Addition of D to ADT increased overall survival in high volume disease mHSPC. Nevertheless, there is a lack of information about the management after disease progression and predictive factors of efficacy for subsequent therapies are unknown.
Retrospective analysis of 163 mHSPC patients (pt) treated with D in 23 Spanish Centers from July 2014 to April 2018. Objectives of the study are: describe baseline and progression characteristics, treatment choices and efficacy outcomes of subsequent therapies based on pretreatment features.
After a median follow up of 18.04 months (m), 93 pt (57.1%) developed CRPC. Median time to CRPC was 15.97 m (CI 95%: 10.97 m – 28.16 m). 80 pt received subsequent treatment after progression: 23 (28.8%) received chemotherapy (CT) (3 D, 17 cabazitaxel, 3 carboplatin-etoposide), 52 (65%) androgen receptor axis-targeted agents (31 enzalutamide, 21 abiraterone) and 5 radium-223. Baseline characteristics of pt at CRPC disease were: median age: 67.1 year; median PSA doubling time (PSADT): 2 m, and median PSA, Hemoglobin (Hb), LDH and alkaline phosphatase (alk-P) was 20.3 ng/mL, 12.95 g/dL, 326 UI/mL and 144 UI/mL, respectively. 26.4% of pt had visceral progression. Median progression free survival (PFS) of pt in first-line treatment for mCRPC was 6.93 m (CI95%: 3.58-10.02). In univariate analysis, hormonal therapy showed a significant longer PFS compared to CT (7.49 m vs 6.27 m; HR 0.55; p 0.048), but no association was found after adjustment by other prognostic characteristics (HR 0.77; p 0.79). Although no significant association was observed in multivariate analysis, pt with more aggressive clinical characteristics achieved a longer PFS with CT (Table).Table: 823P
PFS at first-line treatment of mCRPC
|HT (m)||CT (m)||p|
|PSADT < 3 m PSADT > = 3 m||4.46 9.39||6.27 3.59||0.6 0.07|
|Visceral PD Non Visceral PD||4.33 5.95||5.59 3.54||0.59 0.12|
|LDH H LDH L||4.34 12.0||5.59 8.21||0.29 0.3|
|Hb H Hb L||NR 4.0||5.58 6.27||0.03 0.63|
|alk-P H alk-P L||3.81 11.99||6.93 5.52||0.94 0.03|
|PSA H PSA L||3.81 8.54||5.52 5.58||0.35 0.14|
Baseline characteristics at CRPC disease could help us to identify the best therapy option for pt pretreated with D + ADT in mHSPC. Our analyses suggest that CT could benefit pt with more aggressive clinical features.
Clinical trial identification
Legal entity responsible for the study
Pablo Gajate Borau.
Has not received any funding.
All authors have declared no conflicts of interest.