Meeting
2019 Genitourinary Cancers Symposium
Impact of treatment sequence in metastatic castration-resistant prostate cancer (mCRPC) on outcome in a prospective cohort study.
Authors
Rebeca Lozano
Spanish National Cancer Research Centre, Madrid, Spain
Rebeca Lozano , Elena Castro , Josep M. Piulats , Ana Medina , Jose Carlos Villa Guzman , Iciar Garcia Carbonero , Rosa Villatoro , Jose Angel Arranz , Jose Luis Perez-Gracia , Javier Garde , Aranzazu Gonzalez del Alba , A. Montesa , Raquel Luque , Pablo Borrega , Sergio Vázquez , Esther Martinez , Belen Gonzalez Gragera , Nuria Romero-Laorden , David Olmos , David Lorente
Organizations
Spanish National Cancer Research Centre, Madrid, Spain, Catalan Cancer Institute, Barcelona, Spain, Centro Oncologico de Galicia, La Coruna, Spain, Reina Sofía University Hospital, Córdoba, Spain, HOSPITAL VIRGEN DE LA SALUD, Toledo, Spain, Hospital Costa Del Sol, Marbella, Spain, Hospital General Universitario Gregorio Marañon, Madrid, Spain, Department of Medical Oncology, Clinica Universidad de Navarra, Pamplona, Spain, Hospital Arnau de Vilanova, Valencia, Spain, Medical Oncology Department, Hospital Universitario Puerta de Hierro Majadahonda, Palma De Mallorca, Spain, CNIO-IBIMA Genitorurinary Cancer Clinical Research Unit, Hospitales Universitarios Virgen de la Victoria and Regional de Málaga, Malaga, Spain, Medical Oncology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain, Hospital San Pedro de Alcántara, Cáceres, Spain, Hospital Universitario Lucus Augusti, Lugo, Spain, HOSPITAL JAEN, Jaén, Spain, Hospital Son Llatzer, Palma De Mallorca, Spain, Hospital Universitario La Princesa, Madrid, Spain, CNIO-IBIMA Genitourinary Cancer Research Unit, Malaga, Spain, MEdical Oncology Department, Hospital Provincial de Castellón, Castellón De La Plana, Spain
Research Funding
Other Foundation
Background: Abiraterone (Abi), enzalutamide (Enza) and docetaxel (Doc) are all valid first-line (1L) mCRPC treatment options. Evidence suggests a degree of cross-resistance between agents, which may impact the efficacy of subsequent lines of therapy. Evidence on the optimal treatment sequence is lacking. Methods: We evaluated the outcome of patients (pts) treated with 1L Doc, Abi or Enza in the prospective PROREPAIR-B cohort study. We assessed the impact of 1L treatment option (Doc vs Abi/Enza) on overall survival (OS), progression-free survival (PFS) to 1L-therapy (PCWG2) and PFS2 (time from initiation of 1L-therapy to progression on second-line [2L] therapy). Uni- (UV) and multivariable (MV) cox-regression models were used. MV model covariates included age (≥75 years), local therapy, Gleason Score, metastases at diagnosis, visceral metastases, ALP (≥ULN), LDH (≥ULN), haemoglobin (≤LNL), albumin (≤LNL) and ECOG PS. Results: 406 pts received 1L-Doce (N=188) or Abi/Enza (N=218). Pts receiving Doc were younger (p=0.002), had higher rates of visceral metastases (17.6 vs 8.7%; p=0.008), ALP (52.1% vs 40.4%; p=0.018), LDH (48.1% vs 31.2%; p<0.001) and lower Hb (7.4 vs 2.8%; p=0.029) and albumin (11.3 vs 4.6%). PFS was higher in pts receiving 1L-Abi/Enza (10.8 vs 8.3 months; HR:0.5; p<0.001). Pts receiving 1L Abi/Enza had higher rates of radiographic progression (88.4 vs 80%; p=0.032). 123/188 pts treated with 1L-Doc received 2L-Abi/Enza: 30 received other 2L and 35 had not started 2L. 111/216 pts treated with 1L-Abi/Enza received 2L-Doc, 26 were started on other 2L and 79 had not initiated 2L. A significant difference between pts treated with initial Abi/Enza vs Doc was observed in PFS2 (20.6 vs 16.6m; HR:0.78; p=0.006) but not OS (31.3 vs 29.9 m; HR:1.05; p=0.725). Choice of first-line agent was not associated with OS in the MV model. Conclusions: Despite longer PFS to 1L and PFS2 in pts treated with initial Abi/Enza, no differences in OS were observed between treatment sequences starting with Doc vs Abi/Enza. Pts treated with 1L-Doc had worse baseline prognostic features. Molecular stratification may enable biomarker-driven patient selection to optimize benefit in pts. (NCT03075735).
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Abstract Details
Session Type
Poster Session
Session Title
Poster Session A: Prostate Cancer
Track
Prostate Cancer,Prostate Cancer
Sub Track
Prostate Cancer - Advanced Disease
Citation
J Clin Oncol 37, 2019 (suppl 7S; abstr 264)
DOI
10.1200/JCO.2019.37.7_suppl.264
Abstract #
264
Poster Bd #
L21
Abstract Disclosures
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