Systemic treatment options for metastatic hormone-sensitive prostate cancer

279 Background: The PCSC Program was initiated in 2013 at the Vancouver Prostate Centre to provide a comprehensive program for patients and partners with prostate cancer. This program provides educational sessions (ES) and clinical services, including decision-making for primary therapy, sexual health, pelvic floor physiotherapy, hormone therapy, counseling, exercise, and nutrition for patients in BC, Canada. In 2016, the PCSC Program expanded to BC Cancer Victoria and in 2017 to other BC Cancer sites. In 2018, medical oncologists (MDs) in Victoria (JR, SP) developed an Education Module addressing treatment options for men with metastatic hormone sensitive (mHSPC) and metastatic castration resistant (mCRPC) disease. MDs delivered in-person ES in Victoria in 2018 and, in 2019, added a virtual platform (VP) option. From 3-5/2020, the ESs were on hold due to the COVID pandemic and parental leaves. In 6/2020, the ESs resumed only on VP, and the PCSC Oncology Nurse Practitioner (NP), NI, gave the presentations for the MDs on leave. In 10/2020, due to a changing standard of care for mHSPC, the PCSC team consolidated the two ESs into one. We report on the evolution of this Education Module in response to both the changing standard of care and the COVID pandemic. Methods: We prospectively collected attendance and patient characteristic metrics from all ES for men with mPC. We tracked presenter type (MD vs. NP) and prospectively collected anonymous patient satisfaction questionnaires. Results: From 1/2018 to 1/2021, 100 men registered for 27 ES; 81 men, 41 partners, and 2 family members actually attended. 48/75 (64%) men were white, 39/75 (52%) retired, and 56/75 (74.7%) married. 47 men attended 12 mHSPC ES, 13 men attended ten mCRPC ES, and 17 attended four consolidated ES. MDs presented 15 ES, and the NP presented 12 ES. Responses to questions on 70 satisfaction surveys were similar for MD vs. NP presenters. 9 responders to the recently added VP-specific questions said they agreed (4) or strongly agreed (5) that it was beneficial to watch the ES at home on a computer. The Table below shows attendance per site per year. Conclusions: The ESs for men with mPC were well-received. Although there was a VP option before COVID, attendance increased significantly after the lockdown as patients and providers became more familiar with VPs. Satisfaction surveys confirmed that an NP could deliver the ES rather than MD. Consolidation of the mHSPC and mCRPC ES reflected the changing standard of care and resulted in more efficient use of presenter time. Virtual delivery of the sessions provided greater access to those living in distant or remote areas of the province and those in lockdown during the COVID pandemic. [Table: see text]

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Discussion of Treatment Options for Metastatic Hormone Sensitive Prostate Cancer Patients

Frontiers in Oncology ◽

10.3389/fonc.2020.587981 ◽

2020 ◽

Vol 10 ◽

Author(s):

Samantha S. Sigurdson ◽

Francisco E. Vera-Badillo ◽

Fabio Ynoe de Moraes

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Treatment Options ◽

Hormone Sensitive

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Current Treatment Options for Metastatic Hormone-Sensitive Prostate Cancer.

Cancers ◽

10.3390/cancers11091355 ◽

2019 ◽

Vol 11 (9) ◽

pp. 1355 ◽

Cited By ~ 14

Author(s):

Cattrini ◽

Castro ◽

Lozano ◽

Zanardi ◽

Rubagotti ◽

...

Keyword(s):

Prostate Cancer ◽

Small Sample Size ◽

Treatment Options ◽

Current Treatment ◽

Abiraterone Acetate ◽

Small Sample ◽

Phase 3 ◽

Tumor Patient ◽

Randomized Controlled ◽

Hormone Sensitive

The possible treatments options for metastatic hormone-sensitive prostate cancer (mHSPC) have dramatically increased during the last years. The old backbone, which androgen-deprivation therapy (ADT) is the exclusive approach for hormone-naïve patients, has been disrupted. Despite the fact that several high-quality, randomized, controlled phase 3 trials have been conducted in this setting, no direct comparison is currently available among the different strategies. Inadequate power, absence of preplanning and small sample size frequently affect the subgroup analyses according to disease volume or patient’s risk. The choice between ADT alone and ADT combined with docetaxel, abiraterone acetate, enzalutamide, apalutamide or radiotherapy to the primary tumor remains challenging. Factors that are related to the tumor, patient or drug side effects, currently guide these clinical decisions. This comprehensive review aims to indirectly compare the phase 3 trials in the mHSPC setting, in order to extrapolate data useful for treatment selection, providing also perspectives on future biomarkers.

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ARCHES: Efficacy of androgen deprivation therapy (ADT) with enzalutamide (ENZA) or placebo (PBO) in metastatic hormone-sensitive prostate cancer (mHSPC) by prior local and systemic treatment

European Urology Open Science ◽

10.1016/s2666-1683(20)33160-8 ◽

2020 ◽

Vol 19 ◽

pp. e865-e866

Author(s):

A. Stenzl ◽

R.Z. Szmulewitz ◽

D. Petrylak ◽

J. Holzbeierlein ◽

A. Villers ◽

...

Keyword(s):

Prostate Cancer ◽

Androgen Deprivation Therapy ◽

Systemic Treatment ◽

Androgen Deprivation ◽

Hormone Sensitive

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Efficacy of enzalutamide in patients with metastatic hormone-sensitive and castration-refractory prostate cancer: authors’ experience

Medical Council ◽

10.21518/2079-701x-2021-20-130-136 ◽

2021 ◽

pp. 130-136

Author(s):

T. V. Ustinova ◽

L. V. Bolotina ◽

A. A. Paichadze ◽

A. A. Kachmazov ◽

A. A. Fedenko ◽

...

Keyword(s):

Prostate Cancer ◽

Clinical Case ◽

Treatment Options ◽

Standard Of Care ◽

Male Population ◽

Castration Resistant ◽

Age Of Diagnosis ◽

Hormone Sensitive ◽

New Treatment ◽

New Generation

Prostate cancer is one of the most common neoplasms in men. It currently ranks second in Russian Federation amongst male population in overall number of cases after only lung cancer and third in cancer mortality. Prostate cancer is rarely diagnosed in patients younger than 40 years old, with overage age of diagnosis being between 50 and 70 years. A lot of different new treatment options were developed in the last decade for patients with metastatic prostate cancer (mPC). Despite androgen-deprivation remaining the standard of therapy, it has been proven that the addition of cytotoxic and hormonal drugs of new generation improves overall survival of patients with castration-sensitive and castration-resistant metastatic disease. Recently, enzalutamide became the new standard of care not only in castration-resistant mPC, but also in the setting of metastatic castration-sensitive prostate cancer, due to the data acquired in two large randomized trials ARCHES and ENZAMET. This article provides clinical examples demonstrating the effectiveness of enzalutamide in various forms of prostate cancer. In the first clinical case enzalutamide was used in the treatment of castration-sensitive mPC. Currently, patient continues to receive this therapy with progression-free interval exceeding 11 months. In the second clinical case, enzalutamide has shown its efficacy in the setting of castration-resistant PC. Stable disease was achieved and as of right now patient has shown no signs of progression for 9 months, which is already a significantly better result in comparison with previous lines of treatment.

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A Cost-Effectiveness Analysis of Systemic Therapy for Metastatic Hormone-Sensitive Prostate Cancer

Frontiers in Oncology ◽

10.3389/fonc.2021.627083 ◽

2021 ◽

Vol 11 ◽

Author(s):

Winnie W. Y. Sung ◽

Horace C. W. Choi ◽

Peter H. Y. Luk ◽

Tsz Him So

Keyword(s):

Prostate Cancer ◽

Cost Effectiveness ◽

Lifetime Cost ◽

Treatment Options ◽

Sensitivity Analyses ◽

Line Treatment ◽

First Line ◽

Life Years ◽

Hormone Sensitive ◽

First Line Treatment

BackgroundCurrently, approved first-line treatment options of metastatic hormone-sensitive prostate cancer (mHSPC) include (1) androgen deprivation therapy (ADT) alone, ADT plus one of the following: (2) docetaxel, (3) abiraterone, (4) enzalutamide, and (5) apalutamide. The high cost of novel androgen receptor pathway inhibitors warrants an understanding of the combinations’ value by considering both efficacy and cost.ObjectiveThis study aimed to compare the cost-effectiveness of these five treatment options in mHSPC from the US payer perspective to guide treatment sequence.MethodsA Markov model was developed to compare the lifetime cost and effectiveness of these five first-line treatment options for mHSPC using outcomes data from published literature. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were obtained from the Veterans Affairs Pharmaceutical Catalog. We extrapolated survival beyond closure of the trials.Outcome Measurements and Statistical AnalysisLife-years, QALYs, lifetime costs, and incremental cost-effectiveness ratios (ICERs) were estimated. Univariable, 2-way, and probabilistic sensitivity analyses were performed to evaluate parameter uncertainty. A willingness-to-pay (WTP) threshold of US$100,000 per QALY was used.ResultsCompared to ADT alone, docetaxel plus ADT provided a 0.28 QALY gain at an ICER of US$12,870 per QALY. Abiraterone plus ADT provided an additional 1.70 QALYs against docetaxel plus ADT, with an ICER of US$38,897 per QALY. Compared to abiraterone plus ADT, enzalutamide plus ADT provided an additional 0.87 QALYs at an ICER of US$509,813 per QALY. Apalutamide plus ADT was strongly dominated by enzalutamide plus ADT. Given the WTP threshold of US$100,000 per QALY, abiraterone plus ADT represented high-value health care.ConclusionsAbiraterone plus ADT is the preferred treatment option for men with mHSPC at a WTP threshold of US$100,000 per QALY.

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Systemic treatment for metastatic hormone sensitive prostate cancer: A comprehensive meta-analysis evaluating efficacy, safety and specific sub-groups

European Urology Supplements ◽

10.1016/s1569-9056(19)34650-0 ◽

2019 ◽

Vol 18 (11) ◽

pp. e3495-e3496

Author(s):

V. Di Nunno ◽

V. Mollica ◽

M. Santoni ◽

A. Conti ◽

M. Rodolfo ◽

...

Keyword(s):

Prostate Cancer ◽

Systemic Treatment ◽

Meta Analysis ◽

Hormone Sensitive

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Discovery of primary prostate cancer biomarkers using cross cancer learning

Scientific Reports ◽

10.1038/s41598-021-89789-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kaiyue Zhou ◽

Suzan Arslanturk ◽

Douglas B. Craig ◽

Elisabeth Heath ◽

Sorin Draghici

Keyword(s):

Prostate Cancer ◽

Treatment Options ◽

Cancer Genes ◽

Cancer Disease ◽

Castration Resistant ◽

Primary Prostate Cancer ◽

Study Population ◽

Novel Biomarkers ◽

Hormone Sensitive

AbstractProstate cancer (PCa), the second leading cause of cancer death in American men, is a relatively slow-growing malignancy with multiple early treatment options. Yet, a significant number of low-risk PCa patients are over-diagnosed and over-treated with significant and long-term quality of life effects. Further, there is ever increasing evidence of metastasis and higher mortality when hormone-sensitive or castration-resistant PCa tumors are treated indistinctively. Hence, the critical need is to discover clinically-relevant and actionable PCa biomarkers by better understanding the biology of PCa. In this paper, we have discovered novel biomarkers of PCa tumors through cross-cancer learning by leveraging the pathological and molecular similarities in the DNA repair pathways of ovarian, prostate, and breast cancer tumors. Cross-cancer disease learning enriches the study population and identifies genetic/phenotypic commonalities that are important across diseases with pathological and molecular similarities. Our results show that ADIRF, SLC2A5, C3orf86, HSPA1B are among the most significant PCa biomarkers, while MTRNR2L1, EEPD1, TEPP and VN1R2 are jointly important biomarkers across prostate, breast and ovarian cancers. Our validation results have further shown that the discovered biomarkers can predict the disease state better than any randomly selected subset of differentially expressed prostate cancer genes.

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