743P - Outcomes of metastatic castration-resistant prostate cancer (mCRPC) patients (pts) treated with different new agents (NAs) sequence in post-docetax...

Date 09 October 2016
Event ESMO 2016 Congress
Session Poster display
Topics Prostate Cancer
Presenter Orazio Caffo
Citation Annals of Oncology (2016) 27 (6): 243-265. 10.1093/annonc/mdw372
Authors O. Caffo1, E. Biasco2, G. Facchini3, L. Fratino4, D. Gasparro5, C. Mosillo6, U. Basso7, D. Santini8, M. Tucci9, C. Ortega10, F. Verderame11, S. Scagliarini12, G. Lo Re13, G. Procopio14, G. Fornarini15, E. Campadelli16, R. Sabbatini17, F. Maines18, U. De Giorgi19
  • 1Oncology Department, Ospedale Santa Chiara, 38122 - Trento/IT
  • 2Polo Oncologico, Azienda Ospedaliera Universitaria S.Chiara, 56126 - Pisa/IT
  • 3Genitourinary Oncology, Istituto Nazionale Tumori – I.R.C.C.S - Fondazione Pascale, Napoli/IT
  • 4Medical Oncology, Centro di Riferimento Oncologico, Aviano/IT
  • 5Medical Oncology, Azienda Ospedaliera di Parma, Parma/IT
  • 6Medical Oncology, Sapienza – Università di Roma, Roma/IT
  • 7Medical Oncology Unit 1, Istituto Oncologico Veneto IRCCS, 35128 - Padova/IT
  • 8Medical Oncology, Libero Istituto Universitario Campus Bio-Medico (LIUCBM), 00128 - Roma/IT
  • 9Medical Oncology, Azienda Ospedaliero-Universitaria ASOU San Luigi Gonzaga, Orbassano/IT
  • 10Medical Oncology, Istituto di Candiolo-IRCCS-Fondazione Piemontese per la Ricerca sul Cancro-Onlus, Candiolo/IT
  • 11Medical Oncology, Ospedale Cervello, Palermo/IT
  • 12Medical Oncology, Azienda Ospedaliera di Rilievo Nazionale "Antonio Cardarelli"-AORN A. Cardarelli, Napoli/IT
  • 13Medical Oncology, Azienda Ospedaliera Sta Maria degli Angeli, Pordenone/IT
  • 14Oncologia Medica, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 15Medical Oncology, IRCCS AOU San Martino - IST-Istituto Nazionale per la Ricerca sul Cancro, Genova/IT
  • 16Medical Oncology, Ospedale civile, Lugo di Romagna/IT
  • 17Medical Oncology, Azienda Ospedaliero - Universitaria Policlinico di Modena, Modena/IT
  • 18Medical Oncology, Ospedale Sta Chiara, 38122 - Trento/IT
  • 19Medical Oncology, Istituto Tumori della Romagna I.R.S.T., Meldola/IT



Abiraterone acetate (AA), cabazitaxel (CABA), and enzalutamide (ENZ) may prolong survival in mCRPC pts progressing after DOC, although it is not clear how to use NAs, to best exploit their efficacy and avoiding their possible cross resistances. In 2015, we reported the outcomes of a series of 260 mCRPC pts, receiving at least 2 NAs, after DOC progression in routine clinical practice (Eur Urol. 2015;68:147-53). In the present study we updated the analysis with longer follow-up and by assessing a larger series of pts.


Based on a multi-institutional collaboration, we collected data of pts who received at least 2 NAs after DOC: we assessed biochemical (bRR) and objective response rates (oRR) and progression free survival (PFS) of each NA by treatment line; moreover, we evaluated the overall survival (OS) from the second line start by sequence strategy. For the OS analysis we differentiated three different types of NAs sequences after DOC: one new hormone agent (AA or ENZ) followed by CABA (NHA > CABA); CABA followed by AA or ENZ (CABA > NHA); one NHA followed by the other NHA (NHA > NHA).


A consecutive series of 344 mCRPC pts, median age 71 yrs (43-91), with bone (86%), nodal (55%) or visceral (16%) mets, was identified. All received NDs as 2nd and 3rd line after DOC. The outcomes by both treatment lines and NAs are detailed in the table.

Second line Third line
# pts bRR oRR PFS # pts bRR oRR PFS
AA 190 38.9% 20.0% 7.4 mos 105 27.6% 13.3% 4.6 mos
CABA 113 41.6% 16.8% 6.3 mos 143 27.3% 15.3% 4.4 mos
ENZ 41 41.5% 17.1% 6.2 mos 96 19.8% 8.3% 3.3 mos

We observed a statistically significant difference in terms of OS when compared the three sequence strategies: the median OS of pts treated with NHA®CABA, CABA ®NHA, and NHA ®NHA was respectively 11.9 mos, 13.4 mos, and 8.3 mos, respectively (p = 0.01).


At our knowledge this retrospective study reports the highest number of pts treated post-DOC with at least 2 NAs. Our data confirmed that the activity of NAs decreased in the 3rd line compared to the 2nd line and suggested a cumulative OS advantage when CABA is used in the sequence.

Clinical trial identification


Legal entity responsible for the study

Medical Oncology Dept - Santa Chiara Hospital Trento (Italy)




O. Caffo: Honoraria from Astellas, Bayer, Janssen, Sanofi Aventis.

G. Procopio: Advisor Astellas,Bayer,BMS,Janssen,Novartis Honoraria Amgen,Pfizer. All other authors have declared no conflicts of interest.