Concurrent chemo-hormonal therapy of enzalutamide (ENZ) and cabazitaxel (CAB) in patients (Pts) with metastatic castration-resistant prostate cancer (mCRPC): Final analysis of objective response rate (ORR), radiographic progression-free survival (rPFS), and overall survival (OS).

Authors

Alexandra Sokolova

Alexandra Sokolova

OHSU Knight Cancer Institute, Portland, OR

Alexandra Sokolova , Julie N. Graff , Claire E Smith , Tomasz M. Beer , Emile Latour , Petros Grivas , Michael Thomas Schweizer , Celestia S. Higano , Joshi J. Alumkal , Jacqueline Vuky , Evan Y. Yu , Heather H. Cheng

Organizations

OHSU Knight Cancer Institute, Portland, OR, Boston University, Boston, MA, Exact Sciences Corporation, Madison, WI, Oregon Health & Science University, Portland, OR, University of Washington; Fred Hutchinson Cancer Center, Seattle, WA, Division of Medical Oncology, University of Washington Seattle, WA, USA and Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, University of British Columbia, Vancouver, BC, Canada, University of Michigan Rogel Cancer Center, Ann Arbor, MI, University of Washington, Seattle, WA, University of Washington Medical Center, Seattle, WA

Research Funding

Other Foundation
PCF YIA; SPORE, DoD, SPORE

Background: We previously reported the PSA response rate and toxicity data of a phase 1/2 single-arm, multi-institutional trial to examine the efficacy and safety of co-administration of ENZ + CAB in mCRPC without prior chemotherapy given in the mCRPC setting. We found that full doses of ENZ (160 mg daily) and CAB (25 mg/m2) were tolerable and that 80% of pts had PSA decline ≥50%. Here, we report the final analysis of ORR, rPFS and OS. Methods: We calculated the ORR (CR/PR) and 95% confidence intervals using the Clopper-Pearson Exact Method. We determined response according to RECIST 1.1 for measurable disease and Prostate Cancer Working Group 2 criteria for non-measurable (bone) disease. We estimated median rPFS (time from the study entry to the time of confirmed progression (radiographic or clinical) or death) and OS (time from the study entry to death) with 95% confidence intervals using the Kaplan-Meier method; data cutoff was 6/1/22. Statistical analysis was performed using R: A language and environment for statistical computing. Results: 37 pts consented and 35 were included in the efficacy analyses (1 withdrew consent, 1 was lost to follow up before efficacy assessment); 7/35 (20%) had prior exposure to chemotherapy given for mHSPC and 9/35 (25%) had prior exposure to abiraterone (ABI), including 2/35 (25.7%) with prior exposure to chemotherapy and ABI. 28 pts had at least one on-study trial imaging study and were evaluable for ORR. After a median follow-up of 23.7 (range: 4.9 to 62.4) months (mo), median OS was 25.1 mo (95%CI 19.4 - 37.6 mo). Median PSA PFS was 11.9 mo (95%CI 9.2 - 15.4), and median rPFS was 22.2 mo (95%CI 13.6 - 25.2). PK assessments revealed that ENZ decreased CAB levels: CAB (monotherapy) Cmax 178.9ng*h/ml vs CAB (in the presence of ENZ) Cmax 85.5 ng*h/ml (p<0.05). Conclusions: The combination of ENZ+CAB in this heterogeneous mCRPC population, which included about a quarter of pts with prior chemotherapy and ABI exposure, resulted in an OS of 22.5 mo comparing favorably with the OS of 25.2 mo seen in the FIRSTANA trial of single agent CAB in docetaxel naïve men, 15.1 mo post chemotherapy in the TROPIC trial, and 13.6 mo in the post-docetaxel, post-ABI in the CARD trial. Of note, the rPFS in this trial was 22.2 months compared to 5.1 months in FIRSTANA suggesting improved efficacy; however cross-trial comparisons are discouraged due to several confounders. Chemo-hormonal therapies and prognostic/predictive biomarkers warrant further study in mCRPC. Clinical trial information: NCT02522715.

Radiographic Best Response (n=28)Pts N (%)Lower 95%CIUpper 95%CI
Complete response3 (10.7%)2.3%28.2%
Partial response11 (39.3%)21.5%59.4%
Stable disease12 (42.9%)24.5%62.8%
Progressive disease2 (7.1%)0.9%23.5%
ORR 14 (50%)30.6%69.4%

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Genitourinary Cancer—Prostate, Testicular, and Penile

Track

Genitourinary Cancer—Prostate, Testicular, and Penile

Sub Track

Prostate Cancer– Advanced/Castrate-Resistant

Clinical Trial Registration Number

NCT02522715

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 5047)

DOI

10.1200/JCO.2023.41.16_suppl.5047

Abstract #

5047

Poster Bd #

141

Abstract Disclosures