UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
Charles J. Ryan , Won Kim , Arden Buettner , Susan Lynne Britton , Maria L. Lankford , Doug B. Neely , Mark R. Green
Background: PPrefs of 467 US-based medical oncologists (MOs) in post-DO mCRPC pts were studied prospectively. A validated, proprietary, live, case-based market research tool was utilized with a core case scenario and 4 distinct treatment (Rx) outcomes following chemotherapy (CTx). Data were acquired using blinded audience response technology. Research support sources were double blinded. Methods: Core case: 59 y/o status post (s/p) radical prostatectomy with PSA failure after 15 months (mo), s/p salvage pelvic radiation (RT) → presents with rise in PSA and 3.5cm pelvic lymph node 16mo following RT→ progresses through multiple Rx over the next 42mo, including combined androgen blockade, anti-androgen withdrawal, sipuleucel-T and abiraterone (ABI). Now starting DO CTx due to increasing bone metastases and bone pain (BP). PPrefs for 4 variant scenarios of DO CTx were probed: (1) DO 75 mg/m2Q3wk x 6 cycles (cy) →Resolution of BP/PSA response → DO held due to cumulative myelosuppression/fatigue. Pt more active off CTx, ECOG PS 1. 3mo later →asymptomatic 30% rise in PSA. (2) DO x 4 cy → decrease in PSA, BP, node size. Prior to cy 6, has asymptomatic PSA progression. (3) DO x 4 cy→ decrease in PSA, BP, node size. Prior to cy 6, has both PSA and BP progression. (4) DO x 2 cy → progression with increased BP, PSA, and pelvic nodal disease. Results: See Table. Conclusions: PPrefs after DO CTx were outcome-dependent. In the absence of BP, ENZ is the most common PPref, even in this ABI-refractory pt. PPref for R223 over 2nd line CTx in the acquired symptomatic resistance setting is notable. PPref for 2nd line CTx increases with rapid, symptomatic disease progression.
Rx options | VS 1: PSA rise after DO response and then DO holiday (N=473) | VS 2: Acquired PSA resistance to DO (N=469) | VS 3: Acquired Symptomatic resistance to DO (N=466) | VS 4: Primary resistance to DO (N=458) |
---|---|---|---|---|
Surveillance | 37% | N/O | N/O | N/O |
ABI | N/O | 12% | 6% | 3% |
Radium ra 223 (R223) | 1% | 6% | 41% | 22% |
Cabazitaxel (CBZ) | 9% | 30% | 27% | 47% |
Enzalutamide (ENZ) | 31% | 31% | 15% | 12% |
ENZ-P | 13% | 10% | 7% | 6% |
Mitoxantrone | 0 | 1% | 0 | 3% |
Other | 9% | 10% | 4% | 7% |
Abbreviations: N/O, not offered.
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