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Published on: March 6, 2018
Upfront Androgen Receptor-Axis-Targeted Therapies in Men with De Novo High-Volume Metastatic Hormone-Sensitive
Natsuo Kimura1, Yuki Kaneko2, Takahiko Tetsuka3
1Department of Urology, Asahi General Hospital 1326 I, Asahi City 289-2511, Chiba Prefecture, Japan. Rusikamusic@gmail.com.
Purpose:
The extent of effectiveness of upfront androgen receptor-axis-targeted therapies (ARAT) versus total androgen blockade (TAB) in improving prostate cancer-specific survival (CSS) and progression-free survival (PFS) in a real-world sample of Japanese patients with high-volume mHSPC remains unclear. We, therefore, investigated the efficacy and safety of upfront ARAT versus bicalutamide for de novo high-volume mHSPC in Japanese patients.
Material And Methods:
This was a multicenter retrospective study that analyzed CSS, clinical PFS, and adverse events (AEs) in 170 patients with newly diagnosed high-volume mHSPC. Fifty-six patients were treated with upfront ARAT, and 114 of them were prescribed bicalutamide in addition to ADT between January 2018 and March 2021. The primary and secondary endpoints were CSS and PFS, respectively. A 1:1 nearest neighbor propensity score matching (PSM) with a caliper of 0.2 was performed to match the ARAT group to TAB patients.
Results:
During the follow-up for a median of 21.5 months, the median CSS was not reached and 37 months in the upfront ARAT and total androgen blockade (TAB) groups, respectively (log-rank test: P = 0.006) by propensity score matching (PSM). Moreover, while the PFS of ARAT was unreached, the median PFS of TAB was 9 months (log-rank test: P < 0.001). Nine patients discontinued ARAT owing to grade ≥ 3 AEs; one patient who was treated with TAB had a grade 3 AE.
Conclusion:
Upfront ARAT significantly prolonged the CSS and PFS of patients with high-volume mHSPC better than TAB, although ARAT was associated with a higher rate of grade ≥ 3 AEs. Upfront ARAT can be more beneficial for patients with de novo high-volume mHSPC than TAB.
Insights
Upfront androgen receptor-axis-targeted therapies (ARAT) significantly improved survival for high-volume metastatic hormone-sensitive prostate cancer (mHSPC) in Japanese patients compared to total androgen blockade (TAB). ARAT showed better outcomes but a higher rate of severe adverse events.
Area of Science:
- Oncology
- Urology
- Clinical Pharmacology
Background:
- Metastatic hormone-sensitive prostate cancer (mHSPC) management is evolving.
- Androgen receptor-axis-targeted therapies (ARAT) offer new treatment paradigms.
- Real-world data on upfront ARAT versus total androgen blockade (TAB) in high-volume mHSPC is limited.
Purpose of the Study:
- To compare the efficacy and safety of upfront ARAT versus bicalutamide (as part of TAB) in Japanese patients with de novo high-volume mHSPC.
- To evaluate prostate cancer-specific survival (CSS) and progression-free survival (PFS) between treatment groups.
Main Methods:
- Multicenter retrospective study of 170 patients with newly diagnosed high-volume mHSPC.
- Compared 56 patients treated with upfront ARAT to 114 patients treated with TAB (bicalutamide + ADT).
- Utilized 1:1 nearest neighbor propensity score matching (PSM) to control for confounding factors.
Main Results:
- Upfront ARAT significantly improved CSS (P=0.006) and PFS (P<0.001) compared to TAB after PSM.
- Median CSS was not reached with ARAT vs. 37 months with TAB.
- Median PFS was unreached with ARAT vs. 9 months with TAB.
Conclusions:
- Upfront ARAT demonstrates superior efficacy in prolonging CSS and PFS for high-volume mHSPC patients compared to TAB.
- ARAT was associated with a higher incidence of grade ≥ 3 adverse events.
- Upfront ARAT may be a more beneficial treatment option for de novo high-volume mHSPC in this population.
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