Managing lines of therapy in castration-resistant prostate cancer: real-life snapshot from a multicenter cohort

Ferriero, Mariaconsiglia; Mastroianni, Riccardo; Nunzio, Cosimo De; Cindolo, Luca; Calabrò, Fabio; Tema, Giorgia; Leonardo, Costantino; Flammia, Rocco Simone; Tuderti, Gabriele; Anceschi, Umberto; Brassetti, Aldo; Giacinti, Silvana; Guaglianone, Salvatore; Ghahhari, Jamil; Schips, Luigi; Tubaro, Andrea; Gallucci, Michele; Simone, Giuseppe

doi:10.1007/s00345-019-02974-6

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…A real-life multicentric series showed that patients receiving EZ as first-line treatment had significantly higher PSA response (95.9% vs. 67%, p < 0.001), comparable toxicity rate (10.2% vs. 16.3%, p = 0.437), and PFS probabilities (p = 0.145) compared to AA, while EZ or radiometabolic therapy as second-line treatment displayed equivalent toxicity and PSA response rates to those observed on first-line (11.1% vs. 12.4%, p = 0.77; 73.1% vs. 77.4%, p = 0.62, respectively) [9]. Moreover, 2-year PFS, CSS, and OS probabilities were comparable between first-and second-line cohorts (12.1% vs. 16.2%, p = 0.07; 85.7% vs. 86.4%, p = 0.98; 71% vs. 80.3%, p = 0.66, respectively) [9]. In a more recent series of 117 chemo-naïve mCRPC patients who received AA or EZ as first-line therapy, eight patients underwent salvage chemotherapy after first-line failure and 28 patients shifted to a second-line therapy [11].…”

Section: Discussionmentioning

confidence: 95%

“…The dataset was queried for "high-volume disease". High tumor burden was defined based on the radiological extent of disease, as bulky positive nodes (≥5 cm) or more than 6 bone metastases at mCRPC [9]. Symptoms were not considered a reason for defining a patient as high-volume.…”

Section: Patient Populationmentioning

confidence: 99%

“…Patients were visited monthly and imaging re-evaluation was performed every 6 months regardless of the PSA serum levels and symptoms. Clinical features, treatment outcomes and toxicity were recorded at each visit [9].…”

Section: Staging and Follow-upmentioning

confidence: 99%

“…To overcome this issue, we previously defined high-volume disease based on the radiological extent, as bulky positive nodes (≥5 cm) or more than six bone metastases at mCRPC onset and showed that high-volume was a significant predictor of progression-free survival probability (PFS) [9].…”

Section: Introductionmentioning

confidence: 99%

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Oncological Outcomes of Patients with High-Volume mCRPC: Results from a Longitudinal Real-Life Multicenter Cohort

Ferriero,

Prata,

Anceschi

et al. 2023

Cancers

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Registrative trials recommended the use of upfront chemotherapy in high-volume metastatic prostate cancer. We reported survival outcomes of patients with high-volume mCRPC treated with ARTA in a chemo-naïve setting compared to patients treated with chemotherapy as first-line from a longitudinal real-life multicenter series. We retrospectively collected data on mCRPC patients treated at six centers. The dataset was queried for high-volume disease (defined as more than 6 bone lesions or bulky nodes ≥ 5 cm). We compared the main clinical features of chemo-naïve versus chemo-treated patients. The Mann–Whitney U test and Chi-squared test were used to compare continuous and categorial variables, respectively. The Kaplan–Meier method was used to compare differences in terms of progression-free survival (PFS), cancer specific survival (CSS) and overall survival (OS) in an upfront ARTA or chemo-treated setting. Survival probabilities were computed at 12, 24, 48, and 60 months. Out of 216 patients, 88 cases with high-volume disease were selected. Sixty-nine patients (78.4%) received upfront ARTA, while 19 patients received chemotherapy as the first-line treatment option. Forty-eight patients received Abiraterone (AA), 21 patients received Enzalutamide (EZ) as the first-line treatment. The ARTA population was older (p = 0.007) and less likely to receive further lines of treatment (p = 0.001) than the chemo-treated cohort. The five-year PFS, CSS and OS were 60%, 73.3%, and 72.9%, respectively. Overall, 28 patients (31.8%) shifted after their first-line therapy to a second-line therapy: EZ was prescribed in 17 cases, AA in seven cases and radiometabolic therapy in four patients. Sixteen cases (18.2%) developed significant progression and were treated with chemotherapy. At Kaplan–Meyer analysis PFS, CSS and OS were comparable for upfront ARTA vs chemo-treated patients (log rank p = 0.10, p = 0.64 and p = 0.36, respectively). We reported comparable survival probabilities in a real-life series of high-volume mCRPC patients who either received upfront ARTA or chemotherapy. Patients primarily treated with chemotherapy were younger and more likely to receive further treatment lines than the upfront ARTA cohort. Our data support the use of novel antiandrogens as first line treatment regardless tumor burden, delaying the beginning of a more toxic chemotherapy in case of significant disease progression.

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Section: Discussionmentioning

confidence: 95%

Section: Patient Populationmentioning

confidence: 99%

Section: Staging and Follow-upmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oncological Outcomes of Patients with High-Volume mCRPC: Results from a Longitudinal Real-Life Multicenter Cohort

Ferriero,

Prata,

Anceschi

et al. 2023

Cancers

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“…But ADT has been associated with some adverse effects including sexual dysfunction, metabolic disturbances, cognitive defects, weight gain, and gynecomastia. While abiraterone has been associated with adverse cardiac effects, liver function test abnormalities, hypertension, and hypokalemia, enzalutamide increases the incidence of hypertension and fatigue [45][46][47]. Abiraterone might also increase the risk of hypoglycemia in prostate cancer patients with type 2 diabetes mellitus receiving concurrent glucose-lowering therapy.…”

Section: Metastatic (M1) Castrate-resistant Prostate Cancermentioning

confidence: 99%

Sequencing of Systemic Therapies in the Management of Advanced Prostate Cancer in India: a Delphi-Based Consensus

Desai¹,

Vaid

Biswas

et al. 2022

Oncol Ther

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Introduction: With the availability of an increasing number of therapeutic options for advanced prostate cancer (APC), optimal sequencing and combination of therapies have emerged to be the areas of challenges. In the Indian context, there is a dearth of consensus recommendations to guide clinicians regarding optimal sequencing of therapy in APC management. A Delphi-based consensus regarding optimal therapy sequencing in APC management was developed by an expert panel of medical oncologists from across India.Methods: An expert scientific committee of 11 medical oncologists and an expert panel of 53 medical oncologists from India constituted the panel for the Delphi consensus. In the first phase, a questionnaire with 41 clinical statements was developed in several critical controversial areas in APC treatment. In the second phase, 29 clinical statements were reworked and sent to eight experts to obtain their opinions on best practices. The consensus ratings were based on a 9-point Likert scale. Based on the overall response, statements with a mean score of C 7 with 1 outlier were considered as ''consensus.'' Results: Degarelix was the preferred androgen deprivation therapy (ADT). While ADT plus

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A Systematic Review and Meta-analysis of the Effectiveness and Toxicities of Lutetium-177–labeled Prostate-specific Membrane Antigen–targeted Radioligand Therapy in Metastatic Castration-Resistant Prostate Cancer

Sadaghiani¹,

Sheikhbahaei²,

Werner³

et al. 2021

European Urology

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Managing lines of therapy in castration-resistant prostate cancer: real-life snapshot from a multicenter cohort

Cited by 6 publications

References 20 publications

Oncological Outcomes of Patients with High-Volume mCRPC: Results from a Longitudinal Real-Life Multicenter Cohort

Oncological Outcomes of Patients with High-Volume mCRPC: Results from a Longitudinal Real-Life Multicenter Cohort

Sequencing of Systemic Therapies in the Management of Advanced Prostate Cancer in India: a Delphi-Based Consensus

A Systematic Review and Meta-analysis of the Effectiveness and Toxicities of Lutetium-177–labeled Prostate-specific Membrane Antigen–targeted Radioligand Therapy in Metastatic Castration-Resistant Prostate Cancer

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