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Poon DMC, Tan GM, Chan K, Chan MTY, Chan TW, Kan RWM, Lam MHC, Leung CLH, Wong KCW, Kam KKH, Ng CF, Chiu PKF. Addressing the risk and management of cardiometabolic complications in prostate cancer patients on androgen deprivation therapy and androgen receptor axis-targeted therapy: consensus statements from the Hong Kong Urological Association and the Hong Kong Society of Uro-Oncology. Front Oncol 2024; 14:1345322. [PMID: 38357197 PMCID: PMC10864500 DOI: 10.3389/fonc.2024.1345322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/27/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background Androgen deprivation therapy (ADT) is the foundational treatment for metastatic prostate cancer (PCa). Androgen receptor (AR) axis-targeted therapies are a new standard of care for advanced PCa. Although these agents have significantly improved patient survival, the suppression of testosterone is associated with an increased risk of cardiometabolic syndrome. This highlights the urgency of multidisciplinary efforts to address the cardiometabolic risk of anticancer treatment in men with PCa. Methods Two professional organizations invited five urologists, five clinical oncologists, and two cardiologists to form a consensus panel. They reviewed the relevant literature obtained by searching PubMed for the publication period from April 2013 to April 2023, to address three discussion areas: (i) baseline assessment and screening for risk factors in PCa patients before the initiation of ADT and AR axis-targeted therapies; (ii) follow-up and management of cardiometabolic complications; and (iii) selection of ADT agents among high-risk patients. The panel convened four meetings to discuss and draft consensus statements using a modified Delphi method. Each drafted statement was anonymously voted on by every panelist. Results The panel reached a consensus on 18 statements based on recent evidence and expert insights. Conclusion These consensus statements serve as a practical recommendation for clinicians in Hong Kong, and possibly the Asia-Pacific region, in the management of cardiometabolic toxicities of ADT or AR axis-targeted therapies in men with PCa.
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Affiliation(s)
- Darren M. C. Poon
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Comprehensive Oncology Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong SAR, China
| | - Guang-Ming Tan
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kuen Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong SAR, China
| | - Marco T. Y. Chan
- Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong, Hong Kong SAR, China
| | - Tim-Wai Chan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong SAR, China
| | | | - Martin H. C. Lam
- Hong Kong Integrated Oncology Centre, Hong Kong, Hong Kong SAR, China
| | | | - Kenneth C. W. Wong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kevin K. H. Kam
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Peter K. F. Chiu
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Mita K, Izumi K, Goriki A, Tasaka R, Hatayama T, Shima T, Kato Y, Kamiyama M, Inoue S, Tanaka N, Hoshi S, Okamura T, Yoshio Y, Enokida H, Chikazawa I, Kawai N, Hashimoto K, Fukagai T, Shigehara K, Takahara S, Kadono Y, Mizokami A. Enzalutamide versus Abiraterone Plus Prednisolone for Nonmetastatic Castration-Resistant Prostate Cancer: A Sub-Analysis from the ENABLE Study for PCa. Cancers (Basel) 2024; 16:508. [PMID: 38339260 PMCID: PMC10854983 DOI: 10.3390/cancers16030508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/07/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Enzalutamide (ENZ) and abiraterone plus prednisolone (ABI) can improve the survival of patients with castration-resistant prostate cancer (CRPC). However, the agent that is more effective against nonmetastatic CRPC remains unclear. To evaluate the agent that can be used as the first-line treatment for CRPC, an investigator-initiated, multicenter, randomized controlled trial (ENABLE Study for PCa) including both metastatic and nonmetastatic CRPC was conducted in Japan. The prostate-specific antigen (PSA) response rate, overall survival, some essential survival endpoints, and safety of patients with nonmetastatic CRPC were also analyzed. In this subanalysis, 15 and 26 patients in the ENZ and ABI arms, respectively, presented with nonmetastatic CRPC. There was no significant difference in terms of the PSA response rate between the ENZ and ABI arms (80% and 64%, respectively; p = 0.3048). The overall survival did not significantly differ between the two arms (HR: 0.68; 95% CI: 0.22-2.14, p = 0.5260). No significant differences were observed in terms of radiographic progression-free survival and cancer-specific survival between the ENZ and ABI arms (HR: 0.81; 95% CI: 0.35-1.84; p = 0.6056 and HR: 0.72; 95% CI: 0.19-2.73; p = 0.6443, respectively). Only four and six patients in the ENZ and ABI arms, respectively, had ≥grade 3 adverse events. ABI and ENZ had similar efficacy and safety profiles in patients with nonmetastatic CRPC.
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Affiliation(s)
- Koji Mita
- Department of Urology, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1 Kameyama-Minami, Asakita-ku, Hiroshima 731-0293, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8641, Japan
| | - Akihiro Goriki
- Department of Urology, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1 Kameyama-Minami, Asakita-ku, Hiroshima 731-0293, Japan
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Ryo Tasaka
- Department of Urology, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1 Kameyama-Minami, Asakita-ku, Hiroshima 731-0293, Japan
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Tomoya Hatayama
- Department of Urology, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1 Kameyama-Minami, Asakita-ku, Hiroshima 731-0293, Japan
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Takashi Shima
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama 930-8550, Japan
| | - Yuki Kato
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8641, Japan
- Department of Urology, Fukui-Ken Saiseikai Hospital, 7-1 Wadanakacho-Funabashi, Fukui 918-8503, Japan
| | - Manabu Kamiyama
- Department of Urology, University of Yamanashi, 1110 Shimokato, Chuo 409-3898, Japan
| | - Shogo Inoue
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
- Department of Urology, Shobara Red Cross Hospital, 2-7-10 Nishihonmachi, Shobara 727-0013, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijocho, Kashihara 634-8521, Japan
| | - Seiji Hoshi
- Department of Urology, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Takehiko Okamura
- Department of Urology, Anjo Kosei Hospital, 28 Anjocho-Higashihirokute, Anjo 446-8602, Japan
| | - Yuko Yoshio
- Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Hideki Enokida
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Ippei Chikazawa
- Department of Urology, Kanazawa Medical University, 1-1 Uchinadamachi-Daigaku, Kahoku 920-0293, Japan
| | - Noriyasu Kawai
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8602, Japan
| | - Kohei Hashimoto
- Department of Urology, School of Medicine, Sapporo Medical University, 16-291 Minami-1-Jo-Nishi, Sapporo 060-8543, Japan
| | - Takashi Fukagai
- Department of Urology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8641, Japan
- Department of Urology, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa 920-8530, Japan
| | - Shizuko Takahara
- Innovative Clinical Research Center, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan
- Medical Research Support Center, University of Fukui Hospital, 23-3 Shimoaizuki, Matsuoka Eiheiji-cho Yoshida-gun, Fukui 910-1193, Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8641, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-8641, Japan
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Hu Y, Wu J, Cheng B, You R, Yin X, Chen G, Yang L, Zhang Y, Si L, Jiang H, Zhang Y, Huang J, Huang J. Effect of food and polymorphisms in SLCO2B1, CYP3A4 and UGT1A4 on pharmacokinetics of abiraterone and its metabolites in Chinese volunteers. Br J Clin Pharmacol 2024; 90:247-263. [PMID: 37574850 DOI: 10.1111/bcp.15883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/09/2022] [Revised: 07/03/2023] [Accepted: 08/05/2023] [Indexed: 08/15/2023] Open
Abstract
AIMS Abiraterone acetate, a prodrug of abiraterone (ABI), provides an efficient therapeutic option for metastatic castration-resistant prostate cancer patients. ABI undergoes extensive metabolism in vivo and is transformed into active metabolites Δ4 -abiraterone and 3-keto-5α-abiraterone as well as inactive metabolites abiraterone sulfate and abiraterone N-oxide sulfate. We aimed to examine the effect of polymorphisms in SLCO2B1, CYP3A4 and UGT1A4 on the pharmacokinetics of ABI and its metabolites. METHODS In this study, 81 healthy Chinese subjects were enrolled and divided into 2 groups for fasted (n = 45) and fed (n = 36) studies. Plasma samples were collected after administering a 250 mg abiraterone acetate tablet followed by liquid chromatography-tandem mass spectrometry analysis. Genotyping was performed on a MassARRAY system. The association between SLCO2B1, CYP3A4, UGT1A4 genotype and pharmacokinetic parameters of ABI and its metabolites was assessed. RESULTS Food effect study demonstrated high fat meal remarkedly increased systemic exposure of ABI and its metabolites. The geometric mean ratio and 90% confidence interval of area under the plasma concentration-time curve from time 0 to the time of the last quantifiable concentration (AUC0-t ) and maximum plasma concentration (Cmax ) of ABI in fed state vs. fasted state were 351.64% (286.86%-431.04%) and 478.45% (390.01%-586.94%), respectively, while the corresponding results were ranging from 145.11% to 269.42% and 150.10% to 478.45% for AUC0-t and Cmax of ABI metabolites in fed state vs. fasted state, respectively. The SLCO2B1 rs1077858 had a significant influence on AUC0-t and Cmax , while 7 other SLCO2B1 variants prolonged half-life of ABI under both fasted and fed conditions. As for ABI metabolites, the systemic exposure of Δ4 -abiraterone, abiraterone sulfate and abiraterone N-oxide sulfate as well as the elimination of 3-keto-5α-abiraterone were significantly affected by SLCO2B1 polymorphisms. Polymorphisms in CYP3A4 and UGT1A4 did not significantly affect pharmacokinetics of ABI and its metabolites. CONCLUSION Polymorphisms in SLCO2B1 were significantly related to the pharmacokinetic variability of ABI and its metabolites under both fasted and fed conditions.
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Affiliation(s)
- Yixin Hu
- Department of Pharmaceutics, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianyuan Wu
- Clinical Trial Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bingyu Cheng
- Department of Pharmaceutics, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rongli You
- Department of Pharmacology, Beijing Zhendong Pharmaceutical Research Institute Co, Ltd, Beijing, China
| | - Xueyan Yin
- Department of Pharmaceutics, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- The Third Affiliated Hospital of School of Medicine, Shihezi University, Shihezi, China
| | - Guiying Chen
- Wuhan Hongren Biopharmaceutical Inc., Wuhan, China
| | - Ling Yang
- Wuhan Hongzhi Biomedical Inc., Wuhan, China
| | - Yang Zhang
- Wuhan Hongren Biopharmaceutical Inc., Wuhan, China
| | - Luqin Si
- Department of Pharmaceutics, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongliang Jiang
- Department of Pharmaceutics, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongjun Zhang
- The Third Affiliated Hospital of School of Medicine, Shihezi University, Shihezi, China
| | - Jianying Huang
- Clinical Trial Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiangeng Huang
- Department of Pharmaceutics, School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Megeed A, Magas H, Accursi M, Burant CJ, Hansen E. The impact of a pharmacist-led oral anticancer clinic on medication adherence and laboratory monitoring. J Oncol Pharm Pract 2023; 29:1921-1927. [PMID: 37350157 DOI: 10.1177/10781552231159870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
PURPOSE To evaluate the impact that a pharmacist-managed oral anticancer clinic has on patient adherence to oral anticancer therapy in regard to medication adherence and adherence to lab monitoring. METHODS A retrospective chart review was completed for patients prescribed abiraterone, enzalutamide, or ibrutinib within the study time period. The primary outcome was assessing medication adherence by comparing the medication possession ratio (MPR) before (Phase 1) and after (Phase 2) initiation of the pharmacist-led oral anticancer therapy clinic. The secondary outcome was assessing lab monitoring adherence by patients and providers in Phase 1 and Phase 2. This will be done by assessing whether labs were ordered at the appropriate time frame by oncology providers, as well as whether or not the patient came and got these labs drawn. This study will also examine outcomes related to the pharmacist-led oral anticancer therapy clinic (phase 2) for descriptive purposes. RESULTS A total of 189 charts were analyzed with 134 excluded and 55 included (25 patients in phase 1 and 30 patients in phase 2). Independent sample t-test analyses revealed a statistically significant increase (t(30.57) = -1.99; p = 0.027) in the MPR ratio between phase 1 (mean = 0.98, SD = 0.13) compared to phase 2 (mean = 1.04, SD = 0.08). For patient adherence to lab monitoring, there was a statistically significant improvement between phase 1 and phase 2 for patients on abiraterone (21.9% vs 67%; t(25) = -5.73; p < 0.001) and enzalutamide (35.7% vs. 90.5%; t(8) = -3.26; p = 0.006). However, for patients on ibrutinib, there was a slight decline in lab monitoring adherence between phase 1 and phase 2 but this effect was not statistically significant (56.2% vs. 51%; t(17) = 0.58; p = 0.283). Similar results were shown for provider adherence to lab monitoring. Descriptive outcomes showed that the pharmacist had, on average, 6.7 encounters per patient with the majority being phone and face-to-face appointments. CONCLUSIONS Data from this study demonstrated that a pharmacist-led oral anticancer clinic can improve MPR ratios and patient adherence to oral anticancer medication regimens. In addition, patient and provider lab monitoring adherence was improved for abiraterone and enzalutamide. Improvement in patient and provider lab monitoring adherence for ibrutinib was not shown, possibly due to the impact of the COVID-19 pandemic, relatively small sample size, and retrospective nature of this study. The results of this study support that overall, a pharmacist-led oral anticancer clinic can significantly improve patient outcomes, which aligns with previous smaller studies that have shown similar benefits.
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Affiliation(s)
- Ayaa Megeed
- Veterans Affairs Central Ohio Healthcare System, Columbus, OH, USA
| | - Hannah Magas
- Veterans Affairs Central Ohio Healthcare System, Columbus, OH, USA
| | - Mallory Accursi
- Veterans Affairs Central Ohio Healthcare System, Columbus, OH, USA
| | - Christopher J Burant
- Statistical Resource Center at the Geriatric Research, Education & Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Elizabeth Hansen
- Veterans Affairs Central Ohio Healthcare System, Columbus, OH, USA
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Shagera QA, Karfis I, Kristanto P, Spyridon S, Diamand R, Santapau A, Peltier A, Roumeguère T, Flamen P, Artigas C. PSMA PET/CT for Response Assessment and Overall Survival Prediction in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Androgen Receptor Pathway Inhibitors. J Nucl Med 2023; 64:1869-1875. [PMID: 37770114 DOI: 10.2967/jnumed.123.265874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/07/2023] [Indexed: 10/02/2023] Open
Abstract
We aimed to evaluate the role of prostate-specific membrane antigen (PSMA) PET/CT for response assessment and outcome prediction in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with androgen receptor pathway inhibitors (ARPIs), including abiraterone acetate or enzalutamide. Methods: We retrospectively analyzed 30 ARPI-treated mCRPC patients who underwent 68Ga-PSMA-11 PET/CT within 8 wk before (baseline) and 12 ± 4 wk after treatment initiation. Total PSMA tumor volume was calculated using the fixed threshold method (SUV ≥ 3). Patients were categorized as PSMA responders (PSMA-Rs) or PSMA nonresponders (PSMA-NRs) on the basis of both European Association of Urology/European Association of Nuclear Medicine (EAU/EANM) criteria and Response Evaluation Criteria in PSMA PET/CT (RECIP) 1.0. PSMA-R included patients with a complete response, a partial response, or stable disease, and PSMA-NR included those with progressive disease. On the basis of prostate-specific antigen (PSA), patients were classified as biochemical responders if PSA decreased by at least 50% and as nonresponders if it did not. The Φ-coefficient was used to evaluate the correlation of PSMA- and PSA-based responses. Survival analysis was performed using the Cox regression hazard model and the Kaplan-Meier method. Predictive accuracy was tested for both response criteria. Results: On the basis of PSMA PET/CT, 13 (43%) patients were PSMA-NR according to the EAU/EANM criteria and 11 (37%) patients were PSMA-NR according to RECIP 1.0. Significant correlations were observed between PSMA- and PSA-based responses for both criteria (Φ = 0.79 and 0.66, respectively). After a median follow-up of 25 mo (interquartile range, 21-43 mo), the median overall survival was significantly longer for PSMA-R than PSMA-NR (54 vs. 22 mo) for both the EAU/EANM criteria and RECIP 1.0, with hazard ratios of 6.9 (95% CI, 1.9-26; P = 0.004) and 5.6 (95% CI, 1.69-18.26, P = 0.005), respectively. No significant difference in predictive accuracy was found between the 2 criteria (C-index, 0.79 vs. 0.76, respectively, P = 0.54). Flare phenomena at the second PSMA PET study were not observed in our cohort. Conclusion: Our results demonstrate that PSMA PET/CT is a valuable imaging biomarker for response assessment and overall survival prediction when performed at 3 mo after ARPI treatment initiation in mCRPC patients. Both proposed PSMA response criteria (EAU/EANM and RECIP 1.0) seem to perform equally well. No PSMA flare was observed. Prospective validation of these findings is strongly needed.
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Affiliation(s)
- Qaid Ahmed Shagera
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Ioannis Karfis
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Paulus Kristanto
- Data Centre, Unité de Gestion de l'Information, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Sideris Spyridon
- Department of Oncology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; and
| | - Romain Diamand
- Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Albert Santapau
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Roumeguère
- Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Flamen
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos Artigas
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium;
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Schaaf ZA, Ning S, Leslie AR, Sharifi M, Han X, Armstrong C, Lou W, Lombard AP, Liu C, Gao AC. Therapeutic Resistance Models and Treatment Sequencing in Advanced Prostate Cancer. Cancers (Basel) 2023; 15:5273. [PMID: 37958444 PMCID: PMC10650051 DOI: 10.3390/cancers15215273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Current common treatments for castration-resistant prostate cancer (CRPC) typically belong to one of three major categories: next-generation anti-androgen therapies (NGAT) including enzalutamide, abiraterone acetate, apalutamide, and darolutamide; taxane therapy represented by docetaxel; and PARP inhibitors (PARPi) like olaparib. Although these treatments have shown efficacy and have improved outcomes for many patients, some do not survive due to the emergence of therapeutic resistance. The clinical landscape is further complicated by limited knowledge about how the sequence of treatments impacts the development of therapeutic cross-resistance in CRPC. We have developed multiple CRPC models of acquired therapeutic resistance cell sublines from C4-2B cells. These include C4-2B MDVR, C4-2B AbiR, C4-2B ApaR, C4-2B DaroR, TaxR, and 2B-olapR, which are resistant to enzalutamide, abiraterone, apalutamide, darolutamide, docetaxel, and olaparib, respectively. These models are instrumental for analyzing gene expression and assessing responses to various treatments. Our findings reveal distinct cross-resistance characteristics among NGAT-resistant cell sublines. Specifically, resistance to enzalutamide induces resistance to abiraterone and vice versa, while maintaining sensitivity to taxanes and olaparib. Conversely, cells with acquired resistance to docetaxel exhibit cross-resistance to both cabazitaxel and olaparib but retain sensitivity to NGATs like enzalutamide and abiraterone. OlapR cells, significantly resistant to olaparib compared to parental cells, are still responsive to NGATs and docetaxel. Moreover, OlapR models display cross-resistance to other clinically relevant PARP inhibitors, including rucaparib, niraparib, and talazoparib. RNA-sequencing analyses have revealed a complex network of altered gene expressions that influence signaling pathways, energy metabolism, and apoptotic signaling, pivotal to cancer's evolution and progression. The data indicate that resistance mechanisms are distinct among different drug classes. Notably, NGAT-resistant sublines exhibited a significant downregulation of androgen-regulated genes, contrasting to the stable expression noted in olaparib and docetaxel-resistant sublines. These results may have clinical implications by showing that treatments of one class can be sequenced with those from another class, but caution should be taken when sequencing drugs of the same class.
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Affiliation(s)
- Zachary A. Schaaf
- Department of Urologic Surgery, University of California Davis, Sacramento, CA 95817, USA; (Z.A.S.); (S.N.); (A.R.L.); (M.S.); (X.H.); (C.A.); (W.L.); (A.P.L.); (C.L.)
| | - Shu Ning
- Department of Urologic Surgery, University of California Davis, Sacramento, CA 95817, USA; (Z.A.S.); (S.N.); (A.R.L.); (M.S.); (X.H.); (C.A.); (W.L.); (A.P.L.); (C.L.)
| | - Amy R. Leslie
- Department of Urologic Surgery, University of California Davis, Sacramento, CA 95817, USA; (Z.A.S.); (S.N.); (A.R.L.); (M.S.); (X.H.); (C.A.); (W.L.); (A.P.L.); (C.L.)
| | - Masuda Sharifi
- Department of Urologic Surgery, University of California Davis, Sacramento, CA 95817, USA; (Z.A.S.); (S.N.); (A.R.L.); (M.S.); (X.H.); (C.A.); (W.L.); (A.P.L.); (C.L.)
| | - Xianrui Han
- Department of Urologic Surgery, University of California Davis, Sacramento, CA 95817, USA; (Z.A.S.); (S.N.); (A.R.L.); (M.S.); (X.H.); (C.A.); (W.L.); (A.P.L.); (C.L.)
| | - Cameron Armstrong
- Department of Urologic Surgery, University of California Davis, Sacramento, CA 95817, USA; (Z.A.S.); (S.N.); (A.R.L.); (M.S.); (X.H.); (C.A.); (W.L.); (A.P.L.); (C.L.)
| | - Wei Lou
- Department of Urologic Surgery, University of California Davis, Sacramento, CA 95817, USA; (Z.A.S.); (S.N.); (A.R.L.); (M.S.); (X.H.); (C.A.); (W.L.); (A.P.L.); (C.L.)
| | - Alan P. Lombard
- Department of Urologic Surgery, University of California Davis, Sacramento, CA 95817, USA; (Z.A.S.); (S.N.); (A.R.L.); (M.S.); (X.H.); (C.A.); (W.L.); (A.P.L.); (C.L.)
- UC Davis Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, CA 95616, USA
| | - Chengfei Liu
- Department of Urologic Surgery, University of California Davis, Sacramento, CA 95817, USA; (Z.A.S.); (S.N.); (A.R.L.); (M.S.); (X.H.); (C.A.); (W.L.); (A.P.L.); (C.L.)
- UC Davis Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
| | - Allen C. Gao
- Department of Urologic Surgery, University of California Davis, Sacramento, CA 95817, USA; (Z.A.S.); (S.N.); (A.R.L.); (M.S.); (X.H.); (C.A.); (W.L.); (A.P.L.); (C.L.)
- UC Davis Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
- VA Northern California Health Care System, Sacramento, CA 95655, USA
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7
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Hettle R, Mihai A, Lang SH, Tatman S, Swift SL. Real-world outcomes for first line next-generation hormonal agents in metastatic prostate cancer: a systematic review. Future Oncol 2023; 19:2425-2443. [PMID: 37681288 DOI: 10.2217/fon-2023-0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 09/09/2023] Open
Abstract
Aim: This review aims to summarize published evidence on the real-world (RW) outcomes of abiraterone or enzalutamide in first-line metastatic castration-resistant prostate cancer. Materials & methods: Studies reporting on RW effectiveness, safety, economic and/or health-related quality of life outcomes were identified by systematic literature review (2011-2021, incl. Embase®, MEDLINE®) and presented in a qualitative synthesis. Risk of bias was assessed using ROBINS-I or the Molinier checklist. Results: 88 studies (n = 83,427 patients) were included. Median progression-free (40 studies) and overall survival (38 studies) ranged from 3.7 to 20.9 months and 9.8 to 45 months, respectively. Survival, safety and economic outcomes were similar across individual treatments, while limited health-related quality of life evidence suggested improvements with abiraterone. Risk of bias was moderate to high. Conclusion: RW outcomes in first-line metastatic castration-resistant prostate cancer remain poor despite treatment, highlighting an unmet need for new regimens. This review was supported by AstraZeneca and Merck Sharp & Dohme.
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Affiliation(s)
- Robert Hettle
- Payer Simulation & Analytics, Oncology Market Access and Pricing, AstraZeneca, Cambridge, Cambridgeshire, CB2 8PA, UK
| | - Adela Mihai
- Health Economics & Payer Evidence, Oncology Market Access and Pricing, AstraZeneca, Cambridge, Cambridgeshire, CB2 8PA, UK
| | - Shona H Lang
- Mtech Access, York, North Yorkshire, YO10 5NY, UK
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8
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Fusaro M, Leś A, Stolarczyk EU, Stolarczyk K. Computational Modeling of Gold Nanoparticle Interacting with Molecules of Pharmaceutical Interest in Water. Molecules 2023; 28:7167. [PMID: 37894646 PMCID: PMC10609557 DOI: 10.3390/molecules28207167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/03/2023] [Revised: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
We derived a theory of biomolecule binding to the surface of Aun clusters and of the Au plane based on the hard soft acid base (HSAB) principle and the free electron metallic surface model. With the use of quantum mechanical calculations, the chemical potential (μ) and the chemical hardness (η) of the biomolecules are estimated. The effect of the gold is introduced via the empirical value of the gold chemical potential (-5.77 eV) as well as by using the expression (modified here) for the chemical hardness (η). The effect of an aqueous environment is introduced by means of the ligand molecular geometry influenced by the PCM field. This theory allows for a fast and low-cost estimation of binding biomolecules to the AuNPs surface. The predicted binding of thiolated genistein and abiraterone to the gold surface is about 20 kcal/mol. The model of the exchange reaction between these biomolecules and citrates on the Au surface corresponds well with the experimental observations for thiolated abiraterone. Moreover, using a model of the place exchange of linear mercaptohydrocarbons on 12-mercaptododecane acid methyl ester bound to the Au surface, the present results reflect the known relation between exchange energy and the size of the reagents.
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Affiliation(s)
- Massimo Fusaro
- Faculty of Chemistry, University of Warsaw, Pasteura 1, 02-093 Warsaw, Poland; (M.F.); (A.L.)
| | - Andrzej Leś
- Faculty of Chemistry, University of Warsaw, Pasteura 1, 02-093 Warsaw, Poland; (M.F.); (A.L.)
| | | | - Krzysztof Stolarczyk
- Faculty of Chemistry, University of Warsaw, Pasteura 1, 02-093 Warsaw, Poland; (M.F.); (A.L.)
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9
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Elshazly AM, Gewirtz DA. Making the Case for Autophagy Inhibition as a Therapeutic Strategy in Combination with Androgen-Targeted Therapies in Prostate Cancer. Cancers (Basel) 2023; 15:5029. [PMID: 37894395 PMCID: PMC10605431 DOI: 10.3390/cancers15205029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Androgen receptor targeting remains the primary therapeutic strategy in prostate cancer, encompassing androgen biosynthesis inhibitors and androgen receptor antagonists. While both androgen-receptor-positive and "castration-resistant" prostate cancer are responsive to these approaches, the development of resistance is an almost inevitable outcome leading to the castration-resistant form of the disease. Given that "cytoprotective" autophagy is considered to be a predominant mechanism of resistance to various chemotherapeutic agents as well as to radiation in the cancer literature, the purpose of this review is to evaluate whether autophagy plays a central role in limiting the utility of androgen deprivation therapies in prostate cancer. Unlike most of our previous reports, where multiple functional forms of autophagy were identified, making it difficult if not impossible to propose autophagy inhibition as a therapeutic strategy, the cytoprotective form of autophagy appears to predominate in the case of androgen deprivation therapies. This opens a potential pathway for improving the outcomes for prostate cancer patients once effective and reliable pharmacological autophagy inhibitors have been developed.
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Affiliation(s)
- Ahmed M. Elshazly
- Department of Pharmacology and Toxicology, Massey Cancer Center, Virginia Commonwealth University, 401 College St., Richmond, VA 23298, USA;
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
| | - David A. Gewirtz
- Department of Pharmacology and Toxicology, Massey Cancer Center, Virginia Commonwealth University, 401 College St., Richmond, VA 23298, USA;
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10
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Luo Z, Zhu B, Xu H, Chen L, Song X, Wang Y, Wang R, Zheng J, Qiu Y, Yang J, Shi Y. Efficacy and safety of olaparib combined with abiraterone in patients with metastatic castration-resistant prostate cancer: a systematic review and meta-analysis of randomized controlled trials. Front Oncol 2023; 13:1265276. [PMID: 37869079 PMCID: PMC10587563 DOI: 10.3389/fonc.2023.1265276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Background Olaparib has been proven for the treatment of metastatic castration-resistant prostate cancer (mCRPC). This meta-analysis aims to comprehensively evaluate the efficacy and safety of the combination of olaparib and abiraterone in patients with mCRPC. Methods The literature in PubMed, Embase, and Cochrane Library up until April 27, 2023, was systematically searched. In the studies included in this meta-analysis, olaparib combined with abiraterone was compared with abiraterone combined with placebo. Results Two randomized controlled trials involving a total of 938 patients were included. Analysis indicated that olaparib combined with abiraterone significantly prolonged radiographic progression-free survival (rPFS: relative risk [RR] 0.66, 95% confidence interval [CI] 0.55-0.79), time to secondary progression or death (PFS2: hazard ratio [HR] 0.72, 95% CI 0.56-0.93), time to first subsequent therapy or death (TFST: HR 0.75, 95% CI 0.63-0.89), time to second subsequent therapy or death (TSST: HR 0.73, 95% CI 0.58-0.93), and confirmed prostate-specific antigen (PSA) response (RR 1.14, 95% CI 1.05-1.24). However, no statistically significant differences were found in the overall survival (OS: HR 0.87 95% CI 0.70-1.09), objective response rate (ORR: RR 0.97, 95% CI 0.70-1.33), and incidence of total adverse events (RR 1.07, 95% CI 0.94-1.22). A notable detail that the combination of olaparib and abiraterone was associated with an increased incidence of high-grade anemia (RR 7.47, 95% CI 1.36-40.88). Conclusion Olaparib combined with abiraterone is effective for patients with mCRPC. However, combination therapy has treatment-related adverse events compared with monotherapy, and this could be improved in future treatment management. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023432287.
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Affiliation(s)
- Zhanyang Luo
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bukun Zhu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hong Xu
- Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Lixin Chen
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoyun Song
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rui Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jinzhou Zheng
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yunhua Qiu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianfeng Yang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Youyang Shi
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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11
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Ma Y. OCT4‑positive circulating tumor cells may predict a poor prognosis in patients with metastatic castration‑resistant prostate cancer treated with abiraterone plus prednisone therapy. Oncol Lett 2023; 26:452. [PMID: 37720669 PMCID: PMC10502952 DOI: 10.3892/ol.2023.14039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/30/2023] [Indexed: 09/19/2023] Open
Abstract
Octamer-binding transcription factor 4 (OCT4) and circulating tumor cells (CTCs) are key factors associated with tumor metastasis and drug resistance in cancer. The present prospective study aimed to investigate the prevalence of OCT4-positive (OCT4+) CTCs and the potential association with the clinical features and survival of patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone + prednisone. In total, 70 patients with mCRPC treated with abiraterone + prednisone were enrolled in the present study and peripheral blood samples were collected prior to treatment initiation to determine CTC count via a Canpatrol system. RNA in situ hybridization was performed for OCT4+ CTC quantification. Lactate dehydrogenase (LDH) was detected by automatic biochemical analyzer (AU54000, OLYMPUS). Results demonstrated that 34 (48.6%), 21 (30.0%) and 15 (21.4%) patients harbored OCT4+ (CTC+/OCT4+) or OCT4-negative CTCs (CTC+/OCT4-) or were CTC-negative (CTC-), respectively. Notably, CTC+/OCT4+ occurrence was associated with visceral metastasis and high levels of LDH. In addition, radiographic progression-free survival [rPFS; median, 15.0, 95% confidence interval (CI), 9.6-20.4 vs. not reached vs. median, 29.5, 95% CI, 18.6-40.4 months; P=0.001] and overall survival (OS) were significantly decreased (median, 27.3, 95% CI, 20.1-34.5 vs. not reached vs. not reached; P=0.016) in CTC+/OCT4+ compared with CTC+/OCT4- and CTC- patients. Subsequently, the adjustment was performed by multivariate Cox regression models, which revealed that CTC+/OCT4+ (vs. CTC+/OCT4- or CTC-) was independently associated with decreased rPFS [hazard ratio (HR), 3.833; P<0.001] and OS (HR, 3.938; P=0.008). In conclusion, OCT4+ CTCs were highly prevalent in patients with mCRPC and associated with visceral metastasis and increased levels of LDH. Thus, the presence of OCT4+ CTCs may serve as an independent prognostic factor for patients with mCRPC treated with abiraterone + prednisone.
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Affiliation(s)
- Yong Ma
- Department of Urology, Shanghai Songjiang District Sijing Hospital, Shanghai 201601, P.R. China
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12
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Tani M, Hayashi Y, Miki A, Wakita T, Horibe Y, Kakuta Y, Tsutahara K, Takao T. A case of abiraterone acetate withdrawal syndrome after initiation of upfront abiraterone therapy for high-risk prostate cancer. IJU Case Rep 2023; 6:282-285. [PMID: 37667762 PMCID: PMC10475332 DOI: 10.1002/iju5.12604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/13/2023] [Accepted: 06/15/2023] [Indexed: 09/06/2023] Open
Abstract
Introduction Transient decrease in serum prostate-specific antigen level can occur after abiraterone acetate withdrawal in male patient with metastatic castration-resistant prostate cancer. Here, we report a case of abiraterone acetate withdrawal syndrome with transient prostate-specific antigen decrease after progression to castration-resistant disease while using upfront abiraterone therapy for high-risk prostate cancer. Case presentation A 73-year-old man with hormone-sensitive high-risk prostate cancer with multiple bone metastases (prostate-specific antigen level, 294.109 ng/mL) received upfront abiraterone/prednisolone combination and androgen deprivation therapy. One year later, prostate-specific antigen level decreased to 0.017 ng/mL (nadir) but it gradually rose by 15 months after treatment initiation. He was diagnosed as castration-resistant and new bone metastases appeared. After abiraterone was discontinued, prostate-specific antigen level decreased and stabilized at a low level for 5 months. Conclusion Abiraterone acetate withdrawal syndrome was observed when hormone-sensitive prostate cancer with upfront abiraterone therapy progressed to castration-resistant prostate cancer.
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Affiliation(s)
- Masaru Tani
- Department of UrologyOsaka General Medical CenterOsakaJapan
| | - Yujiro Hayashi
- Department of UrologyOsaka General Medical CenterOsakaJapan
| | - Airi Miki
- Department of UrologyOsaka General Medical CenterOsakaJapan
| | - Teppei Wakita
- Department of UrologyOsaka General Medical CenterOsakaJapan
| | - Yuki Horibe
- Department of UrologyOsaka General Medical CenterOsakaJapan
| | - Yoichi Kakuta
- Department of UrologyOsaka General Medical CenterOsakaJapan
| | | | - Tetsuya Takao
- Department of UrologyOsaka General Medical CenterOsakaJapan
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13
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Mitsogianni M, Papatsoris A, Bala VM, Issa H, Moussa M, Mitsogiannis I. An overview of hormonal directed pharmacotherapy for the treatment of prostate cancer. Expert Opin Pharmacother 2023; 24:1765-1774. [PMID: 37545430 DOI: 10.1080/14656566.2023.2244415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Prostate cancer is the most common malignancy in the male. Androgen-deprivation therapy (ADT) has been the mainstay in the treatment of metastatic prostate cancer however, due to the outgrowth of castration-resistant cell population the disease inevitably progresses to an aggressive, difficult to handle stage. AREAS COVERED We have reviewed the literature regarding hormonal-directed therapy prostate cancer. New agents, namely abiraterone acetate, combined with prednisone, and next generation antiandrogens (enzalutamide, apalutamide and darolutamide) have shown considerable efficacy, not only in patients with metastatic but also in those with non-metastatic disease, either castration resistant (CRPC) or hormone sensitive (HSPC). EXPERT OPINION The addition of abiraterone and of the second-generation antiandrogens to our therapeutic armamentarium has improved prognosis ofprostate cancer in the last decade. Abiraterone is a viable option in patients with metastatic disease (hormone-sensitive and castration-resistant), whereas all next-generation antiandrogens have demonstrated efficacy in terms of metastasis-free and overall survival in non-metastatic CRPC. In addition, enzalutamide has also been found efficacious in mCRPC and mHSPC, while apalutamide in mHSPC. Currently there are no reliable data to indicate a potential superiority of one of these agents over the others in CRPC or HSPC as there are no relevant head to head studies . Sequencing hormone treatment modalities, chemotherapies and immunotherapies have not reached a consensus as yet. Randomized controlled trials are warranted to clearly define the role of novel antiandrogens in the treatment of prostate cancer. The choice of treatment should be individualized following discussion with the patient .
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Affiliation(s)
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vanessa-Meletia Bala
- 2nd Department of Medical Oncology, General Oncology Hospital of Kifissia 'Agioi Anargyroi', Athens, Greece
| | - Hussein Issa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Beirut, Lebanon
| | - Mohammad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Beirut, Lebanon
| | - Iraklis Mitsogiannis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Arafa AT, Blader LR, Ramakrishna K, Engle J, Ryan CJ, Zorko NA, Jha G, Antonarakis ES. Clinical outcomes in patients with metastatic castrate-resistant prostate cancer treated with abiraterone with or without ongoing androgen deprivation therapy: A retrospective case-control study. Prostate 2023; 83:1279-1284. [PMID: 37337669 PMCID: PMC10914526 DOI: 10.1002/pros.24589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Abiraterone and concurrent androgen deprivation therapy (ADT) are used in the treatment of patients with metastatic castration-resistant prostate cancer. Recently, it has been suggested that the use of abiraterone alone (without ADT) may have comparable efficacy to abiraterone with ongoing ADT. Here, we sought to assess the impact of ADT cessation in patients beginning abiraterone for castration-resistant prostate cancer. METHODS We identified 39 patients at our institution who received abiraterone alone (with discontinuation of ADT) between 2011 and 2022. We then procured a comparable group of 39 patients (matched by age, Gleason score, and prostate-specific antigen [PSA] level) who received abiraterone with ongoing ADT during the same period. We assessed and compared clinical outcomes in the two groups (abiraterone-alone vs. abiraterone-ADT) with respect to PSA response rates, PSA progression-free survival, and overall survival. Results were adjusted using Cox proportional-hazards multivariable models. RESULTS The median PSA before treatment initiation was 12.7 (range: 0.2-199) ng/mL in the abiraterone-alone group and 15.5 (range: 0.6-212) ng/mL in the abiraterone-ADT group. Use of abiraterone alone adequately suppressed testosterone levels in 35/37 (94.6%) patients. Patients receiving abiraterone alone had a median PSA reduction of 80.2% versus 79.5% in patients receiving abiraterone plus ADT. The median PSA progression-free survival in patients receiving abiraterone alone was 27.4 versus 25.8 months in patients receiving abiraterone plus ADT (hazard ratio [HR] 1.10; 95% confidence interval [CI] 0.65-1.71; p = 0.82). In addition, abiraterone alone was associated with an overall survival of 3.6 versus 3.1 years in patients receiving abiraterone plus ADT (HR 0.90; 95% CI 0.50-1.62; p = 0.72). There were no differences in PFS or OS between groups after performing Cox multivariable regression analyses. CONCLUSION Use of abiraterone alone was associated with comparable clinical outcomes to patients who received abiraterone together with ADT. Further prospective studies are warranted to evaluate the impact of abiraterone alone on treatment outcomes and cost savings.
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Affiliation(s)
- Ali T. Arafa
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Leah R. Blader
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | | | - Jeff Engle
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Charles J. Ryan
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
- Prostate Cancer Foundation, Santa Monica, CA
| | | | - Gautam Jha
- University of Minnesota Masonic Cancer Center, Minneapolis, MN
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15
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La Vecchia M, Fazio I, Borsellino N, Lo Casto A, Galanti D. Stereotactic body radiotherapy in oligoprogressive metastatic castration-resistant prostate cancer during abiraterone or enzalutamide. Tumori 2023; 109:413-417. [PMID: 36358013 DOI: 10.1177/03008916221132592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/21/2023]
Abstract
INTRODUCTION This monocentric, single-arm, retrospective study investigated the role of stereotactic body radiotherapy in patients with metastatic castration resistant prostate cancer who experienced oligoprogression during androgen receptor targeted agents. METHODS We retrospectively enrolled metastatic castration resistant prostate cancer patients treated with androgen receptor targeted agents between December 2016 and January 2022. All patients experienced an oligoprogression (defined as the appearance and/or the progression of ⩽5 bone or nodal or soft tissue metastases) during treatment with androgen receptor targeted agents and received stereotactic body radiotherapy upon oligoprogressive sites, preserving the androgen receptor targeted agents. Further stereotactic body radiotherapy upon new metastatic sites was permitted. Patients showing visceral metastases or receiving palliative radiotherapy were excluded. Progressive disease at >5 metastatic sites or the appearance of visceral metastases led to a change of the systemic treatment. Primary endpoints were 36-month survival rate and 36-month rate of patients receiving treatment with androgen receptor targeted agents. Secondary endpoints were local disease control, biochemical response and safety. RESULTS We analyzed data from 30 patients. The 36-month survival rate was 90% (27 patients); 36-month rate of patients who were still on treatment with androgen receptor targeted agents was 50%. 20 of 30 patients had performed imaging control after a single course of stereotactic body radiotherapy: overall response rate was 50%, while clinical benefit was 93%. No ⩾G2 adverse events related to stereotactic body radiotherapy were recorded. CONCLUSIONS Stereotactic body radiotherapy in oligoprogressive metastatic sites during androgen receptor targeted agent treatment resulted in a feasible and effective treatment to delay the start of next-line systemic treatment and prolong overall survival in metastatic castration resistant prostate cancer. Longer follow-up and further prospective studies are necessary to confirm our preliminary results.
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Affiliation(s)
- Maria La Vecchia
- Graduate School of Oncological Radiotherapy, University of Palermo, Palermo, Italy
- Radiaton Therapy Unit, Casa di Cura Macchiarella SpA, Palermo, Italy
| | - Ivan Fazio
- Radiaton Therapy Unit, Casa di Cura Macchiarella SpA, Palermo, Italy
| | - Nicolò Borsellino
- Medical Oncology Unit, Ospedale Buccheri La Ferla Fatebenefratelli, Palermo, Italy
| | - Antonio Lo Casto
- Department of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
| | - Daniele Galanti
- Medical Oncology Unit, Ospedale Buccheri La Ferla Fatebenefratelli, Palermo, Italy
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16
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Tsao PA, Burns J, Kumbier K, Sparks JB, Entenman S, Bloor LE, Bohnert ASB, Skolarus TA, Caram MEV. Mental health care utilization among men with castration-resistant prostate cancer receiving abiraterone or enzalutamide. Cancer Med 2023; 12:16490-16501. [PMID: 37325888 PMCID: PMC10469813 DOI: 10.1002/cam4.6237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/19/2023] [Revised: 05/23/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Abiraterone and enzalutamide are castration-resistant prostate cancer (CRPC) therapies with potentially distinct associations with mental health symptoms given their differing antiandrogen targets. METHODS We used national Veterans Health Administration data to identify patients with CRPC who received first-line abiraterone or enzalutamide from 2010 to 2017. Using Poisson regression, we compared outpatient mental health encounters per 100 patient-months on drug between the abiraterone and enzalutamide cohorts adjusting for patient factors (e.g., age). We compared mental health encounters in the year before versus after starting therapy using the McNemar test. RESULTS We identified 2902 CRPC patients who received abiraterone (n = 1992) or enzalutamide (n = 910). We found no difference in outpatient mental health encounters between the two groups (adjusted incident rate ratio [aIRR] 1.04, 95% confidence interval [CI] 0.95-1.15). However, men with preexisting mental health diagnoses received 81.3% of the outpatient mental health encounters and had higher rates of these encounters with enzalutamide (aIRR 1.21, 95% CI 1.09-1.34). Among patients with ≥1 year of enrollment before and after starting abiraterone (n = 1139) or enzalutamide (n = 446), there was no difference in mental health care utilization before versus after starting treatment (17.0% of patients vs. 17.6%, p = 0.60, abiraterone; 16.4% vs. 18.4%, p = 0.26, enzalutamide). CONCLUSION We found no overall differences in mental health care utilization between CRPC patients who received first-line abiraterone versus enzalutamide. However, men with preexisting mental health diagnoses received the majority of mental health care and had more mental health visits with enzalutamide.
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Affiliation(s)
- Phoebe A. Tsao
- Division of Hematology/Oncology, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Veterans Affairs Health Services Research & Development, Center for Clinical Management and ResearchVeterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
- Institute of Health Policy and Innovation, University of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Jennifer Burns
- Veterans Affairs Health Services Research & Development, Center for Clinical Management and ResearchVeterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Kyle Kumbier
- Veterans Affairs Health Services Research & Development, Center for Clinical Management and ResearchVeterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Jordan B. Sparks
- Veterans Affairs Health Services Research & Development, Center for Clinical Management and ResearchVeterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Shami Entenman
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Lindsey E. Bloor
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of PsychiatryVeterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Amy S. B. Bohnert
- Veterans Affairs Health Services Research & Development, Center for Clinical Management and ResearchVeterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
- Institute of Health Policy and Innovation, University of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of AnesthesiologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Ted A. Skolarus
- Veterans Affairs Health Services Research & Development, Center for Clinical Management and ResearchVeterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
- Department of Surgery, Section of UrologyUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
| | - Megan E. V. Caram
- Division of Hematology/Oncology, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Veterans Affairs Health Services Research & Development, Center for Clinical Management and ResearchVeterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
- Institute of Health Policy and Innovation, University of Michigan Medical SchoolAnn ArborMichiganUSA
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Chen HX, Tsai LH, Chang CH, Wu HC, Lin CC, Lin CH, Yeh CC, Yang CR, Lien CS, Chang YH, Liang JA, Chen GH, Hsiao PJ, Hsieh PF, Huang CP. Enzalutamide Prior to Radium-223 Is Associated with Better Overall Survival in Metastatic Castration-Resistant Prostate Cancer Patients Compared to Abiraterone-A Retrospective Study. Cancers (Basel) 2023; 15:3516. [PMID: 37444626 DOI: 10.3390/cancers15133516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/11/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Metastatic castration-resistant prostate cancer (mCRPC) is a progressive stage of prostate cancer that often spreads to the bone. Radium-223, a bone-targeting radiopharmaceutical, has been shown to improve the overall survival in mCRPC in patients without visceral metastasis. However, the impact of prior systemic therapy on the treatment outcome of mCRPC patients receiving radium-223 remains unclear. This study aimed to investigate the optimal choice of systemic therapy before radium-223 in mCRPC patients. The study included 41 mCRPC patients who received radium-223 therapy, with 22 receiving prior enzalutamide and 19 receiving prior abiraterone. The results showed that the median overall survival was significantly longer in the enzalutamide group than in the abiraterone group (25.1 months vs. 14.8 months, p = 0.049). Moreover, the number of patients requiring blood transfusion was higher in the abiraterone group than in the enzalutamide group (9.1% vs. 26.3%, p = 0.16). The study also found that the number of doses of Radium-223 received was significantly associated with overall survival (≥5 vs. <5, HR 0.028, 95%CI 0.003-0.231, p = 0.001). Our study provides insights into the optimal treatment choice for mCRPC prior to radium-223, indicating that enzalutamide prior to radium-223 administration may have better outcomes compared to abiraterone in mCRPC patients without visceral metastasis.
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Affiliation(s)
- Hao Xiang Chen
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Li-Hsien Tsai
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Hsi-Chin Wu
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin 651012, Taiwan
| | - Ching-Chan Lin
- Department of Internal Medicine, Division of Hematology and Oncology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan 70965, Taiwan
| | - Che-Hung Lin
- Department of Internal Medicine, Division of Hematology and Oncology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Chin-Chung Yeh
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Chi-Rei Yang
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Chi-Shun Lien
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Yi-Huei Chang
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung 406333, Taiwan
| | - Ji-An Liang
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Radiation Oncology, China Medical University Hospital, Taichung 40402, Taiwan
| | - Guan-Heng Chen
- Department of Urology, China Medical University Hsinchu Hospital, Hsinchu 30272, Taiwan
| | - Po-Jen Hsiao
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
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18
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Nkwocha BI, Singh M. Abiraterone-Induced Hypokalemia: A Case Report. Cureus 2023; 15:e42533. [PMID: 37637533 PMCID: PMC10460115 DOI: 10.7759/cureus.42533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Abiraterone, an androgen biosynthesis inhibitor drug approved by the Food and Drug Administration (FDA) in 2011 for the treatment of metastatic prostate cancer, has seen an increase in prescriptions over the years, owing largely to the aging population and the association of prostate cancer with increasing age. As the rate of abiraterone prescription increases, it is important for physicians to be aware of its adverse effects profile to improve patient outcomes. This case report explains the mechanism, clinical presentation, and management of abiraterone-induced hypokalemia in a 67-year-old male with prostate cancer and highlights the importance of close monitoring and management of electrolyte levels for patients on abiraterone.
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Affiliation(s)
- Bernard I Nkwocha
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Meenu Singh
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, USA
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19
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Akpokavie D, Gubert C, Abdelli I, Stern AO, Zender H. Fatal fulminant hepatitis in a patient taking abiraterone acetate: a case report. Front Med (Lausanne) 2023; 10:1143244. [PMID: 37457563 PMCID: PMC10349381 DOI: 10.3389/fmed.2023.1143244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Abiraterone acetate is a steroidal inhibitor of cytochrome P450 17A1 indicated in the treatment of metastatic prostate cancer. This report examines the case of a 66-year-old patient diagnosed with prostate adenocarcinoma that had metastasized to the bones and lymph nodes. Treatment with abiraterone acetate and corticosteroid co-administration as well as LH-RH analog hormone therapy was initiated. Four and a half months later, the patient consulted for deterioration of general condition. Biologically, he developed a fulminant hepatitis of which he eventually died. An infectious or metabolic origin was ruled out. Oncological cause by either disease progression or second neoplastic process was eliminated by means of imaging. Hepatic toxicity was imputed to the treatment with abiraterone acetate. This case suggests that fulminant hepatitis on abiraterone acetate may be underestimated, and underscores the importance of regular monitoring of liver tests on this therapy.
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Affiliation(s)
- Dela Akpokavie
- Department of Medicine, Service of Internal Medicine, Neuchâtel Hospital Network – La Chaux-de-Fonds, Neuchâtel, Switzerland
| | - Capucine Gubert
- Department of Medicine, Service of Internal Medicine, Neuchâtel Hospital Network – Pourtalès, Neuchâtel, Switzerland
| | - Imene Abdelli
- Department of Medicine, Service of Internal Medicine, Neuchâtel Hospital Network – La Chaux-de-Fonds, Neuchâtel, Switzerland
- Department of Oncology, Neuchâtel Hospital Network – La Chaux-de-Fonds, Neuchâtel, Switzerland
| | - Alix O'Meara Stern
- Department of Oncology, Neuchâtel Hospital Network – La Chaux-de-Fonds, Neuchâtel, Switzerland
| | - Hervé Zender
- Department of Medicine, Service of Internal Medicine, Neuchâtel Hospital Network – La Chaux-de-Fonds, Neuchâtel, Switzerland
- Faculty of Medicine, University of Geneva, Genève, Switzerland
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20
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In brief: A new prostate cancer indication for olaparib (Lynparza). Med Lett Drugs Ther 2023; 65:e106-7. [PMID: 37339094 DOI: 10.58347/tml.2023.1679g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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21
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Zhuang J, Wang Y, Zhang S, Fu Y, Huang H, Lyu X, Zhang S, Marra G, Xu L, Qiu X, Guo H. Androgen deprivation therapy plus abiraterone or docetaxel as neoadjuvant therapy for very-high-risk prostate cancer: a pooled analysis of two phase II trials. Front Pharmacol 2023; 14:1217303. [PMID: 37435500 PMCID: PMC10331422 DOI: 10.3389/fphar.2023.1217303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
Objective: The study aimed to compare the efficacy and safety of androgen deprivation therapy (ADT) with abiraterone or docetaxel versus ADT alone as neoadjuvant therapy in patients with very-high-risk localized prostate cancer. Methods: This was a pooled analysis of two single-center, randomized, controlled, phase II clinical trials (ClinicalTrials.gov: NCT04356430 and NCT04869371) conducted from December 2018 to March 2021. Eligible participants were randomly assigned to the intervention (ADT plus abiraterone or docetaxel) and control (ADT alone) groups at a 2:1 ratio. Efficacy was evaluated by pathological complete response (pCR), minimal residual disease (MRD), and 3-year biochemical progression-free survival (bPFS). Safety was also analyzed. Results: The study included 42 participants in the ADT group, 47 in the ADT plus docetaxel group, and 48 in the ADT plus abiraterone group. A total of 132 (96.4%) participants had very-high-risk prostate cancer, and 108 (78.8%) had locally advanced disease. The ADT plus docetaxel group (28%) and ADT plus abiraterone group (31%) had higher rates of pCR or MRD (p = 0.001 and p < 0.001) compared with the ADT group (2%). The 3-year bPFS was 41.9% (95% CI: 26.6-57.2), 51.1% (95% CI: 36.8-65.4), and 61.2% (95% CI: 45.5-76.9), respectively. Significant difference was found among groups in terms of bPFS (p = 0.037). Conclusion: Compared with ADT alone, neoadjuvant therapy with ADT plus docetaxel or abiraterone could achieve better pathological outcomes (pCR or MRD) for very-high-risk localized prostate cancer. The ADT plus abiraterone group showed longer bPFS than ADT alone. The combination regimens were tolerable.
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Affiliation(s)
- Junlong Zhuang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Yuwen Wang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Medical School of Southeast University Nanjing Drum Tower Hospital, Nanjing, China
| | - Shun Zhang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Yao Fu
- Department of Pathology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Haifeng Huang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Xiaoyu Lyu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Shiwei Zhang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Giancarlo Marra
- Department of Surgical Sciences, Division of Urology, Molinette Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Linfeng Xu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Xuefeng Qiu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
- Medical School of Southeast University Nanjing Drum Tower Hospital, Nanjing, China
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22
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Liu M, Yan J, Le K, Li Y, Xing N, Li G. Abiraterone acetate and prednisone in metastatic castration-resistant prostate cancer: a real-world retrospective study in China. Front Endocrinol (Lausanne) 2023; 14:1158949. [PMID: 37251681 PMCID: PMC10213513 DOI: 10.3389/fendo.2023.1158949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Background This research work was aimed at evaluating the incidence and risk factors of adverse events (AEs) occurring in patients treated with abiraterone acetate (AA) and prednisone (PDN) outside clinical trials. These associations were assessed regarding the survival outcomes. Methods The study included 191 patients aged ≥18 years of confirmed metastatic castration-resistant prostate cancer (mCRPC) between March 2017 and April 2022. AE incidences were descriptively summarized from the whole cohort. Baseline characteristics, safety (treatment-emergent AEs and severe AEs), and efficacy [progression-free survival (PFS)] were analyzed. Multi-variable Cox proportional hazards models were employed to assess the factors linked with PFS. Results Overall, the median PFS was 17.16 months (range, 0.5-57.58). Patient baseline prostate-specific antigen (PSA) ≧̸10 ng/ml (p = 0.000), multiple organ metastasis (p = 0.007), hypertension (p = 0.004), and coronary heart disease (p = 0.004) were associated with worse PFS; however, radiotherapy (p = 0.028) was linked to better PFS at univariate analysis in the overall cohort. Baseline multiple organ metastasis, hypertension, and radiotherapy remained statistically significant in multivariable models (p = 0.007, p= 0.005, and p = 0.011, respectively).Incidence of AEs showed increased bilirubin (BIL) (55/191 patients, 28.8%) followed by increased alanine aminotransferase/aspartate aminotransferase (ALT/AST) (48/191 patients, 25.09%). The most common grade 3 AEs were increased ALT (3/191, 1.57%) followed by elevated BIL, hypercholesterolemia, and hypokalemia. Anemia had shorter PFS. There were no unexpected AEs in any patient. Conclusion AA is effective and tolerated in asymptomatic or slightly symptomatic mCRPC in "real-life" setting. The survival outcomes are influenced by multiple organ metastasis, hypertension, and radiotherapy.
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Affiliation(s)
- Min Liu
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaqing Yan
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kaidi Le
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Li
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nianzeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guohui Li
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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23
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Stangl A, Wilner C, Li P, Maahs L, Hwang C, Pilling A. Molecular features and race-associated outcomes of SPOP-mutant metastatic castration-resistant prostate cancer. Prostate 2023; 83:524-533. [PMID: 36604824 DOI: 10.1002/pros.24481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Inactivating alterations in SPOP frequently occur in prostate cancer and promote increased dependency on androgen receptor (AR)-mediated oncogenic signaling. The presence of SPOP mutation (SPOP-mutant [SPOP-mut]) may therefore impact therapeutic outcomes with AR-directed therapies and docetaxel in metastatic castration-resistant (mCRPC). METHODS This was a retrospective study of mCRPC patients treated at an urban academic hospital (n = 103). Patients underwent tumor DNA sequencing to determine SPOP mutational status (SPOP-mut). Outcomes measured were overall survival (OS) from diagnosis and treatment with second-generation AR signaling inhibitor (ARSI) or docetaxel and time to PSA progression (prostate-specific antigen-progression-free survival [PSA-PFS]) compared by SPOP status using Kaplan-Meier curves and log-rank test. The univariable and multivariable Cox proportional hazard model evaluated the association of SPOP mutation and outcomes adjusted for clinicopathologic features. RESULTS SPOP-mut was associated with longer PSA-PFS in mCRPC (median 1.79 vs. 0.84 years; p = 0.06) and multivariate analysis (hazard ratio [HR] = 0.37; 95% confidence interval [CI]: 0.17-0.84; p = 0.02). SPOP-mut demonstrated a higher median PSA decline compared to SPOP wild-type (median decline 100% vs. 92%, p = 0.02). SPOP-mut was not associated with OS from the start of ARSI or docetaxel (median OS not reached vs. 2.0 years) or PSA-PFS on docetaxel (median PSA-PFS 0.4 vs. 0.5 years) in mCRPC. The majority of SPOP mutations were identified in African American (AA) patients (69.2%) compared to Caucasian patients (30.8%). Race-associated multivariate analysis revealed no significant differences in OS from the start of ARSI or the start of docetaxel and no differences in ARSI or docetaxel PSA-PFS between AA and Caucasian patients. Molecular profiling demonstrated that AA patients had a higher frequency of SPOP mutations and greater heterogeneity of SPOP variants within the coding sequence. Analysis of concurrent genomic alterations revealed that SPOP mutations co-occur with APC mutations (p = 0.001) and alterations in the Wnt pathway (p = 0.017). CONCLUSIONS Inactivating mutations in SPOP are associated with better response to ARSI treatment in mCRPC overall. Additional analysis with a larger cohort is needed to evaluate the association of SPOP status and outcomes with docetaxel. Race-associated clinical outcomes and molecular features were observed, suggesting the benefit of biomarker-directed therapy selection for individualized patient subsets in guiding treatment decisions for mCRPC patients.
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Affiliation(s)
- Andrew Stangl
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Christopher Wilner
- Department of Internal Medicine, Henry Ford Health System, Henry Ford Cancer Institute, Detroit, Michigan, USA
| | - Pin Li
- Depatment of Public Health Sciences, Henry Ford Health System, Henry Ford Cancer Institute, Detroit, Michigan, USA
| | - Lucas Maahs
- Department of Internal Medicine, Henry Ford Health System, Henry Ford Cancer Institute, Detroit, Michigan, USA
| | - Clara Hwang
- Department of Internal Medicine, Henry Ford Health System, Henry Ford Cancer Institute, Detroit, Michigan, USA
| | - Amanda Pilling
- Department of Internal Medicine, Henry Ford Health System, Henry Ford Cancer Institute, Detroit, Michigan, USA
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24
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Yanagisawa T, Hata K, Narita S, Hatakeyama S, Mori K, Yata Y, Sano T, Otsuka T, Hara S, Miyajima K, Enei Y, Fukuokaya W, Nakazono M, Matsukawa A, Miki J, Habuchi T, Ohyama C, Shariat SF, Kimura T. Docetaxel versus abiraterone for metastatic hormone-sensitive prostate cancer with focus on efficacy of sequential therapy. Prostate 2023; 83:563-571. [PMID: 36661102 DOI: 10.1002/pros.24488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/11/2022] [Accepted: 12/30/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE We aimed to assess the oncologic efficacy of combining docetaxel (DOC) versus abiraterone (ABI) with androgen deprivation therapy (ADT) in patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC), with a focus on the efficacy of sequential therapy, in a real-world clinical practice setting. METHODS The records of 336 patients who harbored de novo high-risk mHSPC, based on the LATITUDE criteria, and had received ADT with either DOC (n = 109) or ABI (n = 227) were retrospectively analyzed. Overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), including time to castration-resistant prostate cancer (CRPC), time to 2nd-line progression (PFS2), and 2nd- and 3rd-line PFS, were compared. We used one-to-two propensity score matching to minimize the confounders. The differential efficacy of 2nd-line therapy based on agents in each arm was evaluated using the unmatched cohort as an additional interest. RESULTS After propensity score matching, 86 patients treated with DOC + ADT and 172 with ABI + ADT were available for analyses. The 3-year OS and CSS for DOC versus ABI were 76.2% versus 75.1% (p = 0.8) and 78.2% versus 78.6% (p = 1), respectively. There was no difference in the median PFS2 (49 vs. 43 months, p = 0.39), while the median time to CRPC in patients treated with ABI was significantly longer compared to those treated with DOC (42 vs. 22 months; p = 0.006). The median 2nd-line PFS (14 vs. 4 months, p < 0.001) and 3rd-line PFS (4 vs. 2 months, p = 0.012) were significantly better in the DOC group than in the ABI group. Among the unmatched cohort, after ABI for mHSPC, the median 2nd-line PFS did not differ between the patients treated with DOC and those treated with enzalutamide as 2nd-line therapy (both 3 months, p = 0.8). CONCLUSIONS ADT with DOC or ABI has comparable oncologic outcomes in terms of OS, CSS, and PFS2 in patients with de novo high-risk mHSPC. Compared to DOC, ABI resulted in longer time to CRPC but worse 2nd and 3rd-line PFS. Further studies are needed to clarify the optimal sequence of therapy in the upfront intensive treatment era.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Kenichi Hata
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Atsugi City Hospital, Kanagawa, Japan
| | - Shintaro Narita
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Shingo Hatakeyama
- Department of Urology, Division of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Yata
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takayuki Sano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Otsuka
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shuhei Hara
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Miyajima
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Enei
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Minoru Nakazono
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Matsukawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Chikara Ohyama
- Department of Urology, Division of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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25
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Jang A, Lanka SM, Huang M, Casado CV, Caputo SA, Sweeney PL, Gupta K, Pocha O, Habibian N, Hawkins ME, Lieberman AD, Schwartz J, Jaeger EB, Miller PJ, Layton JL, Barata PC, Lewis BE, Ledet EM, Sartor O. Comparison of circulating tumor DNA between African American and Caucasian patients with metastatic castrate-resistant prostate cancer post- abiraterone and/or enzalutamide. Prostate 2023. [PMID: 37113064 DOI: 10.1002/pros.24544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/18/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND African American men are much more likely than Caucasian men to be diagnosed with and to die of prostate cancer. Genetic differences likely play a role. The cBioPortal database reveals that African American men with prostate cancer have higher rates of CDK12 somatic mutations compared to Caucasian men. However, this does not account for prior prostate cancer treatments, which are particularly important in the castrate-resistant setting. We aimed to compare somatic mutations based on circulating tumor DNA (ctDNA) in metastatic castration-resistant prostate cancer (mCRPC) between African American and Caucasian men after exposure to abiraterone and/or enzalutamide. METHODS This single-institution retrospective study characterizes the somatic mutations detected on ctDNA for African American and Caucasian men with mCRPC who had progressed after abiraterone and/or enzalutamide from 2015 through 2022. We evaluated the gene mutations and types of mutations in this mCRPC cohort. RESULTS There were 50 African American and 200 Caucasian men with CRPC with available ctDNA data. African American men were younger at the time of diagnosis (p = 0.008) and development of castration resistance (p = 0.006). African American men were more likely than Caucasian men to have pathogenic/likely pathogenic (P/LP) mutations in CDK12 (12% vs. 1.5%; p = 0.003) and copy number amplifications and P/LP mutations in KIT (8.0% vs. 1.5%; p = 0.031). African American men were also significantly more likely to have frameshift mutations (28% vs. 14%; p = 0.035). CONCLUSIONS Compared to Caucasian men, African American men with mCRPC after exposure to abiraterone and/or enzalutamide had a higher incidence of somatic CDK12 P/LP mutations and KIT amplifications and P/LP mutations based on ctDNA. African American men also had more frameshift mutations. We hypothesize that these findings have potential implications for tumor immunogenicity.
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Affiliation(s)
- Albert Jang
- Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Sree M Lanka
- Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Minqi Huang
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Crystal V Casado
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Sydney A Caputo
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Patrick L Sweeney
- Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Kanika Gupta
- Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Olivia Pocha
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Madeline E Hawkins
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Alexandra D Lieberman
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jennifer Schwartz
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ellen B Jaeger
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Patrick J Miller
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jodi L Layton
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Pedro C Barata
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Brian E Lewis
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Elisa M Ledet
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Oliver Sartor
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
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26
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Mittal A, Sridhar SS, Ong M, Jiang DM. Triplet Therapy in Metastatic Castrate Sensitive Prostate Cancer (mCSPC)-A Potential New Standard of Care. Curr Oncol 2023; 30:4365-4378. [PMID: 37185445 PMCID: PMC10136811 DOI: 10.3390/curroncol30040332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/27/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
The treatment paradigm for metastatic castrate-sensitive prostate cancer (mCSPC) has evolved rapidly in the past decade with the approval of several life-prolonging therapies including docetaxel chemotherapy and multiple androgen receptor pathway inhibitors (ARPI) in combination with androgen deprivation therapy (ADT). Recently reported phase-three trials have demonstrated a survival benefit of upfront triplet therapy with ADT, docetaxel plus either abiraterone acetate or darolutamide when compared to ADT plus docetaxel alone. However, multiple questions including the incremental benefit of docetaxel to a combination of ADT and ARPI, the timing of ARPI, optimal patient selection for triplet therapy and clinical and genomic biomarkers still remain to be answered. Moreover, real-world data suggest suboptimal treatment intensification with many patients treated with ADT alone highlighting challenges in implementation. In this article, we review the phase-three data associated with triplet therapy in mCSPC. We also discuss the knowledge gaps that exist despite the completion of these studies and how ongoing studies are likely to change the paradigm in the near future. Finally, we provide a simple algorithm based on current data that clinicians can use in daily practice to select patients for appropriate treatment strategies.
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Affiliation(s)
- Abhenil Mittal
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C1, Canada
| | - Srikala S Sridhar
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C1, Canada
| | - Michael Ong
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Di Maria Jiang
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C1, Canada
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27
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Shiota M, Inoue R, Tashiro K, Kobayashi K, Horiyama S, Kanji H, Eto M, Egawa S, Haginaka J, Matsuyama H. A Phase II Trial of Abiraterone With Dutasteride for Second-Generation Antiandrogen- and Chemotherapy-Naïve Patients With Castration-Resistant Prostate Cancer. J Clin Pharmacol 2023; 63:445-454. [PMID: 36484758 DOI: 10.1002/jcph.2191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/27/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
The development of a novel therapy to overcome primary and acquired resistance to abiraterone is an unmet need. This study aimed to evaluate the efficacy and safety of adding 5α-reductase inhibitor dutasteride to abiraterone, explore proof of concept, and identify candidates suitable for combination therapy. This phase II, single-arm, and open-label study enrolled second-generation antiandrogen- and chemotherapy-naïve patients with castration-resistant prostate cancer. Patients received abiraterone and prednisolone for 4 weeks, followed by adding dutasteride. The primary end point was a 50% prostate-specific antigen response rate. Serum concentrations of abiraterone and its metabolites as well as HSD3B1 and SRD5A2 genotypes were measured. The association between drug metabolism and genotypes and their impact on the efficacy of combination therapy were assessed. Among 21 patients, 18 (85.7%) achieved ≥50% PSA reduction. Median time to treatment failure was not reached during the median follow-up of 15.4 months. No patients experienced grade ≥3 adverse events. Although dutasteride reduced serum 3-keto-5α-abiraterone concentrations, higher serum 3-keto-5α-abiraterone concentrations on combination therapy were associated with a shorter time to treatment failure. HSD3B1 and SRD5A2 genotypes were associated with serum Δ4-abiraterone and 3-keto-5α-abiraterone concentrations before adding dutasteride, respectively. Time to treatment failure was longer in patients with homozygous wild-type HSD3B1, but comparable between those with the SRD5A2 genotype. The promising outcomes of this study warrant further investigation of combination therapy in a randomized trial. Stratification by HSD3B1 and SRD5A2 genetic profiles might identify patients suitable for combination therapy.
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Affiliation(s)
- Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryo Inoue
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keita Kobayashi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Shizuyo Horiyama
- School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Hiromi Kanji
- School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Haginaka
- Institute of Biosciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
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28
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Decamps S, Lis R, Ekanayake P. Abiraterone-Induced Endocrinopathies. JCEM Case Rep 2023; 1:luad039. [PMID: 37908462 PMCID: PMC10580404 DOI: 10.1210/jcemcr/luad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Indexed: 11/02/2023]
Abstract
Abiraterone, a CYP17A1 inhibitor, is used along with prednisone in patients with castration-resistant and castration-sensitive prostate cancer, yielding improved overall and disease-free survival. However, little is documented in the endocrinology literature about the incidences of the endocrine side effects of abiraterone. In this case series, we discuss the diagnosis and management of 3 prostate cancer patients who experienced mineralocorticoid excess and secondary adrenal insufficiency related to abiraterone and prednisone use.
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Affiliation(s)
- Scarlett Decamps
- Division of Endocrinology, Diabetes and Metabolism, University of California, San Diego, 9350 Campus Point Drive, La Jolla, CA 92037, USA
- Department of Endocrinology, Diabetes and Metabolism, Veterans’ Affairs, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Rita Lis
- Division of Endocrinology, Diabetes and Metabolism, University of California, San Diego, 9350 Campus Point Drive, La Jolla, CA 92037, USA
- Department of Endocrinology, Diabetes and Metabolism, Veterans’ Affairs, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Preethika Ekanayake
- Division of Endocrinology, Diabetes and Metabolism, University of California, San Diego, 9350 Campus Point Drive, La Jolla, CA 92037, USA
- Department of Endocrinology, Diabetes and Metabolism, Veterans’ Affairs, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
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29
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Petrunak EM, Bart AG, Peng HM, Auchus RJ, Scott EE. Human cytochrome P450 17A1 structures with metabolites of prostate cancer drug abiraterone reveal substrate-binding plasticity and a second binding site. J Biol Chem 2023; 299:102999. [PMID: 36773804 PMCID: PMC10023946 DOI: 10.1016/j.jbc.2023.102999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/25/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Abiraterone acetate is a first-line therapy for castration-resistant prostate cancer. This prodrug is deacetylated in vivo to abiraterone, which is a potent and specific inhibitor of cytochrome P450 17A1 (CYP17A1). CYP17A1 performs two sequential steps that are required for the biosynthesis of androgens that drive prostate cancer proliferation, analogous to estrogens in breast cancer. Abiraterone can be further metabolized in vivo on the steroid A ring to multiple metabolites that also inhibit CYP17A1. Despite its design as an active-site-directed substrate analog, abiraterone and its metabolites demonstrate mixed competitive/noncompetitive inhibition. To understand their binding, we solved the X-ray structures of CYP17A1 with three primary abiraterone metabolites. Despite different conformations of the steroid A ring and substituents, all three bound in the CYP17A1 active site with the steroid core packed against the I helix and the A ring C3 keto or hydroxyl oxygen forming a hydrogen bond with N202 similar to abiraterone itself. The structure of CYP17A1 with 3-keto, 5α-abiraterone was solved to 2.0 Å, the highest resolution to date for a CYP17A1 complex. This structure had additional electron density near the F/G loop, which is likely a second molecule of the inhibitor and which may explain the noncompetitive inhibition. Mutation of the adjacent Asn52 to Tyr positions its side chain in this space, maintains enzyme activity, and prevents binding of the peripheral ligand. Collectively, our findings provide further insight into abiraterone metabolite binding and CYP17A1 function.
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Affiliation(s)
- Elyse M Petrunak
- Department of Medicinal Chemistry, University of Kansas, Lawrence, Kansas, USA
| | - Aaron G Bart
- Program in Biophysics, University of Michigan, Ann Arbor, Michigan, USA
| | - Hwei-Ming Peng
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard J Auchus
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Department of Pharmacology, University of Michigan, Ann Arbor, Michigan, USA; Endocrinology & Metabolism Section, Medicine Service, LTC Charles S. Kettles Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
| | - Emily E Scott
- Department of Medicinal Chemistry, University of Kansas, Lawrence, Kansas, USA; Program in Biophysics, University of Michigan, Ann Arbor, Michigan, USA; Department of Pharmacology, University of Michigan, Ann Arbor, Michigan, USA; Department of Biological Chemistry, University of Michigan, Ann Arbor, Michigan, USA; Department of Medicinal Chemistry, University of Michigan, Ann Arbor, Michigan, USA.
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30
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Patterson JC, Varkaris A, Croucher PJP, Ridinger M, Dalrymple S, Nouri M, Xie F, Varmeh S, Jonas O, Whitman MA, Chen S, Rashed S, Makusha L, Luo J, Isaacs JT, Erlander MG, Einstein DJ, Balk SP, Yaffe MB. Plk1 Inhibitors and Abiraterone Synergistically Disrupt Mitosis and Kill Cancer Cells of Disparate Origin Independently of Androgen Receptor Signaling. Cancer Res 2023; 83:219-238. [PMID: 36413141 PMCID: PMC9852064 DOI: 10.1158/0008-5472.can-22-1533] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/09/2022] [Revised: 10/20/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
Abiraterone is a standard treatment for metastatic castrate-resistant prostate cancer (mCRPC) that slows disease progression by abrogating androgen synthesis and antagonizing the androgen receptor (AR). Here we report that inhibitors of the mitotic regulator polo-like kinase-1 (Plk1), including the clinically active third-generation Plk1 inhibitor onvansertib, synergizes with abiraterone in vitro and in vivo to kill a subset of cancer cells from a wide variety of tumor types in an androgen-independent manner. Gene-expression analysis identified an AR-independent synergy-specific gene set signature upregulated upon abiraterone treatment that is dominated by pathways related to mitosis and the mitotic spindle. Abiraterone treatment alone caused defects in mitotic spindle orientation, failure of complete chromosome condensation, and improper cell division independently of its effects on AR signaling. These effects, although mild following abiraterone monotherapy, resulted in profound sensitization to the antimitotic effects of Plk1 inhibition, leading to spindle assembly checkpoint-dependent mitotic cancer cell death and entosis. In a murine patient-derived xenograft model of abiraterone-resistant metastatic castration-resistant prostate cancer (mCRPC), combined onvansertib and abiraterone resulted in enhanced mitotic arrest and dramatic inhibition of tumor cell growth compared with either agent alone. Overall, this work establishes a mechanistic basis for the phase II clinical trial (NCT03414034) testing combined onvansertib and abiraterone in mCRPC patients and indicates this combination may have broad utility for cancer treatment. SIGNIFICANCE Abiraterone treatment induces mitotic defects that sensitize cancer cells to Plk1 inhibition, revealing an AR-independent mechanism for this synergistic combination that is applicable to a variety of cancer types.
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Affiliation(s)
- Jesse C. Patterson
- Center for Precision Cancer Medicine, David H. Koch Institute for Integrative Cancer Research, Departments of Biology and Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Andreas Varkaris
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, 02114, USA,Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | | | | | - Susan Dalrymple
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA,Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Mannan Nouri
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Fang Xie
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Shohreh Varmeh
- Center for Precision Cancer Medicine, David H. Koch Institute for Integrative Cancer Research, Departments of Biology and Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Oliver Jonas
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Matthew A. Whitman
- Center for Precision Cancer Medicine, David H. Koch Institute for Integrative Cancer Research, Departments of Biology and Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sen Chen
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Saleh Rashed
- Center for Precision Cancer Medicine, David H. Koch Institute for Integrative Cancer Research, Departments of Biology and Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Lovemore Makusha
- Center for Precision Cancer Medicine, David H. Koch Institute for Integrative Cancer Research, Departments of Biology and Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jun Luo
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA,Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - John T. Isaacs
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA,Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | | | - David J. Einstein
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Steven P. Balk
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Michael B. Yaffe
- Center for Precision Cancer Medicine, David H. Koch Institute for Integrative Cancer Research, Departments of Biology and Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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31
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Shiota M, Akamatsu S, Sekine Y, Kimura H, Narita S, Fujimoto N, Terada N, Blas L, Habuchi T, Kamoto T, Momozawa Y, Eto M. Genetic variations predicting progression with docetaxel and novel androgen-receptor pathway inhibitors. Cancer Sci 2023; 114:1625-1634. [PMID: 36602227 PMCID: PMC10067425 DOI: 10.1111/cas.15718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/06/2022] [Revised: 12/20/2022] [Accepted: 12/25/2022] [Indexed: 01/06/2023] Open
Abstract
Genetic variations represented by single-nucleotide polymorphisms (SNPs) could be helpful for choosing an effective treatment for patients with prostate cancer. This study investigated the prognostic and predictive values of SNPs associated with the prognoses of pharmacotherapy for prostate cancer through their pharmacological mechanisms. Patients treated with docetaxel or androgen receptor pathway inhibitors (ARPIs), such as abiraterone and enzalutamide, for castration-resistant prostate cancer were included. The SNPs of interest were genotyped for target regions. The prognostic and predictive values of the SNPs for time to progression (TTP) were examined using the Cox hazard proportional model and interaction test, respectively. Rs1045642 in ABCB1, rs1047303 in HSD3B1, rs1856888 in HSD3B1, rs523349 in SRD5A2, and rs34550074 in SLCO2A1 were differentially associated with TTP between docetaxel chemotherapy and ARPI treatment. In addition to rs4775936 in CYP19A1, rs1128503 in ABCB1 and rs1077858 in SLCO2B1 might be differentially associated with TTP between abiraterone and enzalutamide treatments. Genetic predictive models using these SNPs showed a differential prognosis for treatments. This study identified SNPs that could predict progression as well as genetic models that could predict progression when patients were treated with docetaxel versus ARPI and abiraterone versus enzalutamide. The use of genetic predictive models is expected to be beneficial in selecting the appropriate treatment for the individual patient.
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Affiliation(s)
- Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shusuke Akamatsu
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuya Sekine
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.,Department of Urology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Hiroko Kimura
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Narita
- Department of Urology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Naohiro Fujimoto
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Naoki Terada
- Department of Urology, Faculty of Medicine, Miyazaki University, Miyazaki, Japan
| | - Leandro Blas
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomonori Habuchi
- Department of Urology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Toshiyuki Kamoto
- Department of Urology, Faculty of Medicine, Miyazaki University, Miyazaki, Japan
| | - Yukihide Momozawa
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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32
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Al-Samsam S, Bartoš J, Šámal V, Dvořák J, Kolářová H, Richter I. Enzalutamide and abiraterone in the treatment of patients with metastatic castration-resistant prostate cancer treated previously with chemotherapy. Klin Onkol 2023; 37:300-306. [PMID: 38195384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND The evaluation of treatment outcomes and toxicity in patients with metastatic castration-resistant prostate cancer (mCRPC) treated by enzalutamide or abiraterone after previous docetaxel. PATIENTS AND METHODS We analyzed 66 patients with mCRPC treated by enzalutamide (55 patients) or abiraterone (11 patients) after previous therapy with docetaxel. The median follow-up was 31.2 months. Enzalutamide and abiraterone were administered in daily doses of 160 mg and 1,000 mg per day, respectively. The progression free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier analysis. The prognostic influence of the factors on OS was evaluated by regression analysis. RESULTS The progression was observed in 55 (83%) patients, and mPFS was 12.1 (95% CI 7.7-16.4) months. In total, 43 patients died, and he median OS was 21.9 (95% CI 12.2-31.7) months. In the regression analysis, we observed statistical favorable influence of the following factors on OS: PSA decrease ≥ 50%, in patients with early decrease of prostatic specific antigen (PSA) ≥ 50% in 3 months after initiation of enzalutamide or abiraterone treatment, in patients with visceral metastatic sites, in patients treated with only one regimen of previous chemotherapy and in those without anemia. We observed the toxicity grades 3-4 in 45.5% and 36.3% patients treated with enzalutamide and abiraterone, respectively. CONCLUSION Our analysis demonstrated efficacy and good tolerance in patients with mCRPC treated with enzalutamide and abiraterone after previous docetaxel therapy.
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33
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Machulkin AE, Nimenko EA, Zyk NU, Uspenskaia AA, Smirnova GB, Khan II, Pokrovsky VS, Vaneev AN, Timoshenko RV, Mamed-Nabizade VV, Zavertkina MV, Erofeev A, Gorelkin P, Majouga AG, Zyk NV, Khazanova ES, Beloglazkina EK. Synthesis and Preclinical Evaluation of Small-Molecule Prostate-Specific Membrane Antigen-Targeted Abiraterone Conjugate. Molecules 2022; 27. [PMID: 36557929 DOI: 10.3390/molecules27248795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Prostate cancer is the second most common type of cancer among men. The main method of its treatment is androgen deprivation therapy, which has a wide range of side effects. One of the solutions to this challenge is the targeted delivery of drugs to prostate cancer cells. In this study, we performed the synthesis of a novel small-molecule PSMA-targeted conjugate based on abiraterone. Cytotoxicity, the induction of intracellular reactive oxygen species, and P450-cytochrome species inhibition were investigated for this conjugate PSMA-abiraterone. The conjugate demonstrated a preferential effect on prostate tumor cells, remaining inactive at up to 100 µM in human fibroblast cells. In addition, it revealed preferential efficacy, specifically on PSMA-expressing lines with a 65% tumor growth inhibition level on 22Rv1 (PSMA+) xenografts after 14-fold oral administration of PSMA-Abi at a single dose of 500 mg/kg (7.0 g/kg total dose) was observed. This compound showed significantly reduced acute toxicity with comparable efficacy compared to AbiAc.
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34
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Rescigno P, Maruzzo M, Rebuzzi SE, Murianni V, Cinausero M, Lipari H, Fratino L, Gamba T, De Giorgi U, Caffo O, Bimbatti D, Dri A, Mosca A, Giunta EF, Ermacora P, Vignani F, Msaki A, Bonifacio B, Lombardo V, Conteduca V, Basso U, Fornarini G, Banna GL. Adherence to Oral Treatments in Older Patients with Advanced Prostate Cancer, the ADHERE Study: A Prospective Trial of the Meet-URO Network. Oncologist 2022; 27:e949-e956. [PMID: 35920559 PMCID: PMC9732238 DOI: 10.1093/oncolo/oyac147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Novel androgen receptor signaling inhibitors for prostate cancer (PC) impose the burden of self-administration on older patients overwhelmed by the requirement of many other concomitant medications. PATIENTS AND METHODS This study evaluated the proportion of non-adherence in a 12-month follow-up period and the first 3 months to abiraterone (ABI) or enzalutamide (ENZ). In a prospective multicenter observational cohort study, patients with metastatic castration-resistant PC (mCRPC) aged ≥70 years receiving ABI or ENZ pre- or post-docetaxel were enrolled. Treatment monitoring included pill counting, a self-assessment questionnaire, and clinical diaries at each clinical visit. Non-adherence rates were based on proportions of missed/prescribed pills ratios by pill counting. RESULTS Overall, 234 patients were recruited with median age of 78 years (range, 73-82); 86 (37%) were treated with ABI, and 148 (63%) with ENZ. The median follow-up for adherence was seven monthly cycles (IQR: 4-12). The two cohorts were well balanced for baseline characteristics. The percentage of non-adherence by pill counting was slightly higher for ABI than ENZ (5.2% vs. 4.2%, P < .001). By self-reporting, patients on ENZ tended to report more frequently than those with ABI forgetfulness as the reason for missing events (42% vs. 17%, P < .001). A lower Geriatric G8 score correlated with non-adherence (P = .004). Overall survival (OS) was 48.8 months. Patients on ABI had radiographic progression-free survival (rPFS) of 28.4 [24.2-32.5], while for ENZ patients, we reported a median rPFS of 23.1 [18.2-28.1] months. CONCLUSION Physicians tend to treat older mCRPC patients with ENZ. Non-adherence rate is relatively low overall but can be higher with ABI than with ENZ and correlates with the Geriatric G8 score. Forgetfulness is a potential barrier for ENZ.
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Affiliation(s)
| | - Marco Maruzzo
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, Ospedale San Paolo, Savona, Italy.,Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genova, Italy
| | - Veronica Murianni
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marika Cinausero
- Department of Oncology, ASUFC Santa Maria Della Misericordia, Udine, Italy
| | - Helga Lipari
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | - Lucia Fratino
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano CRO-IRCCS, Aviano, Italy
| | - Teresa Gamba
- Medical Oncology, Mauriziano Hospital,Turin, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Davide Bimbatti
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Arianna Dri
- Department of Oncology, ASUFC Santa Maria Della Misericordia, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | | | | | - Paola Ermacora
- Department of Oncology, ASUFC Santa Maria Della Misericordia, Udine, Italy
| | | | - Aichi Msaki
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Barbara Bonifacio
- Department of Oncology, ASUFC Santa Maria Della Misericordia, Udine, Italy
| | | | - Vincenza Conteduca
- Department of Medical and Surgical Sciences, Unit of Medical Oncology and Biomolecular Therapy, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Umberto Basso
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Pan J, Zhao J, Ni X, Gan H, Wei Y, Wu J, Zhang T, Wang Q, Freedland SJ, Wang B, Song S, Ye D, Liu C, Zhu Y. The prevalence and prognosis of next-generation therapeutic targets in metastatic castration-resistant prostate cancer. Mol Oncol 2022; 16:4011-4022. [PMID: 36209367 PMCID: PMC9718110 DOI: 10.1002/1878-0261.13320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/18/2022] [Accepted: 10/07/2022] [Indexed: 12/24/2022] Open
Abstract
The success of the PROfound, IPATential150, and TheraP trials promoted the transition from sequential treatment to therapeutic targets (TTs)-guided precision treatment in metastatic castration-resistant prostate cancer (mCRPC). The objective of this study was to evaluate the prevalence and prognostic value of TTs from these three trials. All included Chinese mCRPC patients underwent circulating tumor DNA (ctDNA) sequencing, PTEN status assessment, and dual-tracer [68 Ga-prostate-specific membrane antigen (PSMA) and 18 F-fluorodexyglucose (FDG)] positron emission tomography/computed tomography (PET/CT). Previous treatment with cabazitaxel, Lu-PSMA or olaparib was unallowed. Patients with known significant sarcomatoid or spindle cell or neuroendocrine small cell components were also excluded. TTs were defined as positive as follows: (a) high PSMA and no PSMA-/FDG+ disease on dual-tracer PET/CT scans; (b) defects in homologous recombination repair (HRR) genes in ctDNA; and (c) loss of PTEN immunohistochemistry staining in tumor tissue. The prevalence and prognostic value on progression-free survival (PFS) of TTs were evaluated. A total of 106 consecutive mCRPC patients were included. The prevalence of positive PET/CT, HRR defect, and PTEN loss was 30%, 29% and 16%, respectively. Sixty-three patients had at least one TT. Metastatic volume (odds ratio = 5.0; P = 0.017) was the only independent factor of positive TT in multivariate analysis. Seventy-four patients received abiraterone after TT screening. Patients with positive PET/CT (P = 0.011) and HRR defect (P = 0.002) had a significantly shorter PFS after receiving abiraterone than patients with negative TTs. However, PTEN status was unrelated to PFS, which may be due to a less number of patients with PTEN loss (P = 0.952). Overall, patients with any positive TTs had a significantly shorter PFS after abiraterone than patients with negative TTs (P = 0.009). Nearly 60% of Chinese patients with mCRPC who had a poor prognosis on abiraterone were candidates for precision treatments based on the specific criteria of TTs.
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Affiliation(s)
- Jian Pan
- Department of UrologyFudan University Shanghai Cancer CenterChina,Shanghai Genitourinary Cancer InstituteChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Jinou Zhao
- Department of UrologyFudan University Shanghai Cancer CenterChina,Shanghai Genitourinary Cancer InstituteChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Xudong Ni
- Department of UrologyFudan University Shanghai Cancer CenterChina,Shanghai Genitourinary Cancer InstituteChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Hualei Gan
- Shanghai Genitourinary Cancer InstituteChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yu Wei
- Department of UrologyFudan University Shanghai Cancer CenterChina,Shanghai Genitourinary Cancer InstituteChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Junlong Wu
- Department of UrologyFudan University Shanghai Cancer CenterChina,Shanghai Genitourinary Cancer InstituteChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Tingwei Zhang
- Department of UrologyFudan University Shanghai Cancer CenterChina,Shanghai Genitourinary Cancer InstituteChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Qifeng Wang
- Shanghai Genitourinary Cancer InstituteChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Stephen J. Freedland
- Department of Nuclear MedicineFudan University Shanghai Cancer CenterChina,Department of Surgery, Division of Urology and Samuel Oschin Comprehensive Cancer InstituteCedars‐Sinai Medical CenterLos AngelesCAUSA,Urology Section, Department of SurgeryVeterans Affairs Medical CenterDurhamNCUSA
| | - Beihe Wang
- Department of UrologyFudan University Shanghai Cancer CenterChina,Shanghai Genitourinary Cancer InstituteChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Shaoli Song
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Department of PathologyFudan University Shanghai Cancer CenterChina
| | - Dingwei Ye
- Department of UrologyFudan University Shanghai Cancer CenterChina,Shanghai Genitourinary Cancer InstituteChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Chang Liu
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Department of PathologyFudan University Shanghai Cancer CenterChina
| | - Yao Zhu
- Department of UrologyFudan University Shanghai Cancer CenterChina,Shanghai Genitourinary Cancer InstituteChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
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Makhov P, Fazliyeva R, Tufano A, Uzzo RG, Cai KQ, Serebriiskii I, Snyder NW, Andrews AJ, Kolenko VM. Acetyl-CoA Counteracts the Inhibitory Effect of Antiandrogens on Androgen Receptor Signaling in Prostate Cancer Cells. Cancers (Basel) 2022; 14:cancers14235900. [PMID: 36497382 PMCID: PMC9738902 DOI: 10.3390/cancers14235900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/02/2022] Open
Abstract
The commonly used therapeutic management of PC involves androgen deprivation therapy (ADT) followed by treatment with AR signaling inhibitors (ARSI). However, nearly all patients develop drug-resistant disease, with a median progression-free survival of less than 2 years in chemotherapy-naïve men. Acetyl-coenzyme A (acetyl-CoA) is a central metabolic signaling molecule with key roles in biosynthetic processes and cancer signaling. In signaling, acetyl-CoA serves as the acetyl donor for acetylation, a critical post-translational modification. Acetylation affects the androgen receptor (AR) both directly and indirectly increasing expression of AR dependent genes. Our studies reveal that PC cells respond to the treatment with ARSI by increasing expression of ATP-citrate lyase (ACLY), a major enzyme responsible for cytosolic acetyl-CoA synthesis, and up-regulation of acetyl-CoA intracellular levels. Inhibition of ACLY results in a significant suppression of ligand-dependent and -independent routes of AR activation. Accordingly, the addition of exogenous acetyl-CoA, or its precursor acetate, augments AR transcriptional activity and diminishes the anti-AR activity of ARSI. Taken together, our findings suggest that PC cells respond to antiandrogens by increasing activity of the acetyl-coA pathway in order to reinstate AR signaling.
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Affiliation(s)
- Peter Makhov
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Rushaniya Fazliyeva
- Cancer Signaling and Epigenetics Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Antonio Tufano
- Urology Unit, Department of Maternal-Child and Urological Sciences, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Robert G. Uzzo
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Kathy Q. Cai
- Histopathology Facility, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Ilya Serebriiskii
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
- Kazan Federal University, 420000 Kazan, Russia
| | - Nathaniel W. Snyder
- Center for Metabolic Disease Research and the Department of Cardiovascular Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Andrew J. Andrews
- Cancer Signaling and Epigenetics Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Vladimir M. Kolenko
- Cancer Signaling and Epigenetics Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
- Correspondence: ; Tel.: +1-215-728-5620
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Hu J, Aprikian AG, Saleh RR, Dragomir A. Utilization Trends of Novel Hormonal Agents in Metastatic Castration-Resistant Prostate Cancer in Quebec. Curr Oncol 2022; 29:8626-8637. [PMID: 36421333 PMCID: PMC9688923 DOI: 10.3390/curroncol29110680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The introduction of novel hormonal agents (NHAs) such as abiraterone acetate (ABI) and enzalutamide (ENZ) for metastatic castration-resistant prostate cancer (mCRPC) was an important milestone given their survival benefits, tolerability, and ease of administration relative to taxane chemotherapies. This descriptive study sought to describe the utilization trends of ABI and ENZ in patients with mCRPC in the early years after their approval in the province of Quebec in Canada. METHODS A retrospective population-based cohort was extracted from Quebec public healthcare administrative databases. The cohort included first-time users of NHAs (ABI or ENZ) from 2011 to 2016. The primary analyses aimed to describe the overall temporal trends (2011-2016) of NHA initiators by chemotherapy status (chemotherapy-naïve versus post-chemotherapy), and prescribing specialty (medical oncology versus urology versus others). RESULTS The cohort comprised 2183 patients, with 1562 (72%) in the chemotherapy-naïve group and 621 (28%) in the post-chemotherapy group. While the majority of patients were post-chemotherapy NHA initiators in 2012, this proportion decreased over time and accounted for only 13% of NHA initiators by the end of 2016. Medical oncologists were the most frequent prescribers of NHAs (upwards of 60%) throughout 2012 but fell to 45% by the end of 2016. Conversely, the proportion of prescriptions by urologists increased from 22% in 2012 to 42% in 2016. CONCLUSION Over time, there was an increasing proportion of (1) patients who initiated NHAs without prior chemotherapy treatment, (2) NHA prescribing by urologists, and (3) ENZ users. Taken together, this implies that the introduction of NHAs has altered the management of mCRPC and urologists quickly adopted NHAs into their practice.
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Affiliation(s)
- Jason Hu
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada
| | - Armen G. Aprikian
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada
- Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
- Division of Urology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Ramy R. Saleh
- Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
- Division of Medical Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Alice Dragomir
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada
- Correspondence:
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Zhang J, Gallaher J, Cunningham JJ, Choi JW, Ionescu F, Chatwal MS, Jain R, Kim Y, Wang L, Brown JS, Anderson AR, Gatenby RA. A Phase 1b Adaptive Androgen Deprivation Therapy Trial in Metastatic Castration Sensitive Prostate Cancer. Cancers (Basel) 2022; 14:5225. [PMID: 36358643 PMCID: PMC9656891 DOI: 10.3390/cancers14215225] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background: We hypothesize that cancer survival can be improved through adapting treatment strategies to cancer evolutionary dynamics and conducted a phase 1b study in metastatic castration sensitive prostate cancer (mCSPC). Methods: Men with asymptomatic mCSPC were enrolled and proceeded with a treatment break after achieving > 75% PSA decline with LHRH analog plus an NHA. ADT was restarted at the time of PSA or radiographic progression and held again after achieving >50% PSA decline. This on-off cycling of ADT continued until on treatment imaging progression. Results: At data cut off in August 2022, only 2 of the 16 evaluable patients were off study due to imaging progression at 28 months from first dose of LHRH analog for mCSPC. Two additional patients showed PSA progression at 12.4 and 20.5 months and remain on trial. Since none of the 16 patients developed imaging progression at 12 months, the study succeeded in its primary objective of feasibility. The secondary endpoints of median time to PSA progression and median time to radiographic progression have not been reached at a median follow up of 26 months. Conclusions: It is feasible to use an individual’s PSA response and testosterone levels to guide intermittent ADT in mCSPC.
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Affiliation(s)
- Jingsong Zhang
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Jill Gallaher
- Department of Integrated Mathematical Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | | | - Jung W. Choi
- Department of Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Filip Ionescu
- Department of Oncological Science, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Monica S. Chatwal
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Rohit Jain
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Liang Wang
- Department of Tumor Biology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Joel S. Brown
- Department of Integrated Mathematical Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Alexander R. Anderson
- Department of Integrated Mathematical Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Robert A. Gatenby
- Department of Integrated Mathematical Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
- Department of Radiology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
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George DJ, Ramaswamy K, Huang A, Russell D, Schultz NM, Janjan N, Freedland SJ. Does race make a difference in how long men with advanced prostate cancer live when treated with abiraterone or enzalutamide? Future Oncol 2022; 18:3783-3790. [PMID: 36226872 DOI: 10.2217/fon-2022-0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/21/2022] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This is a summary of a research article originally published in Prostate Cancer and Prostatic Diseases. There were few Black men in the clinical trials that led to the approval of the medications abiraterone and enzalutamide. Abiraterone and enzalutamide are the two most commonly used drugs to treat men with advanced prostate cancer that has progressed on traditional hormonal therapy. This type of prostate cancer is called metastatic castration-resistant prostate cancer (mCRPC). Overall, Black men have a higher likelihood of dying from prostate cancer than White men. Researchers wanted to find out if Black men and White men with mCRPC benefitted differently when treated with either abiraterone or enzalutamide. To do this, researchers looked at medical information from the Veterans Health Administration (VHA). The VHA is a large healthcare system for veterans in the US where everyone has equal access to treatment. This was a real-world study, not a clinical trial. This means that researchers looked at what happened when men received the treatments prescribed by their healthcare practitioners. WHAT WERE THE RESULTS? After accounting for differences in the men's age and health conditions, researchers found that, on average, Black men with mCRPC actually lived 8 months longer than White men with mCRPC. WHAT DO THE RESULTS OF THE STUDY MEAN? This real-world, US study of men with mCRPC treated with abiraterone or enzalutamide found that Black men lived longer than White men. All men in this study had equal access to healthcare and were treated with either abiraterone or enzalutamide. More research is needed to understand the reasons for this. Understanding these reasons could guide treatment to help men with mCRPC live longer.
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Affiliation(s)
- Daniel J George
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Section of Hematology & Oncology, Durham VA Medical Center, Durham, North Carolina, USA
| | | | - Ahong Huang
- Formerly of STATinMED Research, Plano, Texas, USA
- Tigermed, Dallas, Texas, USA
| | | | | | - Nora Janjan
- Formerly of STATinMED Research, Plano, Texas, USA
- Goodman Institute, Dallas, Texas, USA
| | - Stephen J Freedland
- Division of Urology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Section of Urology, Durham VA Medical Center, Durham, North Carolina, USA
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40
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Murgić J, Fröbe A, Challapalli A, Bahl A. ROLE OF ANDROGEN RECEPTOR-TARGETED AGENTS IN LOCALIZED PROSTATE CANCER. Acta Clin Croat 2022; 61:51-56. [PMID: 36938555 PMCID: PMC10022413 DOI: 10.20471/acc.2022.61.s3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Anti-androgen therapy continues to be a basic pilar of treatment for both localized and metastatic prostate cancer. The advent of new generation of androgen receptor targeted agents (ARTA) transformed the care of patients with advanced disease. After such a success, the steps were taken to incorporate a new generation of ARTAs into the treatment landscape of localized prostate cancer. High-risk prostate cancer represents the most aggressive form of localized disease with significant metastatic potential and poor outcome. Here, the impact of novel therapies will likely be profound and transforming. This clinical space has already been a showcase for multidisciplinary treatment where the combination of local therapies with systemic treatment gradually improved patient outcomes and the chances of cure. The most recent step in redefining the treatment of localized disease is the adoption of novel ARTAs moving forward the multidisciplinary platform. In this narrative review, we discuss current clinical evidence supporting the use of novel ARTAs in patients with localized high-risk prostate cancer and cover recent developments in biomarker-driven strategies for treatment individualization in this clinical context.
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Affiliation(s)
- Jure Murgić
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ana Fröbe
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Amarnath Challapalli
- University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol BS13NU, UK
| | - Amit Bahl
- University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol BS13NU, UK
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41
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Antunac K, Beketić-Orešković L. HOW TO OPTIMALLY SEQUENCE AVAILABLE THERAPY LINES IN ADVANCED PROSTATE CANCER. Acta Clin Croat 2022; 61:32-44. [PMID: 36938556 PMCID: PMC10022401 DOI: 10.20471/acc.2022.61.s3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Optimal sequencing of available therapy lines in patients with advanced prostate cancer often poses quite a challenge. The guidelines are sometimes equivocal and clinical trial data are not always applicable to a particular patient. There is a difference in availability of therapy options throughout the world. In decision making, a patient as a whole should be taken into consideration, not just the stage and biology of the disease, but also patient's age, performance status, comorbidities, previous therapy lines, drug's safety profile and patient's preferences. This review article will show certain therapeutic options in the treatment of advanced hormone-sensitive prostate cancer and castration resistant prostate cancer: non- metastatic and metastatic. An attempt will be made to clarify the optimal sequencing.
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Affiliation(s)
- Katarina Antunac
- Division of Oncology and Radiotherapy, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Lidija Beketić-Orešković
- Division of Oncology and Radiotherapy, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- Department of Clinical Oncology, School of Medicine University of Zagreb, Croatia
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42
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Jiao B, Nyame YA, Carlson JJ, Garrison LP, Basu A. Does Clinical Evidence of Heterogeneity Impact Treatment Selection? A Case Study of Abiraterone for Metastatic Prostate Cancer. J Natl Compr Canc Netw 2022; 20:1107-1115.e12. [PMID: 36240855 DOI: 10.6004/jnccn.2022.7044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Two pivotal randomized controlled trials (RCTs) demonstrate that abiraterone acetate + prednisone (AAP) combined with androgen deprivation therapy (ADT) significantly extends the survival of men with metastatic hormone-sensitive prostate cancer (mHSPC) compared with ADT alone. Their subgroup analyses indicate that the survival benefit is significant for younger men but not older men. We aimed to assess whether publication of the RCTs was associated with differential real-world AAP utilization by age groups. METHODS Using TriNetX electronic medical records data collected from 43 healthcare organizations across the United States, we performed a difference-in-differences event study among men with newly diagnosed mHSPC observed from June 2014 to June 2019. Eligible subjects were identified based on a comprehensive published algorithm. We analyzed the change in utilization rate of AAP before versus after publication of the RCTs among men aged <70 years versus ≥70 years, adjusting for demographic factors and clinical conditions. RESULTS Our study included 6,888 men with newly diagnosed mHSPC with 12,738 observations, of whom 46% were aged <70 years. The prepublication trends of AAP utilization were similar between the age groups, whereas publication of the RCTs was associated with a 3.5% higher adjusted uptake rate of AAP among younger men (95% CI, 1.2%-5.8%) relative to older men. This estimate reflects an uptake rate nearly 3 times higher than would have been expected had younger men followed the same utilization trends as older men. The estimates remained consistent throughout the postpublication period. CONCLUSIONS Our study suggests that publication of the RCTs was associated with faster uptake of AAP among younger versus older men with newly diagnosed mHSPC, despite the absence of clinical guidance for differential treatment selection. This finding highlights the importance of confirmatory studies among older men, considering the uncertainties of subgroup analyses in RCTs.
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Affiliation(s)
- Boshen Jiao
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, and
| | - Yaw A Nyame
- Department of Urology, University of Washington, Seattle, Washington
| | - Josh J Carlson
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, and
| | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, and
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, and
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Shiota M, Akamatsu S, Tsukahara S, Nagakawa S, Matsumoto T, Eto M. Androgen receptor mutations for precision medicine in prostate cancer. Endocr Relat Cancer 2022; 29:R143-R155. [PMID: 35900853 DOI: 10.1530/erc-22-0140] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/27/2022] [Indexed: 11/08/2022]
Abstract
Hormonal therapies including androgen deprivation therapy and androgen receptor (AR) pathway inhibitors such as abiraterone and enzalutamide have been widely used to treat advanced prostate cancer. However, treatment resistance emerges after hormonal manipulation in most prostate cancers, and it is attributable to a number of mechanisms, including AR amplification and overexpression, AR mutations, the expression of constitutively active AR variants, intra-tumor androgen synthesis, and promiscuous AR activation by other factors. Although various AR mutations have been reported in prostate cancer, specific AR mutations (L702H, W742L/C, H875Y, F877L, and T878A/S) were frequently identified after treatment resistance emerged. Intriguingly, these hot spot mutations were also revealed to change the binding affinity of ligands including steroids and antiandrogens and potentially result in altered responses to AR pathway inhibitors. Currently, precision medicine utilizing genetic and genomic data to choose suitable treatment for the patient is becoming to play an increasingly important role in clinical practice for prostate cancer management. Since clinical data between AR mutations and the efficacy of AR pathway inhibitors are accumulating, monitoring the AR mutation status is a promising approach for providing precision medicine in prostate cancer, which would be implemented through the development of clinically available testing modalities for AR mutations using liquid biopsy. However, there are few reviews on clinical significance of AR hot spot mutations in prostate cancer. Then, this review summarized the clinical landscape of AR mutations and discussed their potential implication for clinical utilization.
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Affiliation(s)
- Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shusuke Akamatsu
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigehiro Tsukahara
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shohei Nagakawa
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Matsumoto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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44
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Maiorano BA, De Giorgi U, Roviello G, Messina C, Altavilla A, Cattrini C, Mennitto A, Maiello E, Di Maio M. Addition of androgen receptor targeted agents to androgen deprivation therapy and docetaxel in metastatic hormone-sensitive prostate cancer: a systematic review and meta-analysis. ESMO Open 2022; 7:100575. [PMID: 36152486 PMCID: PMC9588886 DOI: 10.1016/j.esmoop.2022.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background Androgen-deprivation therapy (ADT) historically represented the milestone for the treatment of metastatic hormone-sensitive prostate cancer (mHSPC). Recently, combining androgen receptor-targeted agents (ARTA) or docetaxel with ADT significantly improved clinical outcomes in this setting. The efficacy of the combined use of an ARTA with docetaxel and ADT (triplet), however, was unknown, and often conflicting data derived from subgroup analysis of randomized phase III trials. In order to better define the benefits and risks of the triplet in mHSPC, we carried out a systematic review and meta-analysis of available clinical trials. Methods A literature search with no data restriction using Medline/PubMed, the Cochrane Library, and American Society of Clinical Oncology/European Society for Medical Oncology (ASCO/ESMO) Meeting abstracts was carried out up to April 2022. The meta-analysis was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statements. Overall survival (OS) was the primary endpoint; progression-free survival (PFS) and safety were secondary endpoints. For OS and PFS, summary hazard ratios (HRs) were calculated; for safety, risk ratio (RR) was assessed. Random- or fixed-effects models were used, depending on studies heterogeneity. Results Five randomized clinical trials fulfilled the prespecified inclusion criteria. The triplet significantly improved OS (fixed-effect, HR = 0.74; P < 0.00001) and PFS (fixed-effect; HR = 0.50 for clinical PFS, HR = 0.49 for radiological PFS; P < 0.0001) compared with docetaxel plus ADT. We did not show heterogeneity between treatment efficacy and the disease burden, metachronous versus synchronous presentation, concomitant versus sequential strategy. Compared with docetaxel + ADT, the triplet did not increase the risk of adverse events (AEs) (RR = 1.00, P = 0.27 for any-grade AEs; RR = 1.13, P = 0.14 for severe AEs), except for severe hypertension (RR = 1.73, P = 0.001). Conclusions Emerging evidence supports the combination of an ARTA plus docetaxel and ADT in mHSPC patients. Given the availability of several strategies in this setting, clinical characteristics and drug safety profile may help clinicians select the appropriate treatment for mHSPC patients who are more likely to benefit from treatment intensification. The addition of ARTA or docetaxel to ADT improved survival in mHSPC. Recently, the combination of ARTA plus docetaxel and ADT (triplet) versus docetaxel plus ADT has been investigated. The triplet prolonged OS and PFS compared with docetaxel plus ADT and represents a potential practice-changing treatment. Clinical characteristics and drug safety profile may help clinicians to select the appropriate treatment for mHSPC.
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Affiliation(s)
- B A Maiorano
- Oncology Unit, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy; Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy.
| | - U De Giorgi
- Department of Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - G Roviello
- Department of Health Sciences, University of Florence, Florence, Italy
| | - C Messina
- Oncology Unit, A.R.N.A.S. Civico, Palermo, Italy
| | - A Altavilla
- Department of Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - C Cattrini
- SCDU Oncologia, AOU Maggiore della Carità, Novara, Italy
| | - A Mennitto
- SCDU Oncologia, AOU Maggiore della Carità, Novara, Italy
| | - E Maiello
- Oncology Unit, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
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Zhu S, Ni Y, Wang Z, Zhang X, Zhang Y, Zhao F, Dai J, Wang Z, Zhu X, Chen J, Zhao J, Zeng Y, Chen N, Zeng P, Shen P, Sun G, Zeng H. Plasma Exosomal AKR1C3 mRNA Expression Is a Predictive and Prognostic Biomarker in Patients with Metastatic Castration-Resistant Prostate Cancer. Oncologist 2022; 27:e870-e877. [PMID: 36067250 PMCID: PMC9632314 DOI: 10.1093/oncolo/oyac177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/13/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Aldo-keto reductase family 1 member C3 (AKR1C3) is important in prostate cancer progression, being a potential biomarker in metastatic castration-resistant prostate cancer (mCRPC). Previous explorations of AKR1C3 are mainly based on tissue samples. This study investigates using plasma-based liquid biopsy to validate the prognostic and predictive value of AKR1C3 in patients with mCRPC . MATERIALS AND METHODS We prospectively recruited 62 patients with mCRPC. All patients received repeated prostate biopsies at the time of mCRPC diagnosis, and immunohistochemistry (IHC) staining was used to detect protein expression of AKR1C3 in the tissues. We took their blood simultaneously and performed digital droplet polymerase chain reaction (ddPCR) to measure expression levels of AKR1C3 in the exosomes. The detected plasma and tissue AKR1C3 expression levels were analyzed for patients' overall survival (OS) and progression-free survival under first-line abiraterone use (ABI-PFS). RESULTS All other baseline characteristics were balanced between the 2 groups. 15/62 (24.2%) and 25/62 (40.3%) patients showed AKR1C3-EXO positive (≥20 copies/20 μL) and AKR1C3-IHC positive, respectively. Positive AKR1C3-EXO expression was associated with decreased patients' survival [ABI-PFS: 3.9 vs 10.1 months, P < .001; OS: 16.2 vs 32.5 months, P < .001]. AKR1C3-IHC positivity was also correlated with ABI-PFS and OS (P = .010, P = .016). In patients with worse baseline blood tests (including higher alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) level and lower hemoglobin (HB) level), and lower ISUP/WHO group (<4), their OS was significantly worse when showing AKR1C3-EXO positive. CONCLUSION AKR1C3-EXO is associated with patient prognosis regarding OS and ABI-PFS and can be used as a biomarker in mCRPC.
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Affiliation(s)
| | | | | | - Xingming Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yaowen Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Fengnian Zhao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jindong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zhipeng Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xudong Zhu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Junru Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jinge Zhao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yuhao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Ni Chen
- Department of Pathology, Institute of Urology, West People’s Republic of China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Peng Zeng
- 3D Medicines Inc., Shanghai, People’s Republic of China
| | - Pengfei Shen
- Pengfei Shen, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China.
| | - Guangxi Sun
- Guangxi Sun, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China.
| | - Hao Zeng
- Corresponding author: Hao Zeng, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China.
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Yang T, Liu Y, Chen S, Tian J, Zhu X, Zhang L, Wang W, Qin Y, Richter J, Anand A, Xu C, Chi Y, Wang C, Bian C, Wu D, Li Z, Huang S. Serum prolactin level as a predictive factor for abiraterone response in patients with metastatic castration-resistant prostate cancer. Prostate 2022; 82:1284-1292. [PMID: 35747943 DOI: 10.1002/pros.24402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/20/2022] [Accepted: 06/01/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND To investigate the prognostic value and potential therapeutic target of the baseline serum hormones in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone. METHODS This retrospective study was performed in patients with mCRPC receiving abiraterone acetate (AA) from July 2016 to September 2020. Patients who had serum hormone tests within 2 weeks before AA treatment were included. Univariate analysis and Cox regression were performed to evaluate the correlation of sex hormones with progression-free survival (PFS) and overall survival (OS). Prolactin (PRL) expression in the clinical specimens was evaluated by immunohistochemistry. Bone metastases were quantified by automated Bone Scan Index (aBSI). RESULTS The study included 61 patients with a median follow-up of 19.0 months. Patients with lower baseline PRL levels (median) responded better to AA than those with higher baseline PRL levels as indicated by prostate-specific antigen (PSA) reduction (PSA90, 66.7% vs. 25.8%, p = 0.001), PFS (19.6 vs. 7.9 months), and OS (52.8 vs. 19.2 months). Cox regression adjusted for clinical factors also confirmed that baseline PRL level was an independent predictive factor for PFS (hazard ratio = 1.096, p = 0.007). Prostatic PRL expression increased as the disease progressed. PRL expression was also detected in biopsy samples from bone metastasis but not in normal bone tissue, and the serum PRL levels were positively correlated with aBSIs (r = 0.28, p = 0.037). CONCLUSIONS Serum PRL levels are predictive of response to AA in patients with mCRPC. Serum PRL levels are positively correlated with the volume of metastatic bone disease.
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Affiliation(s)
- Tao Yang
- Department of Urology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ying Liu
- Department of Urology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuzhen Chen
- Department of Nuclear Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiale Tian
- Department of Laboratory Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xuyou Zhu
- Department of Pathology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Long Zhang
- Department of Pathology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Wang
- Department of Radiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yingyi Qin
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Jens Richter
- Department of Digital Imaging Biomarkers, EXINI Diagnostics AB, Lund, Sweden
| | - Aseem Anand
- Department of Digital Imaging Biomarkers, EXINI Diagnostics AB, Lund, Sweden
| | - Chengdang Xu
- Department of Urology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yongnan Chi
- Department of Urology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chenyang Wang
- Department of Urology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Cuidong Bian
- Department of Urology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Denglong Wu
- Department of Urology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhenfei Li
- Department of Urology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, Shanghai, China
| | - Shengsong Huang
- Department of Urology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Fallara G, Belladelli F, Robesti D, Raggi D, Nocera L, Marandino L, Galsky MD, Montorsi F, Malavaud B, Ploussard G, Necchi A, Martini A. Androgen Annihilation Versus Advanced Androgen Blockage as First Line Treatment for Metastatic Castration Resistant Prostate Cancer: a systematic review and meta-analysis. Crit Rev Oncol Hematol 2022;:103801. [PMID: 36031173 DOI: 10.1016/j.critrevonc.2022.103801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/26/2022] [Accepted: 08/23/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Despite recent advances in the treatments of metastatic castration resistant prostate cancer (mCRPC), patients' prognosis remains suboptimal and novel treatment combinations are under scrutiny. On this matter, the recent ACIS trial tested the role of abiraterone plus apalutamide (androgen annihilation) in addition to androgen deprivation therapy, versus abiraterone plus androgen deprivation therapy. Herein, we performed a meta-analysis to compare overall survival (OS) and progression free survival (PFS) among patients who received androgen annihilation versus advanced androgen blockage (abiraterone or enzalutamide), in addition to conventional androgen deprivation therapy. METHODS A comprehensive search for all published phase III randomized control trials on first line mCRPC that evaluated advanced androgen blockage (COU-AA-302, PREVAIL) or androgen annihilation (ACIS) was conducted PubMed, EMBASE, Web of Science, and Scopus databases up to 31/12/2021. We reconstructed survival data from published Kaplan-Meier curves on overall survival (OS) and progression free survival (PFS) and meta-analyzed androgen annihilation versus advanced androgen blockage (grouping together abiraterone and enzalutamide) versus androgen deprivation therapy. The outcomes of interest were assessed using difference in restricted mean survival time (ΔRMST) at different time points. RESULTS Three trials were included involving 3787 patients. Overall, patients receiving androgen annihilation exhibited similar OS compared to advanced androgen blockage: ΔRMST at 36 months of -0.2 (95%CI: -1.1, 0.8, p=0.8). At 36 months, relatively to ADT alone, patients receiving androgen annihilation or advanced androgen blockage exhibited longer OS: ΔRMST of 1.6 (95%CI: 0.6, 2.7, p=0.002) and 1.8 months (95%CI: 1.1, 2.5, p<0.001), respectively. Patients receiving androgen annihilation exhibited better PFS compared to advanced androgen blockage: ΔRMST at 36 months of 2.4 months (95%CI: 1.0, 3.8, p=0.001). CONCLUSION We found no OS benefit for patients with mCRPC treated with androgen annihilation compared to advanced androgen blockage. This might be ascribed to an increased rate of other cause mortality that might determine the absence of an OS benefit or to the efficacy of second line therapies. Optimal treatment sequence and patient selection for androgen annihilation remain open points. However, a PFS benefit was found in case of combination therapy, whose clinical meaning is not yet clear.
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48
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Thurin NH, Rouyer M, Jové J, Gross-Goupil M, Haaser T, Rébillard X, Soulié M, de Pouvourville G, Capone C, Bazil ML, Messaoudi F, Lamarque S, Bignon E, Droz-Perroteau C, Moore N, Blin P. Abiraterone acetate versus docetaxel for metastatic castration-resistant prostate cancer: a cohort study within the French Nationwide Claims Database. Expert Rev Clin Pharmacol 2022; 15:1139-1145. [PMID: 35984212 DOI: 10.1080/17512433.2022.2115356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/04/2022]
Abstract
OBJECTIVES To conduct the direct comparison of abiraterone acetate and docetaxel for first-line treatment of metastatic castration-resistant prostate cancer (mCRPC) in real-life settings. METHODS Data were extracted from the French nationwide claims database (SNDS) on all men aged ≥40 years starting first-line treatment with abiraterone acetate or docetaxel for mCRPC in 2014. A high-dimensional propensity score including 100 baseline characteristics was used to match patients of both groups and form two comparative cohorts. Three-year overall survival and treatment discontinuation-free survival were determined using Kaplan-Meier analysis. RESULTS In 2014, 2,444 patients started abiraterone for treatment of mCRPC and 1,214 started docetaxel. After trimming and matching, 716 patients were available in each group. Median overall survival tended to be longer in the abiraterone acetate cohort (23.8 months, 95% confidence interval = [21.5; 26.0]) than in the docetaxel cohort (20.3 [18.4; 21.6] months). Survival at 36 months was 34.6% for abiraterone acetate and 27.9% for docetaxel (p = 0.0027). Treatment discontinuation-free median was longer in the abiraterone acetate cohort compared to the docetaxel cohort (10.8 [10.1; 11.7] versus 7.4 [7.0; 8.0] months). CONCLUSION The findings underline the interest of oral abiraterone acetate over intravenous docetaxel as the first-line treatment option in mCRPC.
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Affiliation(s)
- Nicolas H Thurin
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Magali Rouyer
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Jérémy Jové
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Marine Gross-Goupil
- Medical Oncology Department, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
| | - Thibaud Haaser
- Radiotherapy Department, Hôpital Haut Lévêque, Bordeaux University Hospital, Pessac, France
| | | | - Michel Soulié
- Urology Department, Hôpital Rangueil, Toulouse University Hospital, Toulouse, France
| | | | | | | | | | - Stéphanie Lamarque
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Emmanuelle Bignon
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | | | - Nicholas Moore
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Patrick Blin
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
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Cattrini C, Messina C, Mennitto A, Di Maio M, Gennari A, Olmos D. Comments on " Abiraterone acetate plus prednisolone for metastatic patients starting hormone therapy: 5-year follow-up results from the STAMPEDE randomised trial (NCT00268476)". Int J Cancer 2022; 151:2291-2292. [PMID: 35975447 DOI: 10.1002/ijc.34246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Carlo Cattrini
- Medical Oncology - Department of Translational Medicine (DIMET), Università del Piemonte Orientale (UPO), "Maggiore della Carità" University Hospital, Novara, Italy.,Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | | | - Alessia Mennitto
- Medical Oncology - Department of Translational Medicine (DIMET), Università del Piemonte Orientale (UPO), "Maggiore della Carità" University Hospital, Novara, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Alessandra Gennari
- Medical Oncology - Department of Translational Medicine (DIMET), Università del Piemonte Orientale (UPO), "Maggiore della Carità" University Hospital, Novara, Italy
| | - David Olmos
- Medical Oncology Department, I+12 Biomedical Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain
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50
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James ND, Clarke NW, Cook A, Ali A, Hoyle AP, Attard G, Brawley CD, Chowdhury S, Cross WR, Dearnaley DP, de Bono JS, Diaz‐Montana C, Gilbert D, Gillessen S, Gilson C, Jones RJ, Langley RE, Malik ZI, Matheson DJ, Millman R, Parker CC, Pugh C, Rush H, Russell JM, Berthold DR, Buckner ML, Mason MD, Ritchie AWS, Birtle AJ, Brock SJ, Das P, Ford D, Gale J, Grant W, Gray EK, Hoskin P, Khan MM, Manetta C, McPhail NJ, O'Sullivan JM, Parikh O, Perna C, Pezaro CJ, Protheroe AS, Robinson AJ, Rudman SM, Sheehan DJ, Srihari NN, Syndikus I, Tanguay JS, Thomas CW, Vengalil S, Wagstaff J, Wylie JP, Parmar MKB, Sydes MR. Abiraterone acetate plus prednisolone for metastatic patients starting hormone therapy: 5-year follow-up results from the STAMPEDE randomised trial (NCT00268476). Int J Cancer 2022; 151:422-434. [PMID: 35411939 PMCID: PMC9321995 DOI: 10.1002/ijc.34018] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 12/10/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022]
Abstract
Abiraterone acetate plus prednisolone (AAP) previously demonstrated improved survival in STAMPEDE, a multiarm, multistage platform trial in men starting long-term hormone therapy for prostate cancer. This long-term analysis in metastatic patients was planned for 3 years after the first results. Standard-of-care (SOC) was androgen deprivation therapy. The comparison randomised patients 1:1 to SOC-alone with or without daily abiraterone acetate 1000 mg + prednisolone 5 mg (SOC + AAP), continued until disease progression. The primary outcome measure was overall survival. Metastatic disease risk group was classified retrospectively using baseline CT and bone scans by central radiological review and pathology reports. Analyses used Cox proportional hazards and flexible parametric models, accounting for baseline stratification factors. One thousand and three patients were contemporaneously randomised (November 2011 to January 2014): median age 67 years; 94% newly-diagnosed; metastatic disease risk group: 48% high, 44% low, 8% unassessable; median PSA 97 ng/mL. At 6.1 years median follow-up, 329 SOC-alone deaths (118 low-risk, 178 high-risk) and 244 SOC + AAP deaths (75 low-risk, 145 high-risk) were reported. Adjusted HR = 0.60 (95% CI: 0.50-0.71; P = 0.31 × 10-9 ) favoured SOC + AAP, with 5-years survival improved from 41% SOC-alone to 60% SOC + AAP. This was similar in low-risk (HR = 0.55; 95% CI: 0.41-0.76) and high-risk (HR = 0.54; 95% CI: 0.43-0.69) patients. Median and current maximum time on SOC + AAP was 2.4 and 8.1 years. Toxicity at 4 years postrandomisation was similar, with 16% patients in each group reporting grade 3 or higher toxicity. A sustained and substantial improvement in overall survival of all metastatic prostate cancer patients was achieved with SOC + abiraterone acetate + prednisolone, irrespective of metastatic disease risk group.
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Affiliation(s)
| | - Noel W. Clarke
- The Departments of Surgery & UrologyThe Christie & Salford Royal HospitalsManchesterUK
| | - Adrian Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Adnan Ali
- The Christie NHS Foundation TrustManchesterUK
| | | | | | - Christopher D. Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Simon Chowdhury
- Guy's, King's, & St. Thomas' Hospitals, and Sarah Cannon Research InstituteLondonUK
| | | | - David P. Dearnaley
- The Institute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUK
| | | | - Carlos Diaz‐Montana
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Duncan Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Silke Gillessen
- Istituto Oncologico della Svizzera ItalianaBellinzonaSwitzerland
| | - Clare Gilson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
- Royal Marsden HospitalLondonUK
| | - Rob J. Jones
- Beatson West of Scotland Cancer Centre, University of GlasgowGlasgowUK
| | - Ruth E. Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Zafar I. Malik
- Radiotherapy UnitThe Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolLiverpoolL7 8YAUK
| | - David J. Matheson
- School of Allied Health and Midwifery, Faculty of Education, Health and WellbeingUniversity of WolverhamptonWolverhamptonWS1 3BDUK
| | | | - Chris C. Parker
- Uro‐Oncology UnitRoyal Marsden Hospital and Institute of Cancer ResearchSuttonUK
| | - Cheryl Pugh
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Hannah Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
- Guys and St Thomas' NHS Foundation TrustLondonUK
| | - J. Martin Russell
- Institute of Cancer Sciences, University of GlasgowGlasgowUK
- Beatson West of Scotland Cancer CentreGlasgowUK
| | | | - Michelle L. Buckner
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | | | | | - Alison J. Birtle
- Rosemere Cancer Centre, Lancashire Teaching Hospitals & University of Manchester, University of Central LancashireLancashireUK
| | | | - Prantik Das
- Department of OncologyUniversity Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
| | - Dan Ford
- City Hospital, Cancer Centre at Queen Elizabeth HospitalBirminghamUK
| | - Joanna Gale
- Portsmouth Hospitals University TrustPortsmouthUK
| | - Warren Grant
- Gloucestershire Oncology Centre, Cheltenham General HospitalCheltenhamUK
| | | | | | - Mohammad M. Khan
- Department of Oncology Castle Hill HospitalHullUK
- Scarborough General HospitalScarboroughUK
| | | | | | - Joe M. O'Sullivan
- Patrick G Johnston Centre for Cancer Research, Queen's University BelfastBelfastUK
| | - Omi Parikh
- Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS TrustPrestonUK
| | - Carla Perna
- Royal Surrey NHS Foundation TrustGuildfordUK
| | | | | | | | | | | | | | - Isabel Syndikus
- Radiotherapy UnitThe Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolLiverpoolL7 8YAUK
| | | | | | - Salil Vengalil
- University Hospital North Midlands NHS TrustStaffordshireUK
| | - John Wagstaff
- Swansea University and the South West UK Cancer CentreSwanseaUK
| | | | - Mahesh K. B. Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Matthew R. Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
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