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Trends in the Use of Second-Generation Androgen Receptor Axis Inhibitors for Metastatic Hormone-Sensitive Prostate
Keita Nakane1, Hiromitsu Watanabe2, Taku Naiki3
1Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan.
Abstract:
The advent of second-generation androgen receptor axis-targeted agents (ARATs) has revolutionized the treatment of metastatic hormone-sensitive prostate cancer (mHSPC). Biochemical recurrence-free survival (BRFS) was used to compare the efficacy of each ARAT. This multicenter retrospective study included 581 patients with newly diagnosed mHSPC who received first-line hormone therapy. The characteristics of patients treated with different ARATs were compared as well as changes in the usage of each drug over time. For BRFS, the apalutamide (Apa) and enzalutamide (Enza) groups, as well as the abiraterone acetate (Abi) and Apa/Enza groups, were compared. In addition, multivariate analysis was performed to determine predictive factors for biochemical recurrence (BCR). The use of second-generation ARATs tended to increase after May 2020. No significant difference in BRFS was found between patients receiving Apa and Enza (p = 0.490) and those receiving Abi or Apa/Enza (p = 0.906). Multivariate analysis revealed that the neutrophil-to-lymphocyte ratio (NLR) ≥ 2.76 and PSA ≥ 0.550 ng/mL were independent predictors of BCR. There were no significant differences in patient characteristics or BRFS in patients with mHSPC receiving different ARATs as first-line treatment. NLR and PSA may be prognostic factors following the first-line treatment of patients with mHSPC.
Insights
Second-generation androgen receptor axis-targeted agents (ARATs) show similar efficacy in treating metastatic hormone-sensitive prostate cancer (mHSPC). Neutrophil-to-lymphocyte ratio (NLR) and PSA levels predict biochemical recurrence (BCR).
Area of Science:
- Oncology
- Urology
- Pharmacology
Background:
- Second-generation androgen receptor axis-targeted agents (ARATs) have transformed metastatic hormone-sensitive prostate cancer (mHSPC) treatment.
- Evaluating the comparative efficacy of these agents is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the biochemical recurrence-free survival (BRFS) of different first-line ARATs in mHSPC patients.
- To identify predictive factors for biochemical recurrence (BCR) in mHSPC.
Main Methods:
- A multicenter retrospective study of 581 newly diagnosed mHSPC patients receiving first-line hormone therapy.
- Comparison of BRFS between apalutamide (Apa), enzalutamide (Enza), and abiraterone acetate (Abi) or Apa/Enza combinations.
- Multivariate analysis to identify predictors of BCR.
Main Results:
- No significant difference in BRFS was observed between apalutamide and enzalutamide (p=0.490).
- No significant difference in BRFS was observed between abiraterone acetate and apalutamide/enzalutamide (p=0.906).
- Neutrophil-to-lymphocyte ratio (NLR) ≥ 2.76 and PSA ≥ 0.550 ng/mL were identified as independent predictors of BCR.
Conclusions:
- First-line treatment with different ARATs demonstrates comparable efficacy in mHSPC patients.
- NLR and PSA levels may serve as valuable prognostic markers for BCR following first-line therapy in mHSPC.
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