Impact of news drugs in the median overall survival of patients with metastatic castration resistant prostate cancer (mCRPC).

Abstract

e16096 Background: In the past 3 years new therapies, such as cabazitaxel (C): a novel taxane, enzulatamide (E): a new androgen receptor signaling inhibitor and abiraterone acetate (A): an inhibitor of androgen synthesis, have been developed in the treatment of post-docetaxel metastatic CRPC patients. This study assessed the clinical impact of these new drugs, comparing the outcomes of two historical cohorts of patients with mCRPC. Methods: We retrospectively reviewed the data of all patients with mCRPC treated by first line chemotherapy with docetaxel (D) at the Centre Léon Bérard. Based on the timing of the development of new drugs, we defined two cohorts based on two time periods depending on drugs available on the market: group 1: 2006-2009 corresponding to the period when only conventional drugs (D, mitoxantrone) were available; group 2: 2009-2012 corresponding to the period when new drugs like C, E, A could be used post docetaxel. Outcome evaluated was overall survival (OS). OS was defined as the time from date of D introduction to date of death or date of last follow-up for patients alive at last contact. Survival distributions were estimated by the Kaplan-Meier method and compared between groups using Log-Rank test. Results: One-hundred and thirty five patients were included: 66 patients in group 1 and 69 patients in group 2. Median age was 64 years in both groups. Karnofsky score was ≥ 80% for 67.7% of patients in group 1 and 81.8% in group 2. Gleason score was ≥ 9 for 38.7% and 31.4% of patients, respectively. In group 1, 47% of patients had visceral metastases when started on chemotherapy vs 40.6% in group 2. The weekly schedule of D (25mg/m2) was significantly more frequently used in group 1 than in group 2 (53% vs 15%, p<0.001). Median cumulative doses of D at first line treatment were significantly higher in group 2: 643 mg/m2 vs 454 mg/m2 (p<0.001). Median overall survival was 10.6 months (95% CI 7.8–15.7) in group 1 vs 32.5 months (95% CI 25–42.4) in group 2 (p<0·0001). Conclusions: This study reflects how the management of mCRPC patients has evolved over the last 7 years. Survival has improved especially through an earlier management, a more intensive schedule of D and the impact of these new drugs.

Influence of abiraterone acetate on circulating neuromediators in chemotherapy-naïve castration-resistant prostate cancer

“…Since 2004 docetaxel, cabazitaxel, AA, enzalutamide, sipuleucel‐T, and radium‐223 have been approved for the clinical treatment of CRPC. This new landscape of potent cancer agents has improved survival of CRPC patients . Nevertheless questions remain how to choose the optimal personalized sequence of these agents to achieve the maximal clinical benefit alongside optimal use of health care resources.…”

CAST: A retrospective analysis of cabazitaxel and abiraterone acetate sequential treatment in patients with metastatic castrate‐resistant prostate cancer previously treated with docetaxel

“…In recent years, cabazitaxel, abiraterone, enzalutamide, sipuleucel‐T and radium‐223 have been introduced to the clinic for mCRPC treatment. This rapidly expanding variety of available therapies has significantly improved survival of mCRPC patients . However, many questions remain how these therapies should be deployed in clinic to maximize clinical benefit.…”

The effects of new life-prolonging drugs for metastatic castration-resistant prostate cancer (mCRPC) patients in a real-world population

“…The median OS in the last period (2014-2015) of the treatment-naïve patients compares favorably to previous reports. Previously reported mOS from mCRPC diagnosis in observational studies in different periods ranges from 9-15 months (before 2004) [21][22][23], 11-26 months (2004-2010) [18,24,25] to 33-34 months (from 2010) [18,25], although these studies differ in methods and should be compared with caution.…”