Clinical efficacy of abiraterone and enzalutamide metastatic castration sensitive prostate cancer patients who progressed rapidly on docetaxel with a genomic analysis.

Authors

null

Gang Chen

NCI/NIH, Bethesda, MD

Gang Chen , David James VanderWeele , Fatima Karzai , Marijo Bilusic , Munjid Al Harthy , Philip M. Arlen , Marc Robert Theoret , Inger L. Rosner , Guinevere Chun , Helen Owens , Anna Couvillon , Amy Hankin , Monique Williams , James L. Gulley , William L. Dahut , Ravi Amrit Madan

Organizations

NCI/NIH, Bethesda, MD, University of Chicago Medical Center, Chicago, IL, National Cancer Institute at the National Institutes of Health, Bethesda, MD, National Cancer Institute, Bethesda, MD, Center for Prostate Disease Research, Bethesda, MD, The National Cancer Institute at the National Institutes of Health, Bethesda, MD

Research Funding

U.S. National Institutes of Health

Background: Docetaxel has become a standard of care for mCSPC. Enzalutamide and abiraterone have been proven to improve survival in metastatic castration-resistant prostate cancer (mCRPC) patients. Little is known about patients who have been treated with docetaxel for mCSPC and subsequent therapeutic responses. This retrospective analysis is to evaluate the response duration of abiraterone and enzalutamide in patients who previously received docetaxel for mCSPC but developed mCRPC within 12 months. Methods: Clinical Trial NCT02649855 enrolled patients with newly diagnosed mCSPC who were treated with standard androgen deprivation therapy (ADT) and docetaxel (75 mg/m2 every 3 weeks for 6 cycles) sequenced with immunotherapy (PROSTVAC) from February 2016 to present. Patients who had progression (based on consecutive PSA rises or imaging) within 1 year of completing docetaxel and went on to subsequent abiraterone/enzalutamide were evaluated. (Note these are different PSA progression criteria than used in CHAARTED, Sweeney, NEJM, 2015). A PCR-based NGS panel (OncoMine Comprehensive Assay v3) will evaluate available tissue from these patients. Results: Of the 46 patients evaluated regardless of immunotherapy sequence, 15 (33%) went on subsequent therapy after progression on docetaxel for mCSPC, with 12 patients starting abiraterone/enzalutamide (7 with high volume disease and 5 with low volume disease). The median age was 62 (41-83) years. 6/12 patients (50%) initiated enzalutamide and 6/12 patients (50%) initiated abiraterone. The median duration of treatment for both was 7.43 (1.53 – 16.0) months, the median time to prostate-specific antigen (PSA) progression was 2 (0 – 11) months; the median duration of PSA decline was 2 months in patients with both high and low volume disease. Of note, 3/12 (25%) of patients did not have PSA response, all of them had high volume disease. Conclusions: These data from a small cohort suggest that patients who have progression within 12 months of completing docetaxel for mCSPC have limited subsequent benefit from enzalutamide or abiraterone. Additional studies are required to determine optimal timing and treatment sequence for patients with mCSPC who rapidly develop mCRPC. Clinical trial information: NCT02649855

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Abstract Details

Meeting

2019 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Genitourinary (Prostate) Cancer: Publication Only

Track

Genitourinary Cancer—Prostate, Testicular, and Penile

Sub Track

Prostate Cancer - Advanced Disease

Clinical Trial Registration Number

NCT02649855

Citation

J Clin Oncol 37, 2019 (suppl; abstr e16536)

DOI

10.1200/JCO.2019.37.15_suppl.e16536

Abstract #

e16536

Abstract Disclosures