–7.7), 5.4 (3.8–8.4), and 3.9 (3.0–4.6) months. Median OS was reached only for patients who received both prior abiraterone and docetaxel and was 12.2 months (95% CI 10.7–16.5). 12-month OS was 78% (59%–100%), 64% (45%–90%), 77% (61%–97%), and 51% (41%–62%). Of 70 patients who failed to achieve any PSA decline on prior abiraterone, 19 (27%) achieved ≥30% PSA decline with subsequent enzalutamide. CONCLUSIONS The activity of enzalutamide is blunted after abiraterone, after docetaxel, and still more after both, suggesting subsets of overlapping and distinct mechanisms of resistance.
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Affiliation(s)
- H H Cheng
- 1] University of Washington, Seattle, WA, USA [2] Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - R Gulati
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - A Azad
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - R Nadal
- Sidney Kimmel Cancer Center/Johns Hopkins University, Baltimore, MA, USA
| | | | - U N Vaishampayan
- Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA
| | - N Agarwal
- Huntsman Cancer Institute/University of Utah, Salt Lake City, UT, USA
| | - E I Heath
- Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA
| | - S K Pal
- City of Hope Cancer Center, Duarte, CA, USA
| | - H-T Rehman
- Sidney Kimmel Cancer Center/Johns Hopkins University, Baltimore, MA, USA
| | - A Leiter
- Tisch Cancer Institute/Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J A Batten
- Huntsman Cancer Institute/University of Utah, Salt Lake City, UT, USA
| | - R B Montgomery
- 1] University of Washington, Seattle, WA, USA [2] Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - M D Galsky
- Tisch Cancer Institute/Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E S Antonarakis
- Sidney Kimmel Cancer Center/Johns Hopkins University, Baltimore, MA, USA
| | - K N Chi
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - E Y Yu
- 1] University of Washington, Seattle, WA, USA [2] Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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8
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Suzman DL, Zhou XC, Zahurak ML, Lin J, Antonarakis ES. Change in PSA velocity is a predictor of overall survival in men with biochemically-recurrent prostate cancer treated with nonhormonal agents: combined analysis of four phase-2 trials. Prostate Cancer Prostatic Dis 2014; 18:49-55. [PMID: 25384338 PMCID: PMC4323734 DOI: 10.1038/pcan.2014.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/28/2014] [Accepted: 09/23/2014] [Indexed: 11/27/2022]
Abstract
Background Multiple phase-2 trials in men with biochemically-recurrent prostate cancer (BRPC) have assessed the impact of non-hormonal agents on PSA kinetics. We have previously demonstrated that changes in PSA kinetics correlate with metastasis-free survival; however, it is unknown whether these changes also correlate with overall survival (OS). Methods We performed a combined retrospective analysis of 146 men with BRPC treated on phase-2 trials using one of four investigational drugs: lenalidomide (n=60), marimastat (n=39), ATN-224 (n=22), and imatinib (n=25). We examined factors influencing OS, including within-subject changes in PSA kinetics (PSA slope, PSA doubling time, and PSA velocity) before and 6 months after treatment initiation. Results After a median follow up of 83.1 months, 49 of 146 men had died. In univariate Cox regression analysis, two factors were associated with OS: baseline PSA velocity and change in PSA velocity on therapy. In a landmark multivariable model, stratified by study (which controlled for age, Gleason score, type of local therapy, and use of ADT prior to metastases), baseline PSA velocity and increase in PSA velocity on therapy remained independent predictors of OS. Median OS for men with an increase in PSA velocity on treatment was 115.4 months and was not reached for men with a decrease in PSA velocity (HR=0.47, 95% CI 0.25 to 0.88; P=0.02). Conclusions This hypothesis-generating study suggests that within-subject changes in PSA velocity after initiation of non-hormonal therapy may correlate with OS in men with BRPC. If validated in prospective trials, change in PSA velocity may represent a reasonable intermediate endpoint for screening new agents in these patients.
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Affiliation(s)
- D L Suzman
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - X C Zhou
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - M L Zahurak
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - J Lin
- Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - E S Antonarakis
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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9
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Sundi D, Wang VM, Pierorazio PM, Han M, Bivalacqua TJ, Ball MW, Antonarakis ES, Partin AW, Schaeffer EM, Ross AE. Very-high-risk localized prostate cancer: definition and outcomes. Prostate Cancer Prostatic Dis 2014; 17:57-63. [PMID: 24189998 PMCID: PMC3945953 DOI: 10.1038/pcan.2013.46] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 08/18/2013] [Accepted: 08/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Outcomes in men with National Comprehensive Cancer Network (NCCN) high-risk prostate cancer (PCa) can vary substantially-some will have excellent cancer-specific survival, whereas others will experience early metastasis even after aggressive local treatments. Current nomograms, which yield continuous risk probabilities, do not separate high-risk PCa into distinct sub-strata. Here, we derive a binary definition of very-high-risk (VHR) localized PCa to aid in risk stratification at diagnosis and selection of therapy. METHODS We queried the Johns Hopkins radical prostatectomy database to identify 753 men with NCCN high-risk localized PCa (Gleason sum 8-10, PSA >20 ng ml(-1), or clinical stage ≥T3). Twenty-eight alternate permutations of adverse grade, stage and cancer volume were compared by their hazard ratios for metastasis and cancer-specific mortality. VHR criteria with top-ranking hazard ratios were further evaluated by multivariable analyses and inclusion of a clinically meaningful proportion of the high-risk cohort. RESULTS The VHR cohort was best defined by primary pattern 5 present on biopsy, or ≥5 cores with Gleason sum 8-10, or multiple NCCN high-risk features. These criteria encompassed 15.1% of the NCCN high-risk cohort. Compared with other high-risk men, VHR men were at significantly higher risk for metastasis (hazard ratio 2.75) and cancer-specific mortality (hazard ratio 3.44) (P<0.001 for both). Among high-risk men, VHR men also had significantly worse 10-year metastasis-free survival (37% vs 78%) and cancer-specific survival (62% vs 90%). CONCLUSIONS Men who meet VHR criteria form a subgroup within the current NCCN high-risk classification who have particularly poor oncological outcomes. Use of these characteristics to distinguish VHR localized PCa may help in counseling and selection optimal candidates for multimodal treatments or clinical trials.
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Affiliation(s)
- D Sundi
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - V M Wang
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - P M Pierorazio
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - M Han
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - T J Bivalacqua
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - M W Ball
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - E S Antonarakis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - A W Partin
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - E M Schaeffer
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - A E Ross
- Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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10
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Schweizer MT, Zhou XC, Wang H, Yang T, Shaukat F, Partin AW, Eisenberger MA, Antonarakis ES. Metastasis-free survival is associated with overall survival in men with PSA-recurrent prostate cancer treated with deferred androgen deprivation therapy. Ann Oncol 2013; 24:2881-6. [PMID: 23946329 DOI: 10.1093/annonc/mdt335] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Clinical trials in men with biochemically recurrent prostate cancer (BRPC) have been hampered by long survival times, making overall survival (OS) a difficult end point to reach. Intermediate end points are needed in order to conduct such trials within a more feasible time frame. PATIENTS AND METHODS This is a retrospective analysis of 450 men with BRPC following prostatectomy treated at a single institution between 1981 and 2010, of which 140 developed subsequent metastases. Androgen deprivation therapy (ADT) was deferred until after the development of metastases. Cox regression models were developed to investigate factors influencing OS. RESULTS Median metastasis-free survival (MFS) was 10.2 years [95% confidence interval (CI) 7.6-14.0 years]; median OS after metastasis was 6.6 years (95%CI 5.8-8.4 years). Multivariable Cox regressions identified four independently prognostic variables for OS: MFS (HR 0.77; 95% CI 0.63-0.94), number of metastases (≤3 versus ≥4; HR 0.50; 95% CI 0.29-0.85), pain (absent versus present; HR 0.43; 95% CI 0.25-0.72), and bisphosphonate use (yes versus no; HR 0.60; 95% CI 0.37-0.98). CONCLUSIONS MFS emerged as an independent predictor of OS in men with BRPC treated with deferred ADT after the development of metastases. MFS may be a reasonable intermediate end point in future clinical trials. This observation requires prospective validation.
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11
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Affiliation(s)
- W Khaliq
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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12
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Antonarakis ES, Armstrong AJ. Emerging therapeutic approaches in the management of metastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis 2011; 14:206-18. [PMID: 21577233 PMCID: PMC4124621 DOI: 10.1038/pcan.2011.24] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 04/11/2011] [Accepted: 04/17/2011] [Indexed: 02/01/2023]
Abstract
Although treatment options for men with castration-resistant prostate cancer (CRPC) have improved with the recent and anticipated approvals of novel immunotherapeutic, hormonal, chemotherapeutic and bone-targeted agents, clinical benefit with these systemic therapies is transient and survival times remain unacceptably short. Thus, we devote the second section of this two-part review to discussing emerging therapeutic paradigms and research strategies that are entering phase II and III clinical testing for men with metastatic CRPC. We will discuss a range of emerging hormonal, immunomodulatory, antiangiogenic, epigenetic and cell survival pathway inhibitors in current clinical trials, with an emphasis on how these therapies may complement our existing treatment options.
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Affiliation(s)
- E S Antonarakis
- Prostate Cancer Research Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21231-1000, USA.
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13
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Antonarakis ES, Armstrong AJ. Evolving standards in the treatment of docetaxel-refractory castration-resistant prostate cancer. Prostate Cancer Prostatic Dis 2011; 14:192-205. [PMID: 21577234 PMCID: PMC3444817 DOI: 10.1038/pcan.2011.23] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 04/11/2011] [Accepted: 04/17/2011] [Indexed: 12/20/2022]
Abstract
The management of men with metastatic castration-resistant prostate cancer (CRPC) has taken several leaps forward in the past year, with the demonstration of improved overall survival with three novel agents (sipuleucel-T, cabazitaxel with prednisone and abiraterone acetate with prednisone), and a significant delay in skeletal-related events observed with denosumab. The pipeline of systemic therapies in prostate cancer remains strong, as multiple agents with a diverse array of mechanisms of action are showing preliminary signs of clinical benefit, leading to more definitive phase III confirmatory trials. In this review, which represents part 1 of a two-part series on metastatic CRPC, we will summarize the mechanisms of resistance to hormonal and chemotherapies and discuss the evolving landscape of treatment options for men with CRPC, with a particular focus on currently approved and emerging treatment options following docetaxel administration, as well as prognostic factors in this post-docetaxel state. As docetaxel remains the standard initial systemic therapy for men with metastatic CRPC for both palliative and life-prolonging purposes, knowledge of these evolving standards will help to optimize delivery of care and long-term outcomes.
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Affiliation(s)
- E S Antonarakis
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21231-1000, USA.
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14
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Sinibaldi VJ, Huang P, Antonarakis ES, Carducci MA, Denmeade SR, Kim JJ, Eisenberger MA, Keizman D. PSA doubling time (PSADT) and serum testosterone (T) during intermittent androgen deprivation (IAD) in patients with biochemically relapsed prostate cancer (BRCP; M0): Potential predictive implications. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Kim JJ, Huang P, Eisenberger MA, Pili R, Antonarakis ES, Hammers HJ, Carducci MA, Keizman D. The role of angiotensin system inhibitors (ASIs) in the outcome of sunitinib treatment (tx) in patients (pts) with metastatic renal cell carcinoma (mRCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Antonarakis ES, Heath EI, Smith DC, Rathkopf DE, Blackford AL, Danila DC, King S, Frost A, Carducci MA. A noncomparative randomized phase II study of two dose levels of itraconazole in men with metastatic castration-resistant prostate cancer (mCRPC): A DOD/PCCTC trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Keizman D, Zhang Z, Sinibaldi VJ, DeMarzo A, Gurel B, Lotan T, Hicks J, Rosenbaum E, Antonarakis ES, Kim JJ, Carducci MA, Eisenberger MA. The association of PTEN loss on outcome in patients with early high-risk prostate cancer (CaP) treated with adjuvant docetaxel following radical prostatectomy (RP). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Antonarakis ES, Kibel AS, Lin DW, Tyler RC, Tabesh M, Drake CG. Design of an open-label randomized phase II trial examining the effect of sequencing of sipuleucel-T and androgen deprivation therapy (ADT) on immune markers in prostate cancer patients with a rising prostate specific antigen (PSA) after primary therapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Eisenberger MA, Huang P, Sinibaldi VJ, Carducci MA, Denmeade SR, Antonarakis ES, Kim JJ, Keizman D. Safety and efficacy of ketoconazole (K) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC): Contemporary experience and prognostic indicators. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Huang P, Carducci MA, Eisenberger MA, Pili R, Kim JJ, Antonarakis ES, Hammers HJ, Keizman D. The association of pretreatment (pre-tx) neutrophil to lymphocyte ratio (NLR) with outcome of sunitinib tx in patients (pts) with metastatic renal cell carcinoma (mRCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Antonarakis ES, Keizman D, Carducci MA, Eisenberger MA. The effect of PSA doubling time (PSADT) and Gleason score on the PSA at the time of initial metastasis in men with biochemical recurrence after prostatectomy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16 Background: We previously reported on a cohort of men with biochemical recurrence after prostatectomy (n=430) who underwent observation until metastatic progression. Here, we describe the PSA at metastasis for those patients who developed metastatic disease. Methods: PSA at metastasis was defined as the PSA value collected at the time of the first occurrence of metastasis as determined by CT or bone scan. We calculated the median PSA at metastasis and the interquartile range (IQR) for the entire cohort of men with metastatic progression, and also across different strata of PSADT (≤3 vs 3-9 vs 9-15 vs ≥15 mo) and Gleason score (≤7 vs 8-10). We used Pearson's correlation coefficient (r) to examine the relationship between PSADT or Gleason score and PSA at metastasis. Results: With a median follow-up of 4 years after biochemical recurrence, 126/430 men (29.3%) had developed metastases. Sites of first metastasis included bone in 114 men (90.5%), extra-pelvic lymph nodes in 5 men (4.0%), lung in 3 men (2.4%), liver in 3 men (2.4%), and brain in 1 man (0.8%). The median PSA at the time of initial metastasis was 31.4 ng/mL (IQR, 8.8–87.5). Median PSA at metastasis across different PSADT strata is shown below (Table). There was a weak but statistically significant correlation between PSADT and 1/PSA at metastasis (r=0.20, P=0.02). There was no correlation between Gleason score and PSA at metastasis (r=0.01, P=0.83). Median PSA at metastasis was 30.3 ng/mL (IQR, 8.6–74.9) for men with Gleason ≤7 (n=69) and 34 ng/mL (IQR, 7.9–115) for men with Gleason 8-10 (n=57). Conclusions: In patients with biochemical recurrence after prostatectomy, there is an inverse correlation between PSADT and PSA at metastasis, while Gleason sum has no effect on PSA at metastasis. These data may be used by clinicians to estimate at what PSA level metastases are likely to first develop across different strata of PSADT, helping to determine when/if to initiate therapy. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- E. S. Antonarakis
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - D. Keizman
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - M. A. Carducci
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - M. A. Eisenberger
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
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22
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Keizman D, Huang P, Antonarakis ES, Sinibaldi VJ, Carducci MA, Denmeade SR, Eisenberger MA. PSA doubling time (PSADT) and serum testosterone (T) during intermittent androgen deprivation (IAD) in patients with biochemically relapsed prostate cancer (BRCP; M0): Potential predictive implications. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
150 Background: The systemic management of patients with BRPC remains controversial. IAD is commonly employed. Aims: To evaluate the PSA dynamics and serum T in pts with BRPC treated with IAD until the development of PSA refractoriness or clinical evidence of metastatic disease. Methods: Data were retrospectively analyzed in all pts with BRCP treated with GnRH at PSA thresholds according to pre-treatment PSADT (10-15ng/mL, 15-20, and 20-30 for PSADT ≤3 mos, 3-9 mos, and ≥ 9 ms, respectively) and continued until PSA nadir. Antiandrogen (AA) was added for PSA > 1.0 ng/mL after 3 mos). Follow-up (FU) consisted of PSA and T q3 mos. Cycles were repeated at the above preselected PSA thresholds and continued until lack of PSA response. Scans were obtained prior to cycles and at the time of CRPC state. Mixed effects model was used to study PSADT change over cycles. Multivariate cox regression model was used to identify prognostic variables. Results: From 1995-2010, with a mean FU of 71 mos (range 22-183 months), 96 pts received a mean of 2.8 cycles (range 1-9) of IAD; 58 (60%) remain on treatment and 38 (40%) were switched to continuous ADT due to PSA refractoriness (n=11) or positive scans (n=27). PSADT at the first off treatment (tx) interval (mean 3.1, 0.59-30.5 range, median 2.3) was significantly shorter than the baseline (p<0.0001; mean 9.7, range 0.27-53.9, median 7.34) but remained relatively stable (p=0.29) in subsequent cycles. PSADT adjusted for T recovery (≥3 ms after T recovery to ≥ 150 ng/dL) was significantly longer (p=0.006) than that based only on all PSA determinations (mean 5.4, range 1.31-30.5, median 3.7 versus mean 3.1, range 0.59-30.5, median 2.3). Significant factors associated with probability of PSA refractoriness were pre-IAD PSADT (≥ 6 vs <6 ms), first off tx interval PSADT (≥3 ms vs <3m), the use of AA during first tx cycle, and PSA nadir during the first tx interval (<0.1 vs ≥0.1 ng/mL). Conclusions: Our data suggest that PSADT becomes shorter after the initial cycle of IAD and correlate with T recovery. PSA dynamics and need for AA to enhance PSA nadir are associated with PSA refractoriness in pts BRPC treated with IAD. No significant financial relationships to disclose.
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Affiliation(s)
- D. Keizman
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - P. Huang
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - E. S. Antonarakis
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - V. J. Sinibaldi
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - M. A. Carducci
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - S. R. Denmeade
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - M. A. Eisenberger
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
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23
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Keizman D, Zhang Z, DeMarzo A, Gurel B, Lotan T, Hicks J, Rosenbaum E, Antonarakis ES, Carducci MA, Eisenberger MA. Association of PTEN loss with outcome of patients (pts) with early high-risk prostate cancer (CaP) treated with adjuvant docetaxel following radical prostatectomy (RP). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
43 Background: Loss of the PTEN tumor suppressor and subsequent activation of the PI3K pathway is common and has potential clinical and therapeutic value in CaP. We examined the PTEN status of primary tumors in pts who underwent adjuvant docetaxel tx in a prospective clinical trial. Methods: Of the 77 pts enrolled in a prospective multi-institutional adjuvant docetaxel trial (TAX 2501, J Urol 2007), we prospectively collected 56 primary tumor pathology specimens suitable for analysis of PTEN status by immunoreactivity (IHC) and/or fluorescence in situ hybridisation (FISH) assay. Protocol defined progression included a PSA of ≥ 0.4 ng/mL, radiological/pathological evidence of recurrent disease or death from any cause. Univariate and multivariable analyses based on the Cox proportional hazards regression model were used to analyze the independent association of PTEN and other known prognostic factors with progression free survival (PFS). Results: PTEN loss was observed in 37/56 pts (66%). Pts with PTEN loss vs detectable PTEN were balanced regarding clinical stage, combined Gleason score, seminal vesicles and surgical margins involvement, and lymph nodes status. Pts with a detectable PTEN had a significantly higher pre-RP PSA (median 14 vs 8.6 ng/mL, p=0.015). 41/56 (73.2%, median followup of 37.5 months, range 10.4 to 44.5) progressed with an overall median PFS of 13 months (mos) (95% CI 9.8–15.8). Independent prognostic factors of progression by multivariate analysis were: seminal vesicles involvement (HR 2.19, p=0.024), combined Gleason score 9–10 (HR 2.46, p=0.027) and PTEN loss (HR 2.36, p=0.037). PFS on pts without PTEN loss (median not reached at a followup time of 37.5 mos, range 10.4–44.5 mos) was significantly longer (log rank test, p = 0.026) compared to those with undetectable PTEN (median PFS 12.9 mos, 95% CI 9.7–15.3). Conclusions: PTEN loss may be an independent prognostic factor associated with poorer outcome of pts with early high-risk CaP treated with adjuvant docetaxel following RP. These findings may have important prognostic and therapeutic implications in CaP. No significant financial relationships to disclose.
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Affiliation(s)
- D. Keizman
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; James Buchanan Brady Urological Institute, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD; Rabin Medical Center, Petah Tikva, Israel
| | - Z. Zhang
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; James Buchanan Brady Urological Institute, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD; Rabin Medical Center, Petah Tikva, Israel
| | - A. DeMarzo
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; James Buchanan Brady Urological Institute, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD; Rabin Medical Center, Petah Tikva, Israel
| | - B. Gurel
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; James Buchanan Brady Urological Institute, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD; Rabin Medical Center, Petah Tikva, Israel
| | - T. Lotan
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; James Buchanan Brady Urological Institute, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD; Rabin Medical Center, Petah Tikva, Israel
| | - J. Hicks
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; James Buchanan Brady Urological Institute, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD; Rabin Medical Center, Petah Tikva, Israel
| | - E. Rosenbaum
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; James Buchanan Brady Urological Institute, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD; Rabin Medical Center, Petah Tikva, Israel
| | - E. S. Antonarakis
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; James Buchanan Brady Urological Institute, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD; Rabin Medical Center, Petah Tikva, Israel
| | - M. A. Carducci
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; James Buchanan Brady Urological Institute, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD; Rabin Medical Center, Petah Tikva, Israel
| | - M. A. Eisenberger
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; James Buchanan Brady Urological Institute, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD; Rabin Medical Center, Petah Tikva, Israel
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Keizman D, Sinibaldi VJ, Carducci MA, Denmeade SR, Drake CG, Pili R, Antonarakis ES, Hudock S, Zahurak M, Eisenberger MA. Phase I/II double-blinded randomized study to determine the tolerability and efficacy of two different doses of lenalidomide (Len) in biochemically relapsed prostate cancer (BRPC) (M0) patients (pts). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Antonarakis ES, Lin J, Keizman D, Carducci MA, Eisenberger MA. The effect of changes in PSA kinetics on metastasis-free survival (MFS) in patients with PSA-recurrent prostate cancer (PC) treated with nonhormonal agents: Combined analysis of three randomized trials. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Antonarakis ES, Trock BJ, Feng Z, Humphreys EB, Carducci MA, Partin AW, Walsh PC, Eisenberger MA. The natural history of metastatic progression in men with PSA-recurrent prostate cancer after radical prostatectomy: 25-year follow-up. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5008 Background: In men with prostate specific antigen (PSA) recurrence following radical prostatectomy (RP) and no other therapy, the natural history of metastatic progression was previously described in 1999. We now report data reflecting up to 25 years of follow-up. Methods: We performed a retrospective analysis of 774 men treated with RP between 4/1982 and 7/2008 who developed PSA recurrence (>0.2 ng/ml) and never received adjuvant or salvage therapy. We investigated factors influencing the development of metastases. Results: Mean follow-up after RP was 8.5 y (median 8 y). Of 774 men with PSA recurrence, 295 (38%) developed metastases, and 433 had data on PSA doubling time (PSADT), forming our cohort. The mean time from RP to PSA recurrence in the entire cohort was 4.2 y (median 3 y). In those who developed metastases, the mean time from PSA recurrence to metastasis was 3.1 y (median 2 y). The mean PSA at the time of metastasis was 90.3 ng/ml (median 31.4 ng/ml). In Cox regression analysis: PSADT, Gleason score, and time to PSA progression were predictive of the development of metastases ( Table ). In Kaplan-Meier survival analysis, the median actuarial time from PSA recurrence to metastasis was 10 y (95% CI 9 - 15 y). Median actuarial metastasis-free survival from PSA recurrence for men with PSADT <3 mo, 3 - 8.9 mo, 9 - 14.9 mo, and >15 mo was 1 y (95% CI 0 - 1 y), 4 y (95% CI 2 - 6 y), 9 y (95% CI 7 - 13 y), and 15 y (95% CI 12 - 20 y), respectively. Conclusions: PSADT, Gleason score, and time to PSA progression are strong independent predictors of metastasis-free survival in men with PSA-recurrent prostate cancer. These data facilitate patient counseling and logical risk-based treatment planning. They also provide the background for appropriate selection of patients, treatments, and endpoints for clinical trials. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- E. S. Antonarakis
- Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Brady Urological Institute, Johns Hopkins, Baltimore, MD
| | - B. J. Trock
- Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Brady Urological Institute, Johns Hopkins, Baltimore, MD
| | - Z. Feng
- Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Brady Urological Institute, Johns Hopkins, Baltimore, MD
| | - E. B. Humphreys
- Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Brady Urological Institute, Johns Hopkins, Baltimore, MD
| | - M. A. Carducci
- Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Brady Urological Institute, Johns Hopkins, Baltimore, MD
| | - A. W. Partin
- Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Brady Urological Institute, Johns Hopkins, Baltimore, MD
| | - P. C. Walsh
- Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Brady Urological Institute, Johns Hopkins, Baltimore, MD
| | - M. A. Eisenberger
- Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Brady Urological Institute, Johns Hopkins, Baltimore, MD
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27
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Abstract
The function of cytotoxics is to damage cells, and it makes teleological sense for the body to expel them as soon after ingestion as possible. Ideally, from the body's point of view, they should simply be avoided, and it is not surprising that the experience of chemotherapy induced nausea and vomiting (CINV) is powerfully aversive. Nausea and vomiting were once among the most intractable and unpleasant experiences of a child undergoing treatment for cancer.
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Affiliation(s)
- E S Antonarakis
- University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK
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28
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Papacharalabous EN, Myles RW, Antonarakis ES. Surgical correction of congenital lymphoedema of external female genitalia: case report and review of the literature. J OBSTET GYNAECOL 2004; 24:469-70. [PMID: 15203604 DOI: 10.1080/01443610410001696987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- E N Papacharalabous
- Department of Obstetrics and Gynaecology, Bronglais General Hospital, Wales, UK.
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29
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Chrast R, Scott HS, Papasavvas MP, Rossier C, Antonarakis ES, Barras C, Davisson MT, Schmidt C, Estivill X, Dierssen M, Pritchard M, Antonarakis SE. The mouse brain transcriptome by SAGE: differences in gene expression between P30 brains of the partial trisomy 16 mouse model of Down syndrome (Ts65Dn) and normals. Genome Res 2000; 10:2006-21. [PMID: 11116095 PMCID: PMC313062 DOI: 10.1101/gr.10.12.2006] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2000] [Accepted: 10/03/2000] [Indexed: 11/24/2022]
Abstract
Trisomy 21, or Down syndrome (DS), is the most common genetic cause of mental retardation. Changes in the neuropathology, neurochemistry, neurophysiology, and neuropharmacology of DS patients' brains indicate that there is probably abnormal development and maintenance of central nervous system structure and function. The segmental trisomy mouse (Ts65Dn) is a model of DS that shows analogous neurobehavioral defects. We have studied the global gene expression profiles of normal and Ts65Dn male and normal female mice brains (P30) using the serial analysis of gene expression (SAGE) technique. From the combined sample we collected a total of 152,791 RNA tags and observed 45,856 unique tags in the mouse brain transcriptome. There are 14 ribosomal protein genes (nine under expressed) among the 330 statistically significant differences between normal male and Ts65Dn male brains, which possibly implies abnormal ribosomal biogenesis in the development and maintenance of DS phenotypes. This study contributes to the establishment of a mouse brain transcriptome and provides the first overall analysis of the differences in gene expression in aneuploid versus normal mammalian brain cells.
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Affiliation(s)
- R Chrast
- Division of Medical Genetics, Geneva University Medical School and University Hospital, Geneva, Switzerland
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