BackgroundBoth Docetaxel (DOC) and Abiraterone (ABI) improve the survival of men with metastatic, castration sensitive prostate cancer (mCSPC). However, the outcome among mCSPC patients is highly variable, while there is a lack of predictive markers of therapeutic benefit. Furthermore, there is limited data on the comparative real-world effectiveness of adding DOC or ABI to androgen deprivation therapy (ADT).MethodsWe conducted a retrospective analysis of 121 mCSPC patients treated at Odette Cancer Centre (Toronto, ON, Canada) between Dec 2014 and Mar 2021 (DOC n = 79, ABI n = 42). The primary endpoint studied was progression free survival (PFS), defined as the interval from start of ADT to either (i) biochemical, radiological, or symptomatic progression, (ii) start of first-line systemic therapy for castration-resistant prostate cancer (CRPC), or (iii) death, whichever occurred first. To identify independent predictive factors for PFS in the entire cohort, a Cox proportional hazard model (stepwise selection) was applied. Overall survival (OS) was among secondary endpoints.ResultsAfter a median follow-up of 39.6 and 25.1 months in the DOC and ABI cohorts, respectively, 79.7% of men in the DOC and 40.5% in the ABI group experienced a progression event. PFS favored the ABI cohort (p = 0.0038, log-rank test), with 78.0% (95%CI 66.4–91.8%) of ABI versus 67.1% (57.5–78.3%) of DOC patients being free of progression at 12 months. In univariate analysis superior PFS was significantly related to older age at diagnosis of mCSPC, metachronous metastatic presentation, low-volume (CHAARTED), and low-risk (LATITUDE) disease, ≥90% PSA decrease at 3 months (PSA90), and PSA nadir ≤0.2 at 6 months. Age (HR = 0.955), PSA90 (HR = 0.462), and LATITUDE risk stratification (HR = 1.965) remained significantly associated with PFS in multivariable analysis. OS at 12 months was 98.7% (96.3–100%) and 92.7% (85.0–100%) in the DOC and ABI groups (p = 0.97), respectively.ConclusionsIn this real-world group of men undergoing treatment intensification with DOC or ABI for mCSPC, we did not find a significant difference in OS, but PFS was favoring ABI. Age at diagnosis of mCSPC, PSA90 at 3 months and LATITUDE risk classification are predictive factors of PFS in men with mCSPC.
69 Background: Androgen deprivation therapy induces osteosarcopenia, which in turn is associated with prostate cancer related morbidity, mortality and health expenditures. Although bone and skeletal muscle health are interconnected at multiple levels, clinical guidelines focus on the prevention and management of osteoporosis while largely ignoring skeletal muscle health. Due to the paucity of studies investigating the impact of A or E therapy on skeletal muscle loss, we decided to compare the effects of the two agents on sarcopenia development among men with mCRPC. Methods: In this retrospective single-centre study we identified a total of 58 mCRPC patients (pts) who (i) had received treatment with A (n = 29) or E (n = 29) for > 1.5 years, (ii) had an available routine abdominopelvic CT scan at baseline, and (iii) had at least one follow-up CT scan 12 and/or 24 months after treatment initiation. Using the contour tool of the eUnity imaging platform, we obtained the total contour area of the left and right psoas muscle at the inferior endplate of L3 in order to calculate the Psoas Muscle Index (PMI; defined as the total contour area divided by patients’ height in meters) as a measure of sarcopenia. Results: The median age of men undergoing A or E therapy was 75 (range 70-79) versus 69 (67-75) years (p = 0.09), with A use for first line mCRPC therapy in 65.5% of pts, and of E in 69.0% of pts. The median time on A was 30.3 (95%CI 27.2-46.0) months, compared to 42.8 (27.4-49.9) months for men on E (p = 0.96). Using a PMI cut-off for sarcopenia of < 5.7, the rate of sarcopenia increased from 34.5% at baseline to 39.3% at 24 months in pts undergoing A therapy (p = 0.71); the median PMI of A pts at baseline was 6.79 (95%CI 5.48-7.22) and steadily decreased to 5.86 (5.46-6.42) at 24 months (p = 0.0002). As for E, the rate of sarcopenia increased from 24.1% to 39.3% after 24 months of treatment (p = 0.21), with a concurrent PMI decrease from 6.73 (95%CI 5.87-7.64) to 6.32 (5.25-6.90; p = 0.001). There were no significant PMI differences between the A and E cohorts at baseline, month 12, or month 24. Furthermore, the presence versus absence of baseline sarcopenia was not significantly associated with the time on A or E therapy (p = 0.15 and p = 0.54, respectively). Conclusions: A sizeable number of men with mCRPC are sarcopenic at start of A or E therapy. In addition, the use of both agents is associated with an increase in the rate of sarcopenia, and with significant PMI decreases over time. The sarcopenia-inducing potential of A and E is comparable, while baseline sarcopenia seems not to predict time on A or E.
Background:: The ongoing COVID-19 pandemic has forced oncologists to alter their daily practice, despite the lack of substantial evidence, in order to reduce the risk of transmission among patients with underlying malignant and other concurrent medical conditions. Objective:: This systematic review compares the characteristics of oncology-focused COVID-19 manuscripts published from January 1st to April 30th, 2020, and from September 1st to September 30th, 2020, to identify the variation of publications between the start of the pandemic and our current state. Methods:: The PubMed database was searched on two different occasions using the search string “Cancer OR Tumor” AND “COVID-19 OR SARS-CoV-2”. All manuscripts pertaining to COVID-19 and oncological topics were included in this review. Results:: The search from January 1st to April 30th, 2020 and from September 1st to September 30th, 2020, resulted in 299 and 249 articles pertaining to our objective, respectively. Comparing the earlier with later publication period, the proportion of articles containing original data increased from 22.4% to 44.2%, whereas the proportion of Editorials/Correspondences decreased from 43.5% to 20.5%. Cancer patient management guidelines accounted for the majority of publications during both periods (59.2% versus 43.4%, respectively). Conclusion:: The study revealed a rapidly increasing number of COVID-19 and oncological-focused publications through-out the pandemic thus far. Given the unprecedented nature of the COVID-19 pandemic, future analyses are expected to reveal rapidly evolving publication patterns.
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