scholarly journals Population-based impact on overall survival after the introduction of docetaxel as standard therapy for metastatic castration resistant prostate cancer

2014 ◽  
Vol 8 (7-8) ◽  
pp. 520 ◽  
Author(s):  
Robert R. Zielinski ◽  
Arun A. Azad ◽  
Kim N. Chi ◽  
Scott Tyldesley
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Survival Benefit ◽  
Palliative Radiotherapy ◽  
Population Level ◽  
Population Based ◽  
Primary Objective ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Multivariable Analyses

Introduction: Utilization of docetaxel in patients with metastatic castration resistant prostate cancer (mCRPC) remains low despite its demonstrated survival benefit. In a population-based cohort, we sought to determine whether the introduction of docetaxel has improved overall survival (OS).Methods: A retrospective review was conducted of mCRPC patients treated with palliative radiotherapy to bone in British Columbia, Canada. Patients in the pre-docetaxel era (pre-DOC, prior to general availability of docetaxel for CRPC) received radiotherapy to bone (RT-B) from 1998 to 2001 and those in the docetaxel era (DOC) received radiotherapy from 2006 to 2009. Time of first radiotherapy to bone was used to select patients at a similar point in their disease state (i.e., onset of bone pain). The primary objective was to determine median OS in the two eras.Results: Of the 919 patients in the pre-DOC era and the 957 in the DOC era, 7% and 37% received docetaxel, respectively. The median OS from time of first palliative RT was 7.5 months versus 10.3 months (hazard ratio [HR]: 0.79, 95% confidence interval [CI] 0.72–0.87; p < 0.0001) in the pre-DOC and DOC cohorts, respectively. On multivariable analyses, both eras treated (HR 0.84; p = 0.001) and the receipt of docetaxel (HR 0.78; p < 0.001) were significantly associated with OS.Conclusion: Although docetaxel penetrance was <50%, median OS was significantly improved in the DOC era compared to the pre-DOC era. This is the first study to demonstrate that docetaxel improves OS in mCRPC patients at a population level.

Survival in men diagnosed with castration resistant prostate cancer: A population-based observational study in Sweden.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16555-e16555
Author(s):  
Markus Aly ◽  
Frida Schain ◽  
Amy Leval ◽  
Johan Liwing ◽  
Joe Lawson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cox Regression ◽  
Specific Antigen ◽  
Population Level ◽  
Population Based ◽  
Calendar Period ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistance ◽  
Prostate Biopsies ◽  
Castration Resistant

e16555 Background: Data focusing on the castration resistant phase of prostate cancer (PC) outside clinical trial settings are scarce. This study aims to investigate PC-specific and overall survival (OS) in men with castration resistant prostate cancer (CRPC) on a population level. Methods: The STHLM-0 cohort (n = 400 000) with data on all prostate specific antigen (PSA) values and prostate biopsies taken in Stockholm, Sweden, from 2003 to 2015 were linked to other population registries. All men with a PC diagnosis and rising PSA after three months consecutive use of gonadotropin-releasing hormone or surgical castration were defined as CRPC (n = 1712). Kaplan-Meier was used to estimate median time-to-event and 95% confidence intervals (CI). Patients were stratified by metastasis status at PC diagnosis and multivariable Cox regression was used to adjust for clinical subgroups, including Gleason, age, T stage and calendar period (2006-2011 vs 2012-2015). Results: Metastasis at PC diagnosis was associated with shorter OS from castration resistance. From CRPC onset the median OS was 22.8 months (95% CI 21.2-25.5) and 13.1 (95% CI 11.5-14.2) months for patients without and with metastasis at PC diagnosis, respectively. The median PC-specific survival from CRPC was 30.7 (95% CI 27.9-34.7) months and 13.5 (95% CI 12.3-16.1) months for patients without and with metastasis at PC diagnosis, respectively. For patients with metastasis at PC diagnosis, factors influencing OS from CRPC were; entering CRPC stage in the later vs earlier calendar period (HR 0.61 95% CI 0.48-0.78, p < 0.001), age > 80 vs < 70 (HR 1.46, 95% CI 1.05-2.02, p < 0.02), T4 vs T1 stage (HR 1.56, 95% CI:1.02-2.37, p < 004). For patients without metastasis at PC diagnosis, developing CRPC in the later vs the earlier calendar period was associated with superior survival from CRPC (HR 0.78 95% CI 0.65-0.92, p < 0.004). Conclusions: Metastasis at PC diagnosis was associated with worse survival outcomes in CRPC patients. Individuals who became castration resistant in the later calendar period survived longer compared to those in the same stage in the earlier calendar period, most likely due to the introduction of novel agents for CRPC patients and more accurate staging methods.

scholarly journals Contemporary agents in the management of metastatic castration-resistant prostate cancer

2016 ◽  
Vol 10 (11-12) ◽  
pp. 414 ◽  
Author(s):  
Anil Kapoor ◽  
Christopher Wu ◽  
Bobby Shayegan ◽  
Adrian P. Rybak
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Survival Benefit ◽  
Cancer Biology ◽  
Abiraterone Acetate ◽  
Novel Agents ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Radium 223 ◽  
Overall Survival Benefit

Docetaxel-based chemotherapy has been the standard of care for metastatic castration-resistant prostate cancer (mCRPC) since 2004. Over the past few years, there has been a significant paradigm shift in the treatment landscape of this disease. A deeper understanding of prostate cancer biology, along with the development of novel agents has created hope towards treating chemotherapy-naïve and resistant disease. Following the implementation of docetaxel as the first-line therapy for mCRPC, five novel therapies have demonstrated survival benefit in mCRPC. Cabazitaxel, abiraterone acetate, and enzalutamide are three agents recently approved for the treatment of mCRPC, having shown overall survival benefit in patients previously treated with docetaxel, while both abiraterone acetate and enzalutamide have also shown promise in the pre-docetaxel setting. Sipuleucel-T has shown overall survival benefit in asymptomatic mCRPC, while radium-223 provides survival benefit to patients with mCRPC who are symptomatic from their skeletal metastases in both docetaxel-naïve patients and post-docetaxel patients. Denosumab, an anti-RANKL antibody, has been approved for the prevention of skeletal-related events in patients with prostate cancer bone metastases. This review examines the phase 3 trials supporting the use of theses novel agents in the treatment of mCRPC. While these agents provide incremental increases in patient survival, further study to determine the best choice, combination, and/or sequencing of administration is still necessary.

scholarly journals Next-generation androgen receptor inhibitors in non-metastatic castration-resistant prostate cancer

2020 ◽  
Vol 12 ◽  
pp. 175883592097813
Author(s):  
Pernelle Lavaud ◽  
Clément Dumont ◽  
Constance Thibault ◽  
Laurence Albiges ◽  
Giulia Baciarello ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Androgen Receptor ◽  
Androgen Deprivation Therapy ◽  
Androgen Deprivation ◽  
Next Generation ◽  
Castration Resistant Prostate Cancer ◽  
Free Survival ◽  
Castration Resistant ◽  
Recent Advances

Until recently, continuing androgen deprivation therapy (ADT) and closely monitoring patients until evolution towards metastatic castration-resistant prostate cancer (CRPC) were recommended in men with non-metastatic CRPC (nmCRPC). Because delaying the development of metastases and symptoms in these patients is a major issue, several trials have investigated next-generation androgen receptor (AR) axis inhibitors such as apalutamide, darolutamide, and enzalutamide in this setting. This review summarizes the recent advances in the management of nmCRPC, highlighting the favourable impact of next-generation AR inhibitors on metastases-free survival, overall survival and other clinically meaningful endpoints.

Earlier use of androgen receptor-axis-targeted drugs may improve overall survival in patients with non-metastatic castration-resistant prostate cancer

The Prostate ◽  
2018 ◽  
Vol 78 (10) ◽  
pp. 766-772 ◽  
Author(s):  
Keiichiro Mori ◽  
Takahiro Kimura ◽  
Kagenori Ito ◽  
Hajime Onuma ◽  
Masatoshi Tanaka ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Androgen Receptor ◽  
Targeted Drugs ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant
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