Abstract
Background
An important clinical question of great interest to clinicians is how to best sequence
androgen receptor targeted agents (ARTAs) and chemotherapy for metastatic castration-resistant
prostate cancer (mCRPC), but the answer is still unclear.
Materials and Methods
To evaluate and compare the clinical outcomes of ARTA and docetaxel (DTX) as second-line
treatment in the post first-line ARTA, we conducted a retrospective analysis of chemotherapy-naive
mCRPC patients who had received sequential treatment with ARTA followed by another
ARTA (ARTA-ARTA) or ARTA followed by DTX (ARTA-DTX).
Results
A total of 97 patients were treated with the ARTA-ARTA sequence and 42 with the ARTA-DTX
sequence. A prostate-specific antigen (PSA) response to the second-line treatment
was observed in 18.6% in the ARTA-ARTA and in 33.3% in the ARTA-DTX sequence, but
the difference in PSA response was not statistically significant (P = .057). The median progression-free survival (PFS) was significantly different between
ARTA and DTX in the second-line treatment (hazard ratio [HR], 0.38; 95% confidence
interval [CI], 0.24-0.59; P < .001). The favorable outcome in the ARTA-DTX sequence compared with the ARTA-ARTA
sequence remained (HR, 0.51, 95% CI, 0.33-0.80; P = .004) in the combined PFS (first-line PFS + second-line PFS). However, no statistically
significant difference in overall survival (OS) between the 2 groups was observed
(HR, 0.60; 95% CI, 0.34-1.09; P = .095). In multivariate analysis, the ARTA-DTX sequence was identified as an independent
prognostic factor for combined PFS, but not OS.
Conclusion
ARTA-DTX might improve clinical outcomes in terms of second-line PFS and combined
PFS, compared with the ARTA-ARTA sequence. However, this significance was not observed
for OS.
Keywords
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Article info
Publication history
Published online: July 26, 2017
Accepted:
July 21,
2017
Received in revised form:
July 8,
2017
Received:
June 4,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
