Highlights
- •The optimal therapeutic sequence for mCRPC is unclear.
- •There is no difference in OS/PFS between first-line abiraterone and enzalutamide.
- •In second line, docetaxel is better than androgen-receptor therapy.
- •Efforts must be made to better select the optimal first- and second-line treatments.
Abstract
Background
The optimal therapeutic sequence for metastatic castrate-resistance prostate cancer
(mCRPC) is still debated. This study aimed to compare activity of taxanes (TAX) versus
that of androgen-receptor therapy (ART) in men with mCRPC treated with first-line
ART.
Patients and Methods
This retrospective study included all consecutive chemo-naive mCRPC patients who have
received first-line ART treatment. Progression-free survival (PFS) and overall survival
(OS) were compared between patients treated with second-line ART or TAX.
Results
Overall, 175 patients treated with first-line enzalutamide (ENZA, n = 75) or abiraterone
(ABI, n = 100) were evaluated. Among them, 69 (39%) and 30 (17%) patients received
second-line TAX and ART, respectively, while 76 (43%) patients did not receive further
treatment. From the start of first-line therapy, the median PFS and OS were 13 months
(95% CI: 11-15) and 34 months (95% CI: 29-39), respectively, without any significant
difference between ENZA and ABI. From the start of second-line therapy, the median
PFS and OS were 6 months (95% CI: 5-7) and 18 months (95% CI: 14-21), respectively.
Compared with ART, docetaxel was associated with significantly higher prostate-specific
antigen (PSA, ≥ 50%) (29% vs. 0%, P < .001) and radiological responses (21% vs. 0%, P < .001). PFS was longer in TAX than in ART (6.7 months vs. 4 months, HR: 0.63, 95%
CI: 0.41-0.96, P = .034), but there was no significant difference in OS (19 months vs. 12 months,
P = .1). After propensity score adjustment, PFS (P = .2) and OS (P = .1) were similar between second-line TAX and ART.
Conclusion
In the second-line setting, TAX provides higher PSA and radiological responses than
does ART for mCRPC patients who received first-line ART, but the PFS and OS are similar.
This study provides new elements to help deciding the best treatment sequence.
Keywords
Abbreviations:
ABI (abiraterone), ART (androgen-receptor therapy), ECOG-PS (Eastern Cooperative Oncology Group Performance Status), ENZA (enzalutamide), mCRPC (metastatic castrate-resistance prostate cancer), OS (overall survival), PARP (poly(ADP-ribose) polymerase), PFS (progression-free survival), PSA (prostate-specific antigen), TAX (taxanes)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 16, 2023
Accepted:
February 13,
2023
Received in revised form:
February 9,
2023
Received:
August 30,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
