Survival benefits of second-line chemotherapy in metastatic castrate-resistant prostate cancer (CRPC) in a southeastern oncology community practice.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15183-e15183
Author(s):  
James W. Gilmore ◽  
Sally Haislip ◽  
Stephen Szabo ◽  
Sean D Sullivan ◽  
Scott David Ramsey ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cox Model ◽  
Small Sample ◽  
Sensitivity Analyses ◽  
Rank Test ◽  
Average Weight ◽  
Second Line ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant ◽  
The Impact

e15183 Background: Clinical studies showed that chemotherapy (CT) yields survival benefits for Metastatic Castrate resistant prostate cancer (CRPC) patients. This study investigated the relationship between patients with 2nd CT and OS using a real-world data. Methods: TheGeorgia Cancer Specialist Database containing chemotherapy, medical and pharmacy information, and lab results for patients with various types of cancer (2005-2011) was used. Patients (PTs) over 18 years of age with initial stage IV CRPC were followed from the first administration of CT (index date, ID) to the earlier of death or loss to follow-up (FU). PTs with one type of CT protocol (PL) were defined as first line CT PTs (1st), those with two types were identified as second line PTs (2nd), and those with three or more types were (3rd) line PTs. Kaplan-Meier survival curve was compared across the three groups using log-rank test. The impact of line of therapy on OS was further examined using multivariate Cox model with adjustment of PTs’ baseline age, race, Charlson Comorbidity Index (CCI), bisphosphonate use, and ECOG performance scores. Sensitivity analyses (SA) was conducted using different definition to define CT lines. Results: The study included148 PTs, with 86 (58.1%) as 1st, 38 (25.7%) as 2nd, and 24 (16.2%) as 3rd, 29 (19.6%) median age 73 with a range from 18 to over 82, 52.7% as race White, 33.8% African American, and 13.5% other or unknown race, average weight was 179 LB (range 100-279), average baseline PSA was 694 ng/ml (range: 0.05-21,743), 14 (9.5%) patients ECOG score of 3 or 4, 131 (88.5%) with one or more CCI comorbid conditions. Median survival was 17 months for overall, and 12, 19, and 23 months for 1st, 2nd, and 3rd line PTs, respectively (P=0.0355). Multivariate COX model found a higher likelihood of survival for 2nd line PTs (HR=0.361, P=0.006), but not for 3rd line PTs (HR=1.25, P=0.648). SA showed same results. Conclusions: This study suggested that second line of CT was associated with prolonged OS in metastatic CRPC. 3rd line CT survival benefit was not observed. Limitations include potential channeling bias and small sample size.

Overall survival beyond first-line docetaxel in patients with metastatic castrate-resistant prostate cancer treated with abiraterone acetate or enzalutamide.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e570-e570
Author(s):  
Mi Hwa Heo ◽  
Se Hoon Park ◽  
Hee Kyung Kim ◽  
Jinhyun Cho ◽  
Youjin Kim ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Abiraterone Acetate ◽  
Small Sample ◽  
Second Line ◽  
Second Line Therapy ◽  
Line Therapy ◽  
Psa Response ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

e570 Background: In post-docetaxel setting of metastatic castrate-resistant prostate cancer (mCRPC), survival benefit with abiraterone acetate or enzalutamide is well established. This retrospective study was performed with the data obtained our cancer chemotherapy registry to evaluate real-world mCRPC patient outcomes. Methods: All consecutive patients treated with either abiraterone acetate or enzalutamide in post-docetaxel setting between 2013 and 2014 were included. The decision for administering second-line agents was, in most cases, at the discretion of the treating oncologists. The primary endpoint of this study was overall survival (OS), and the secondary endpoints included safety, prostate-specific antigen (PSA) response ( ≥ 50% decline) and progression-free survival (PFS). Univariate and multivariate analyses for OS were performed on the recognized baseline parameters and therapy. Results: A total of 54 eligible mCRPC patients received either abiraterone acetate (n = 25) or enzalutamide (n = 29). At the time of commencing second-line therapy, the patients’ median age was 70 years (range, 45-86) and 30 patients (56%) had a symptomatic disease. Visceral disease was present in 12 patients, and 12 had bone-only metastasis. Both were well-tolerated without significant toxicities. PSA response was observed in 36% and 52% for abiraterone acetate and enzalutamide, respectively. The estimated median PFS and OS were 5 and 15 months, respectively. Multivariate analysis revealed that the presence of clinical symptoms was the only independent prognostic factor for OS. Conclusions: Within the limitation of small sample size, the results are consistent with existing literature suggesting that both abiraterone acetate and enzalutamide appear to be effective as second-line therapy for docetaxel-pretreated mCRPC.

Radium 223 treatment in metastatic castrate-resistant prostate cancer: Impact of sequencing on survival—Real-world outcomes from a single United Kingdom center.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 223-223 ◽  
Author(s):  
Xue Yan Jiang ◽  
Sarah Atkinson ◽  
Sam Cuming ◽  
Alexander Burns ◽  
Rachel Anne Pearson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Marrow ◽  
Bone Metastasis ◽  
Systemic Treatment ◽  
Survival Outcomes ◽  
Prior Chemotherapy ◽  
Radium 223 ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant ◽  
The Impact

223 Background: Radium 223 (Ra-223) is a FDA and EMA approved alpha particle radiopharmaceutical used to treat men with metastatic castrate resistant prostate cancer (mCRPC) with symptomatic bone metastasis. In view of emerging systemic options, new EMA 2018 licence indication is for 3rd line onwards. We aim to evaluate the impact of systemic therapy sequencing on survival outcomes from a heterogeneous cohort of 228 patients treated with Ra-223 in a single UK centre. Methods: We prospectively collected data from 228 men underwent Ra-223 therapy for mCRPC between April 2014 and August 2018. Survival outcomes in relation to sequence of systemic treatment used prior to Ra-223 were analysed. Results: Medium age = 72 (51-87) years. Most patients (n = 142, 69%) received at least one systemic agent prior to Ra-223: docetaxel and/or cabaxitaxel chemotherapy (n = 60, 29%), abiraterone (n = 62, 30.1%) and enzalutamide (n = 67, 32.5%) in various sequences. No patients received concurrent Ra-223 /systemic treatment other than LHRH analogue. Key findings are summarized in table below. Conclusions: Our data demonstrated better survival trend in patients who received Ra-223 early. Patients who received prior chemotherapy have worse survival compared with those who were chemo-naïve likely due to bone marrow depletion. Ra-223 should not be offered to patients who have already had both cabaxitaxel and docetaxel as their medium survival is too poor to justify a treatment which takes 6 months to complete.[Table: see text]

PSA values as a surrogate of overall survival (OS) in metastatic castrate resistant prostate cancer (mCRPC) treated with second-line (2L) chemotherapy (CT).

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e16104-e16104
Author(s):  
Martin Richardet ◽  
Matias Nicolas Cortes ◽  
Matias Molina ◽  
Patricia Hernandez ◽  
Romina Brombin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Second Line ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

Personalizing treatment in patients with castrate-resistant prostate cancer: A study of predictive factors for secondary endocrine therapies activity.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 213-213 ◽  
Author(s):  
Yohann Loriot ◽  
Christophe Massard ◽  
Laurence Albiges ◽  
Mario Di Palma ◽  
Pierre Blanchard ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Clinical Trials ◽  
Predictive Factors ◽  
Cox Model ◽  
Performance Status ◽  
Progression Free Survival ◽  
Logrank Test ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

213 Background: Several options have recently demonstrated activity, including survival improvement, in patients with prostate cancer progressing while on androgen deprivation therapy: chemotherapy (docetaxel, cabazitaxel), sipuleucel-T, and abiraterone. There is now an urgent need to identify predictive factors of efficacy for each of these treatments to assist decision-making in pts with castrate-resistant prostate cancer (CRPC). We attempted to identify predictive factors for activity of subsequent endocrine manipulations in patients with CRPC. Methods: Patients with CRPC included in the Institut Gustave Roussy clinical trials database who received endocrine manipulations (abiraterone, ketoconazole-hydrocortisone, DES, bicalutamide) for CRPC were reviewed. The predictive role on response and progression-free survival (PFS) of a series of clinical, biological, and radiological parameters was studied (Khi-2 test for response, Logrank test and Cox model for PFS). Results: 108 patients with CRPC who participated to 5 clinical trials were identified. The median duration of prostate cancer sensitivity to ADT (defined as the time from ADT initiation to the outset of castrate-resistance) was 16 months (range: 0–118 months). Timing of endocrine manipulation (before vs after docetaxel-based chemotherapy), presence of non-bone visceral metastases, the type of progression (clinical vs radiological), Performance Status, and PSA doubling time did not predict for response or PFS. In contrast, the previous duration of prostate cancer sensitivity to ADT (classified as ≥16 months and <16 months) significantly and strongly predicted for both PSA response (58% vs 18%, p=0.01) and PFS (median PFS rates: 5 months (95%CI: 3.46–6.53) and 3 months (95%CI: 2.10–3.89) p<0.043). Conclusions: A previous duration of prostate cancer sensitivity to ADT ≥16 months is the only significant predictive factor for efficacy of subsequent endocrine manipulations in patients with CRPC. This parameter shall be integrated into the decision-making process for these patients.

Progression free survival in patients with castrate resistant metastatic prostate cancer: Does sequence matter?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 356-356
Author(s):  
Adam McLain Kase ◽  
Cheryl Cook ◽  
Winston Tan
Keyword(s):  
Prostate Cancer ◽  
Chart Review ◽  
Progression Free Survival ◽  
Second Line ◽  
First Line ◽  
Free Survival ◽  
First Line Therapy ◽  
Line Therapy ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

356 Background: Approval of multiple therapeutic agents for castrate resistant prostate cancer (CPRPC) has improved survival and also quality of life. However, how to optimize sequencing is still an ongoing challenge for most clinicians. Methods: A retrospective chart review of patients treated with FDA approved regimens for castrate resistant prostate cancer from 2002 to 2017 at Mayo Clinical Florida was completed. Data on progression free survival of the various treatment sequences including abiraterone, docetaxel, and enzalutamide were reviewed. Results: One hundred patients were included in the study. Those on clinical trial were excluded. All patients were on LHRH agonist /antagonist and were continued while on the subsequent treatments. The first line therapy progression free survival (PFS) was 245 days with abiraterone acetate (AA), 307 days with enzalutamide (E) and docetaxel 285 days, respectively. The second line therapy PFS was 201 days with AA and 166 days with E. When AA was given after E PFS was 97 days and when E was given after AA the PFS was 68 days. E given after docetaxel resulted in a PFS of 390 days for one patient. Conclusions: In this chart review, enzalutamide had the longest PFS when used as the first line therapy and the PFS was improved when used as a second line after docetaxel. This retrospective review suggests therapy sequencing may be optimized to increase progressive free survival in patients with metastatic castrate resistant prostate cancer.

scholarly journals COSMiC details

2015 ◽  
Vol 9 (1-2) ◽  
Author(s):  
CUAJ Editorial
Keyword(s):  
Prostate Cancer ◽  
Observational Study ◽  
Metastatic Cancer ◽  
Abiraterone Acetate ◽  
Additional Information ◽  
Patient Reported ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant ◽  
Cancer Of The Prostate ◽  
The Impact

A Canadian Observational Study in Metastatic Cancer of the Prostate: A Study of ZYTIGA Use in the Community Urology Setting. The COSMiC Prospective Prostate Cancer Registry.The purpose of this non-interventional, prospective, observational study is to temporally evaluate the impact of abiraterone acetate (ZYTIGA) therapy on Patient Reported Outcomes (PROs) and on clinical outcomes in the chemotherapy-naive metastatic castrate-resistant prostate cancer (mCRPC) population.Study participants must have a confirmed diagnosis of mCRPC according to medical history and have rising PSA levels or radiographic progression (documented by previous positive bone scan or metastatic lesions identified on CT or MRI) despite ongoing conventional ADT.Study participants will complete Quality of Life and Patient Satisfaction questionnaires longitudinally at defined time points. Safety and efficacy data, as well as levels of health care resource utilization associated with ZYTIGA therapy, will also be prospectively collected and analyzed.Once enrolled, study participants will be followed for a maximum of 72 weeks from the time of initiation of ZYTIGA treatment, or up to the time of early study withdrawal/termination.For additional information please contact Richard K. Plante at [email protected]

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