Development of Nomogram to Non-steroidal Antiandrogen Sequential Alternation in Prostate Cancer for Predictive Model

Abstract

Objectives: To clarify clinical predictors for a prostate-specific antigen decrease 50% in response to alternative non-steroidal antiandrogen therapy and to develop a nomogram to predict the prostate-specific antigen decrease 50% in response to alternative non-steroidal antiandrogen therapy in patients with advanced prostate cancer that relapsed after initial combined androgen blockade. We previously reported that combined androgen blockade with an alternative non-steroidal antiandrogen is effective for advanced prostate cancer that has relapsed after initial combined androgen blockade. Methods: We enrolled 161 patients from 14 medical institutions with histologically confirmed prostate cancer who had been treated with combination therapy and in whom cancer progressed after first-line combined androgen blockade therapy. A nomogram for the prostatespecific antigen decrease 50% from baseline prostate-specific antigen in response to alternative non-steroidal antiandrogen therapy was developed based on the final logistic regression model. Results: Overall prostate-specific antigen decreased 50% in 75 of 161 patients (46.6%) in response to alternative non-steroidal antiandrogen therapy. Using five independent risk factors (initial serum level of prostate-specific antigen, hemoglobin, C-reactive protein, prostate-specific antigen nadir to second hormone therapy and Gleason sum), a nomogram was developed for the prediction of prostate-specific antigen decrease 50% in response to alternative nonsteroidal antiandrogen therapy. The receiver operating characteristic curve showed that the accuracy of the predicted probability was 72.5% for the model. Conclusions: This predictive nomogram could predict the prostate-specific antigen decrease 50% in response to alternative non-steroidal antiandrogen therapy and might be of benefit to determine the sequential treatment strategy in patients with relapse after first combined androgen blockade.

Enzalutamide versus flutamide for castration-resistant prostate cancer after combined androgen blockade therapy with bicalutamide: A retrospective study.

“…The previous studies on flutamide as AAT revealed that the responders, whose PSA decline was >50% from baseline, had better prognosis and achieved sufficient benefits from flutamide [4,5,7,8]. PSA nadir and duration of sensitivity to CAB therapy are predictors of the AAT response [9,22]. Responders to flutamide in this study had statistically lower PSA nadir and longer time to PSA nadir at CAB therapy than did non-responders.…”

A multicenter phase I/II study of enzalutamide in Japanese patients with castration-resistant prostate cancer

“…Furthermore, although hormonal treatments have been the mainstay of treatment in advanced prostate cancer, recent data suggest potential development of cross-resistance after multiple lines of hormonal therapy [ 21 , 22 ]. In the first-in-man enzalutamide phase I/II study in patients in the United States, the rate of PSA decline of ≥50 % was significantly lower in patients with previous ketoconazole treatment versus those without [37 % (95 % CI 25–50 %) versus 71 % (95 % CI 60–81 %; p = 0.0007)] [ 19 ].…”

Predictive Models for Assessing Patients’ Response to Treatment in Metastatic Prostate Cancer: A Systematic Review

“…The remaining 13 studies were identified with an overall high RoB [18] , [22] , [23] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] . Eight of these studies were validated internally or externally.…”

“…Additionally, predictive models can identify which patients are likely to experience adverse events or toxicity from a given treatment based on their clinical characteristics, amongst other factors. This provides useful information for the decision-making process between clinicians and patients when selecting treatment [18] .…”