- •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.
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.
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.
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.
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)
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Published online: February 16, 2023
Accepted: February 13, 2023
Received in revised form: February 9, 2023
Received: August 30, 2022
Publication stageIn Press Journal Pre-Proof
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