Addition of 6 cycles of docetaxel to ADT prolongs survival and is the standard treatment for mHSPC based on results of Chaarted and Stampede trials. Prognostic factors have not been clearly described for these patients. A retrospective analysis of clinical and pathological prognostic factors was performed in 76 patients from 5 academic institutions.
Retrospective analysis of all (n = 76) mHSPC from 5 Spanish Oncology Centres was performed. All patients had been treated with docetaxel + ADT as first line. Clinical and pathological variables were analyzed: age, Gleason (6-7 vs 8-10), presence of visceral metastases, number of bone metastases (0,1-4,5-20,>20), PSA value at diagnosis and previous to CT, PSA response previous to CT (>25%, 25-50%, 50-100% or no response), time from diagnosis to first docetaxel treatment (>or< 50days). Progression free (PFS) and overall survival (OS) were the endpoints analyzed by log-rank test.
Median PFS was 17m and median OS has not been reached (80% of patients alive at 20 months). Median follow-up: 16.6m. Median age 64,3y (range: 46-80), median PSA at diagnosis 691ng/mL (range:15235-1), median PSA previous to CT 214ng/mL (range:5060-0), PSA responses to ADT previous to CT was 25% in 35 pts (46%), 25-50% in 14 pts (18.4%), less than 50% in 13 (17.2%), no response in 14 (18.4%), Gleason 6-7: 19 (25%), 8-10: 53 (69,7%), UK 3 (5.3%). Median time from diagnosis to docetaxel 45.3 d (range 0-167). PFS nor OS was related to age, PSA at diagnosis, PSA response prior to docetaxel or Gleason. Time from diagnosis to docetaxel (p = 0.04) (median 21 vs 15m; HR:2.2)) and Gleason (median not reached vs 15m; HR: 3.3) were statistically significant factors for PFS. Presence of visceral metastasis (p = 0.08) (20m vs median not reached;HR: 3.8) and time from diagnosis to docetaxel (p = 0.02) (median not reached vs 24m; HR:4.1) were significative factors for OS.
A time from diagnosis to docetaxel start longer than 50 days is associated with lower PFS and OS in m+HSPC patients treated with ADT + docetaxel. Gleason ≥ 8 score correlates with shorter PFS and the presence of visceral metastases with a lower OS.
Clinical trial identification
Legal entity responsible for the study
Dr. Miguel A. Climent Durán
All authors have declared no conflicts of interest.