789P - Prognostic factors for survival and sequencing of life-extending therapies in metastatic castration resistant prostate cancer (mCRPC) patients (pts...

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Prostate Cancer
Presenter Stephane Oudard
Citation Annals of Oncology (2014) 25 (suppl_4): iv255-iv279. 10.1093/annonc/mdu336
Authors S. Oudard1, A. Angelergues1, I. Gonzalez Maeso2, N. Delanoy1, A. Flechon3, M. Ozguroglu4, D.E. Castellano5, A. Guillot6, S. Le Moulec7, E. Esteban8, J. Munarriz9, B. Campos10, J. Bellmunt11
  • 1Medical Oncology Service, Georges Pompidou Hospital and Rene Descartes University, 75015 - Paris/FR
  • 2Medical Oncology Department., University Hospital del Mar-IMIM, 08003 - Barcelona/ES
  • 3Oncology Departement, Centre Léon Bérard, 69008 - LYON/FR
  • 4Department Of Medical Oncology, Istanbul University Cerrahpasa, 34098 - Istanbul/TR
  • 5Medical Oncology, Hospital Universitario 12 de Octubre, Madrid/ES
  • 6Medical Oncology, INSTITUT DE CANCÉROLOGIE DE LA LOIRE, 42271 - SAINT PRIEST EN JAREZ CEDEX/FR
  • 7Oncologie Medicale, Hopital du Val de Grace Val de Grace, 75230 - Paris CEDEX /FR
  • 8Oncology Department, Hospital Universitario Central de Asturias, 33006 - Oviedo/ES
  • 9Oncology Department, Hospital Provincial de Castellon, castellon/ES
  • 10Oncoloxia Médica, Hospital Universitario Lucus Augusti de Lugo, Hospital Universitario Lucus Augusti (Lugo)/ES
  • 11Oncology Department, University Hospital del Mar, 08003 - Barcelona/ES

Abstract

Aim

Background: Abiraterone (A), Cabazitaxel (C), enzalutamide (E) are able to prolong overall survival (OS) in mCRPC post-D. Optimal sequencing of these agents is not known. In this large retrospective cohort of mCRPC pts treated with C, we evaluated the impact of prognostic factors and sequencing on OS calculated from the first therapy post-D.

Methods

Methods: Records of 246 consecutive mCRPC pts (median age 68 y, Gleason ≥8 at diagnosis 49.6%) who were treated with C (after D) were retrospectively collected in 25 centers (France, Spain, Turkey). Disease history, treatment with A/E before or after C, clinical characteristics at initiation of first therapy post-D (A/E or C) were collected. The influence of selected variables and sequencing with A/E on OS was analyzed by multivariate logistic regression.

Results

Results: At initiation of first therapy post-D, 86.0% of pts were ECOG 0-1, 61.4% had pain, 63.1% had radiological progression and 47.5% had clinical progression. 17.0% of pts had visceral mets. Median duration of response to first androgen deprivation therapy was 20.3 months (mo). All pts received C (median 6 cycles, range 2-28), mainly after 1 line D (75.4%). A/E were given before C in 24.8% or after C in 17.5%. With C, a PSA decrease of ≥50% and ≥30% was reached in 40.8% and 52.9% of pts. Median clinical and/or radiological PFS was 8 mo. Median OS was 13.5 mo when C was used without A/E,28.9 mo if patients subsequently received A/E and 22.4 mo if A/E were administered before C. In multivariate analysis, OS was significantly reduced in pts with visceral mets (HR [95% CI]: 1.92 [1.19-3.11]) and in those with pain at initiation of first therapy post-D (1.51 [1.05-2.18]). Conversely, OS was significantly prolonged in pts having received 2 active therapies (C and A/E) post-D, with a greater OS benefit when A/E was given after C (0.34 [0.21-0.56]) instead of before C (0.57 [0.39-0.85]).

Conclusions

Conclusions: With the limitation of retrospective design,pts receiving D, C and A/E had a significantly prolonged OS versus those receiving only D and C,which stresses the needs for maximize OS with all available treatment options. Greatest OS benefit was observed in pts receiving D → C → A/E.

Disclosure

S. Oudard: Consultant or AdvisoryRole; Entity: Sanofi, Novartis, Roche, Bayer, Keocyt, Amgen, Relationship: Myself, compensation: Compensated, Honoraria, Entity: Sanofi, Novartis, Roche, Bayer, Keocyt, Amgen, Pfizer, Relationship: Myself; A. Angelergues: Honoraria: Entity: Sanofi-Aventis, Relationship: Myself;

A. Flechon: Honoraria: Entity: Sanofi-Aventis, Astellas, Janssen, Ferring, Relationship: Myself; M. Özgüroğlu: Consultant or AdvisoryRole, Entity: Sanofi-Aventis, Janssen, Astellas, Relationship: Myself, Compensation: Compensated; J. Bellmunt: Consultant or AdvisoryRole - Sanofi Honoraria - Sanofi ResearchFunding - Sanofi;

All other authors have declared no conflicts of interest.