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Published on: March 6, 2018
Is it Necessary to Treat all Metastatic Prostate Cancer With Upfront Androgen Receptor Axis-targeted Agents?
Ryunosuke Nakagawa1, Hiroaki Iwamoto2, Renato Naito1
1Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Background/Aim:
In recent years, initial treatment for patients with high-risk metastatic castration-sensitive (mCS) prostate cancer (PC) has been shifting from vintage hormone therapy to upfront androgen receptor axis-targeted agents (ARAT), but the proportion of Asian patients enrolled in clinical trials investigating the effectiveness of ARAT use is low. We examined the outcomes of Japanese patients with mCSPC who received ARAT as second-line therapy or afterwards.
Patients And Methods:
Among the PC patients receiving treatment at Kanazawa University Hospital from 2000 to 2019, 190 patients with mCSPC were enrolled in the study. Their characteristics and prognosis were retrospectively investigated.
Results:
All patients received androgen deprivation therapy (ADT) as initial treatment. A total of 142 (74.3%) of 190 patients had progression to castration-resistant PC (CRPC), of whom 77 (54.2%) received ARAT as second-line therapy or afterwards. The median overall survival (OS) of CRPC patients was 70.57 months and the median OS from CRPC was 44.88 months. The median OS of LATITUDE high-risk patients that used ARAT after the second-line treatment was 56.15 months, which was significantly longer than that of patients who did not use ARAT (hazard ratio=0.68, 95% confidence interval=0.40-1.15; p=0.0089).
Conclusion:
The prognosis of LATITUDE high-risk patients with CRPC selected for initial ADT therapy had a good prognosis compared to findings in other studies. These results suggest that there is a possibility that a certain number of patients with LATITUDE high-risk may have good prognosis even if only conventional ADT is performed and ARAT is used after CRPC.
Insights
Japanese prostate cancer patients receiving androgen receptor axis-targeted agents (ARAT) after progression to castration-resistant disease showed improved survival. This suggests ARAT may benefit selected high-risk patients even after initial hormone therapy.
Area of Science:
- Oncology
- Urology
- Clinical Research
Background:
- Metastatic castration-sensitive prostate cancer (mCSPC) treatment is evolving towards upfront androgen receptor axis-targeted agents (ARAT).
- Limited data exists on ARAT effectiveness in Asian populations, particularly in Japanese patients.
- This study investigates outcomes for Japanese mCSPC patients treated with ARAT after initial androgen deprivation therapy (ADT).
Purpose of the Study:
- To evaluate the effectiveness of ARAT in Japanese patients with metastatic castration-sensitive prostate cancer (mCSPC).
- To analyze survival outcomes of mCSPC patients who received ARAT as second-line or later therapy.
- To assess the prognostic impact of ARAT in LATITUDE high-risk patients with castration-resistant prostate cancer (CRPC).
Main Methods:
- Retrospective analysis of 190 Japanese prostate cancer patients treated at Kanazawa University Hospital (2000-2019).
- Patients initially received androgen deprivation therapy (ADT).
- Outcomes were analyzed for those progressing to castration-resistant prostate cancer (CRPC) and subsequently receiving ARAT.
Main Results:
- Of 190 mCSPC patients, 142 progressed to CRPC; 77 received ARAT after second-line therapy.
- Median overall survival (OS) for CRPC patients was 70.57 months.
- LATITUDE high-risk patients receiving ARAT after second-line treatment had significantly longer median OS (56.15 months) compared to non-ARAT users (HR=0.68, p=0.0089).
Conclusions:
- Japanese LATITUDE high-risk CRPC patients treated with initial ADT showed a good prognosis.
- ARAT use after CRPC may offer survival benefits in selected high-risk patients.
- Conventional ADT followed by later-line ARAT might be a viable strategy for some LATITUDE high-risk patients.
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