Meeting
2019 ASCO Annual Meeting
Treatment sequence in elderly metastatic castration-resistant prostate cancer (mCRPC) patients (pts) in a prospective cohort study.
Authors
Maria Jose Mendez-Vidal
Reina Sofía University Hospital, Cordoba, Spain
Maria Jose Mendez-Vidal , Rebeca Lozano , Elena Castro , Nuria Romero-Laorden , Alejo Rodriguez-Vida , Nuria Lainez , Amaia Hernandez , Rosa Villatoro , Francisco Zambrana , Jose Carlos Villa Guzman , Rocío García Domínguez , Saray Galvan Ruiz , Ricardo Escribano , Enrique Gallardo Díaz , Rosa Querol , Raquel Luque , Aránzazu Gonzalez del Alba , Javier Puente , David Olmos , David Lorente
Organizations
Reina Sofía University Hospital, Cordoba, Spain, Spanish National Cancer Research Centre, Madrid, Spain, Hospital Universitario La Princesa, Madrid, Spain, Hospital del Mar, Barcelona, Spain, Complejo Hospitalario de Navarra, Pamplona, Spain, Hospital Onkologikoa, San Sebastián, Spain, Hospital Costa del Sol, Oncology Department, Marbella, Spain, Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain, Reina Sofía University Hospital, Córdoba, Spain, Hospital Universitario de Salamanca, Salamanca, Spain, Medical Oncology Unit, Hospital Universitario de Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain, Hospital Universitario de Burgos, Burgos, Spain, Department of Oncology, Parc Tauli Sabadell Hospital Universitari, Institut d’Investigatió i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain, Medical Oncology Department, Centro Oncológico de Galicia, A Coruña, A Coruña, Spain, Medical Oncology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain, Hospital Universitario Puert de Hierro-Majadahonda, Madrid, Spain, Hospital Universitario Clínico San Carlos, Madrid, Spain, Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Center, Madrid, Spain, Medical Oncology Department, Hospital Provincial de Castellón, Castellón De La Plana, Spain
Research Funding
Other
Background: Abiraterone (Abi), enzalutamide (Enza) and docetaxel (Doc) are all valid first-line (1L) mCRPC treatment options. SIOG guidelines (Droz, Eur Urol 2017) recommend that fit elderly pts should receive the same treatment as younger patients. Evidence of the optimal treatment sequence in this patient subpopulation is lacking. Methods: We evaluated the outcome of elderly (≥ 75 years [yrs]) pts treated in the prospective PROREPAIR-B cohort study (NCT03075735). We assessed the impact of 1L treatment option (Doc vs Abi/Enza) on overall survival (OS) and progression-free survival (PFS) to 1L-therapy following PCWG2criteria. Uni- (UV) and multivariable (MV) cox-regression models were used. MV model covariates included local therapy, Gleason Score, stage IV at diagnosis, visceral metastases, ALP (≥ULN), LDH (≥ULN), haemoglobin (Hb; ≤LNL), albumin (≤LNL) and ECOG PS. Results: 419 pts were included in the study. Of these, 137 (32,7%) had age ≥ 75 yrs. 48 (35%) received docetaxel and 88 (64.2%) had Abi/Enza as first-line therapy. Of the 121 pts that progressed on 1L-therapy, 30 (24.8%) did not receive 2L therapy. Choice of 2L-therapy was: Doc in 37 (30,6%), Abi/Enza in 38 (31.4%), Cabazitaxel in 9 (7.4%) and Radium-223 in 7 (5.8%) pts. Pts treated with 1L-Doc had higher rates of visceral metastases (22.9% vs 5.7%; p=0.003), high ALP (68.8% vs 43.2%; p=0.004) and low Hb (12.5% vs 3.4%). PFS to 1L-therapy was longer for Abi/Enza than for Doc treated pts (9.6 vs 8.3m; HR: 0.52; p=0.001). The pattern of disease progression (PSA, radiographic, clinical) was similar in Doce and Abi/Enza treated pts. No difference between pts treated with initial Abi/Enza vs Doc was observed in OS (28.2 vs 24.8m; HR:1.18; p=0.474). No significant OS differences were observed in the MV model. Conclusions: No differences in OS were observed between treatment sequences starting with Doc vs Abi/Enza in pts ≥ 75 yrs. Pts treated with 1L-Doc had worse baseline prognostic features. Age should not be considered as a factor for treatment choice in elderly mCRPC pts based on treatment outcome.
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Abstract Details
Session Type
Poster Session
Session Title
Genitourinary (Prostate) Cancer
Track
Genitourinary Cancer—Prostate, Testicular, and Penile
Sub Track
Prostate Cancer - Advanced Disease
Citation
J Clin Oncol 37, 2019 (suppl; abstr 5053)
DOI
10.1200/JCO.2019.37.15_suppl.5053
Abstract #
5053
Poster Bd #
165
Abstract Disclosures
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