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Abiraterone in "High-" and "Low-risk" Metastatic Hormone-sensitive Prostate Cancer
Alex P Hoyle1, Adnan Ali2, Nicholas D James3
1The Christie and Royal Salford Hospitals, Manchester, UK; Genito Urinary Cancer Research Group and the FASTMAN Centre of Excellence, Division of Cancer Sciences, The University of Manchester, Manchester, UK.
European Urology
|August 27, 2019
Summary
Men with metastatic hormone-naïve prostate cancer (mHNPC) benefit from abiraterone acetate and prednisolone with androgen deprivation therapy (ADT), regardless of risk stratification. This combination therapy improves overall survival and disease control compared to ADT alone.
Area of Science:
- Oncology
- Clinical Trials
- Prostate Cancer Research
Background:
- Abiraterone acetate is licensed for high-risk metastatic hormone-naïve prostate cancer (mHNPC) based on LATITUDE trial data.
- The STAMPEDE trial showed no risk-related effect, creating uncertainty about abiraterone acetate benefits in low-risk mHNPC patients.
Purpose of the Study:
- To evaluate the heterogeneity of abiraterone acetate plus prednisolone (AAP) plus androgen deprivation therapy (ADT) effects in high-risk versus low-risk metastatic prostate cancer patients within the STAMPEDE trial.
Main Methods:
- A post hoc subgroup analysis of the STAMPEDE trial's 2017 abiraterone comparison arm.
- Patients were stratified by risk criteria from the LATITUDE trial.
- Overall survival (OS) and failure-free survival (FFS) were primary outcome measures.
Main Results:
- 901 M1 patients were analyzed; 48% were low-risk and 52% were high-risk.
- AAP + ADT significantly improved OS and FFS in low-risk patients compared to ADT alone (HR for OS: 0.66, FFS: 0.24).
- No significant heterogeneity of effect was observed between low- and high-risk groups for OS or FFS.
Conclusions:
- Men with mHNPC gain significant treatment benefit from AAP + ADT irrespective of risk stratification.
- This combination therapy prolongs overall survival and improves disease control in all men with newly diagnosed metastatic prostate cancer.
