1794P - Prognostic role of metastatic site in patients with de novo metastatic prostate cancer: A population-based analysis in new hormonal agents era

Background

Recently, triplet therapies have improved outcomes in patients with metastatic castration-sensitive prostate cancer (mCSPC). Triplet therapies might be reasonable, especially in de novo metastatic disease. Bones are the most common site of distant metastases, but visceral metastasis also occurs in about 10%. It is still largely unknown how the site of de novo metastasis impacts survival in patients treated with new hormonal agents.

Methods

We identified patients from the Surveillance, Epidemiology, and End Results (SEER) database (17 reg, Nov 2022). We used the following criteria for inclusion: microscopically confirmed de novo metastatic, prostate adenocarcinoma, diagnosed between 2016 and 2020; and exclusion: unknown metastatic site and metastasis only to distant lymph nodes. The primary endpoint was overall survival (OS). We used Cox’s proportional hazards regression models for multivariable analysis.

Results

We included 20,100 patients. Metastatic sites were classified as bone only, bone + distant lymph node metastasis, lung without liver metastasis, liver metastasis, and other sites (i.e., except for bone, lung, liver, and distant lymph node). Bone was the most common metastatic site (95.4%), followed by lung (10%), other sites (6.3%), and liver (4.7%). The median OS was 33.0 (95% Confidence Interval (CI): 31.9-34.1), 29.0 (95% CI: 21.1-30.8), 28.0 (95% CI: 25.1-30.8), 23.0 (95% CI: 20.5-25.4), and 12.0 (95% CI: 10.5-13.4) months in bone only, bone + distant lymph node, lung without liver, other sites, and liver metastatic groups. Liver metastasis was an independent prognostic factor for worse OS (Hazard Ratio: 8.14, 95% CI:3.06-21.62, p<0.001) after adjusting for confounding factors, such as age, race, PSA, and Gleason. However, bone + distant lymph node metastasis, lung metastasis, and metastasis to other sites were not associated with significantly increased mortality compared to bone only metastasis.

Conclusions

Distinguishing by the site of visceral metastasis could add more granularity to the classification of metastatic hormone-sensitive disease and thus may help to select those who would benefit most from the triplet therapies.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

S. Gillessen: Financial Interests, Personal, Advisory Board, 2018: Sanofi, Roche; Financial Interests, Personal, Advisory Board, 2018, 2019: Orion; Financial Interests, Personal, Invited Speaker, 2019 Speaker's Bureau: Janssen Cilag; Financial Interests, Personal, Advisory Board, 2020: Amgen; Financial Interests, Personal, Invited Speaker, 2020: ESMO; Financial Interests, Personal, Other, Travel Grant 2020: ProteoMEdiX; Financial Interests, Institutional, Advisory Board, 2018, 2019, 2022: Bayer; Financial Interests, Institutional, Advisory Board, 2020: Janssen Cilag, Roche, Pfizer; Financial Interests, Institutional, Advisory Board, 2018: AAA International, Menarini Silicon Biosystems; Financial Interests, Institutional, Advisory Board, 2019, 2020: Astellas Pharma; Financial Interests, Institutional, Advisory Board, 2019: Tolero Pharmaceuticals; Financial Interests, Institutional, Advisory Board, 2020, 2022: MSD Merck Sharp & Dohme; Financial Interests, Personal, Invited Speaker, 2021, 2022: SAKK, DESO; Financial Interests, Institutional, Advisory Board, 2021: Telixpharma, BMS, AAA International, Novartis, Modra Pharmaceuticas Holding B.V.; Financial Interests, Institutional, Other, Steering Committee 2021: Amgen; Financial Interests, Institutional, Advisory Board, 2021, 2022: Orion, Bayer; Financial Interests, Personal, Invited Speaker, 2021: SAKK, SAKK, SAMO - IBCSG (Swiss Academy of Multidisciplinary oncology); Financial Interests, Personal, Advisory Board, 2021: MSD Merck Sharp & Dhome; Financial Interests, Personal, Other, 2021: RSI (Televisione Svizzera Italiana); Financial Interests, Institutional, Invited Speaker, 2021, 2022: Silvio Grasso Consulting; Financial Interests, Institutional, Other, Faculty activity 2022: WebMD-Medscape; Financial Interests, Institutional, Advisory Board, 2022: Myriad genetics, AstraZeneca, Amgen; Financial Interests, Institutional, Invited Speaker, 2022: TOLREMO, ESMO; Financial Interests, Personal, Other, Travel support 2022: AstraZeneca; Financial Interests, Institutional, Other, Interview 2022: PeerVoice; Financial Interests, Institutional, Funding, 2021, Unrestricted grant for a Covid related study as co-investigator: Astellas; Non-Financial Interests, Advisory Role, 2019: Menarini Silicon Biosystems, Aranda; Non-Financial Interests, Advisory Role, Continuing: ProteoMediX. T.K. Choueiri: Financial Interests, Personal, Advisory Board, Advice on GU/RCC drugs: BMS, Pfizer, Merck, Exelixis, AstraZeneca; Financial Interests, Personal, Advisory Board, Advice on Onc drugs: Lilly, EMD Serono, Infinity; Financial Interests, Personal, Advisory Board, Advice on RCC drug: Calithera; Financial Interests, Personal, Invited Speaker, RCC drug: Ipsen; Financial Interests, Personal, Advisory Board, Advice on GU Onc drugs: Surface Oncology; Financial Interests, Personal, Other, Consultant on onc drugs: Analysis Group; Financial Interests, Personal, Invited Speaker, CME, ww2.peerview.com: Peerview; Financial Interests, Personal, Invited Speaker, CME, gotoper.com: PER; Financial Interests, Personal, Invited Speaker, CME, researchtopractice.com: ResearchToPractice; Financial Interests, Personal, Invited Speaker, National Association of Managed Care: NAMC; Financial Interests, Personal, Invited Speaker, ASCO-related event: ASCO-SITC; Financial Interests, Personal, Other, Grant review to Orien Network ($400): ORIEN; Financial Interests, Personal, Advisory Board, Advising oncology strategy: Aptitude Health; Financial Interests, Personal, Invited Speaker, Best of ASCO19 talk: Advent health; Financial Interests, Personal, Invited Speaker, Best of ESMO20 talk ($1000): UAE Society of Onc; Financial Interests, Personal, Invited Speaker, CME, mjhlifesciences.com (OncLive): MJH life sciences; Financial Interests, Personal, Invited Speaker, Grand Rounds: MDACC; Financial Interests, Personal, Invited Speaker, RCC webinar: Cancernet; Financial Interests, Personal, Invited Speaker, CME, Kidney Cancer Association ($1300): France Foundation; Financial Interests, Personal, Invited Speaker, CME, RCC: Springer, WebMed; Financial Interests, Personal, Invited Speaker, CME, ImmunoOncology in RCC: ASiM, CE; Financial Interests, Personal, Invited Speaker, CME, PodCast in RCC ($500.00): Caribou Publishing; Financial Interests, Personal, Invited Speaker, Reimbursement ($432.00): Kidney Cancer Association; Financial Interests, Personal, Other, member of the DSMB for clinical trial: Aravive; Financial Interests, Personal, Other, on the DMC of clinical trial: Aravive; Financial Interests, Personal, Advisory Board, GU cancer drug development: alkermes, Gilead; Financial Interests, Personal, Member of Board of Directors, unpaidhttps://www.accru.org/main/public/index.xhtml: ACCRU; Financial Interests, Personal, Member of Board of Directors, Unpaidhttps://kidneycan.org: KidneyCan; Financial Interests, Personal, Other, External Advisory Board Member: Gustave Roussy; Financial Interests, Personal, Stocks/Shares: Pionyr (not publicly traded), Tempest (publicly traded), Osel (not publicly traded), Nuscan ((not publicly traded)), CURESPONSE; Financial Interests, Personal, Royalties, For writing and updating chapters in GU Oncology: Up-To-Date online textbook; Financial Interests, Institutional, Funding, National Chair: BMS, Merck, Takeda, Exelixis, AstraZeneca, Tracon, Peloton; Financial Interests, Institutional, Invited Speaker: Roche, Surface Oncology, GSK; Financial Interests, Institutional, Funding, National co-chair: Pfizer, EMD-Serono; Financial Interests, Institutional, Funding, Chair of trial: Lilly; Financial Interests, Institutional, Funding, SC member: Eisai; Financial Interests, Institutional, Funding, National co-chair on 3 ongoing trials: ALLIANCE Cooperative Group; Financial Interests, Institutional, Research Grant, for GU oncology translational research through IION program: BMS; Financial Interests, Institutional, Research Grant, for GU oncology translational research: Exelixis; Financial Interests, Institutional, Research Grant, For Health outcomes research: Roche; Financial Interests, Institutional, Invited Speaker, leads trials as PI: Nikang; Non-Financial Interests, Leadership Role, Co-Chair of the meeting, 2019-: Kidney Cancer Research Summit of KidneyCAN; Non-Financial Interests, Principal Investigator, Trial Global and National PI with GU Cancers, mostly Kidney Cancer: Multiple Academic and Industry entities; Non-Financial Interests, Personal, Other, Track Leader/Session chair/Speaker/Discussant: ASCO; Non-Financial Interests, Personal, Other, Speaker/Discussant/Track Leader: ESMO; Non-Financial Interests, Institutional, Other, Access to genomic database: Foundation Med, Guardant, Invitae; Non-Financial Interests, Member: ASCO, AACR; Non-Financial Interests, Personal, Other, Grants reviewers: AACR; Non-Financial Interests, Personal, Other, Reviewer of papers: Various journals (e.g. NEJM, Lancet, JCO); Non-Financial Interests, Personal, Other, Medical writing and editorial assistance support (e.g. ClinicalThinking, Envision Pharma Group, Fishawack Group of Companies, Health Interactions, Parexel, Oxford PharmaGenesis, and others). However, first draft frequently initiated by myself when I am 1st author: Medical Communication; Non-Financial Interests, Other, Political vote usually as “independent”, not a member of any political party. I am an issue voter: General US Politics; Other, Other, Employee at DFCI. Please see https://www.dana-farber.org/ for mission statement (non-profit hospital). I am also the past President of Medical Staff at DFCI 2015-2018: Dana-Farber Cancer Institute (DFCI); Other, Other, Professor at HMS, please see https://hms.harvard.edu/ for mission statement (non-profit school): Harvard Medical School (HMS); Other, Other, No financial interest. Institutional.Filed patents related to biomarkers of immune checkpoint blockers and circulating free methylated DNA. No money made and some patents were abandoned: Filed patents. Y. Urun: Financial Interests, Personal, Advisory Board: Astellas, AstraZeneca, Janssen Oncology, Pfizer, BMS, Roche, MSD; Financial Interests, Personal, Invited Speaker: Astellas, Janssen Oncology, Pfizer, BMS, Roche, Amgen; Financial Interests, Personal and Institutional, Invited Speaker: BMS, AstraZeneca, MSD, Janssen, Roche. All other authors have declared no conflicts of interest.