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Impact of Novel Hormonal Agents (Abiraterone, Enzalutamide) on the Development of Visceral and/or Brain Metastases in Patients With Bone-metastatic Castration-resistant Prostate Cancer

Published:April 21, 2022DOI:https://doi.org/10.1016/j.clgc.2022.04.004

      Abstract

      Introduction

      The overall survival (OS) of metastatic castration-resistant prostate cancer (mCRPC) patients has improved since 2011 with the use of novel hormonal agents (NHAs). The incidence of brain metastases (mets) has been reported to increase since 2004 with the use of docetaxel, but not the incidence of visceral mets. Our objective was to study whether the use of NHAs increases the risk of developing visceral or brain mets (VBMs).

      Patients and Methods

      mCRPC patients with mets limited to bone (bmCRPC), treated at Tours University Hospital between 2007 and 2015, were included retrospectively. The primary endpoint was to determine whether treatment with NHAs was associated with an increased incidence of VBMs. Secondary endpoints included the search for putative predictive factors to develop VBMs.

      Results

      On 187 bmCRPC patients included, 65 developed VBMs. VBM incidence increased in bmCRPC patients alive after 2011, compared to patients who died before (39.7 vs. 24.6%, P = .04). Meanwhile, their median OS increased from 16.3 months to 28.5 months (P = .01). The longer was the treatment with NHAs, the lower was the risk of VBMs (HR = 0.96, 95% CI [0.94; 0.99]), whereas age < 70 years (HR = 3.33, 95% CI [1.50; 7.40]) and low PSA level at diagnosis (HR = 1.58, 95% CI [1.16; 2.15]) increased this risk.

      Conclusion

      Though retrospective, our results showed an increased incidence of VBMs in bmCRPC patients after 2011. However, this was not associated with NHA exposure duration. The role of NHA exposure remains unclear and needs further investigation.

      Keywords

      Abbreviations:

      bmCRPC (Bone metastatic castration resistant prostate cancer), CNIL (« Commission Nationale de l'Informatique et des Libertés »), ISUP (International society of urological pathology), mCRPC (Metastatic castration resistant prostate cancer), mets (Metastases), NHA (Novel hormonal agent), OS (Overall survival), PCWG2 (Prostate cancer clinical trials working group), PSA (Prostate-specific antigen), VBM (Visceral and/or brain metastases), wo (Without)
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