A Fléchon1, D Pouessel2, C Ferlay3, D Perol3, P Beuzeboc4, G Gravis5, F Joly6, S Oudard7, G Deplanque8, S Zanetta9, P Fargeot9, F Priou10, J P Droz11, S Culine12. 1. Department of Medical Oncology, Centre Léon Bérard, Lyon. Electronic address: flechon@lyon.fnclcc.fr. 2. Department of Medical Oncology, Centre Val d'Aurelle, Montpellier. 3. Department of Biostatistic, Centre Léon Bérard, Lyon. 4. Department of Medical Oncology, Institut Curie, Paris. 5. Department of Medical Oncology, Institut Paoli-Calmettes, Marseille. 6. Department of Medical Oncology, Centre François Baclesse, Caen. 7. Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris. 8. Department of Medical Oncology, Fondation Hôpital Saint Joseph, Paris. 9. Department of Medical Oncology, Centre G.F. Leclerc, Dijon. 10. Department of Medical Oncology, CHD Les Oudairies, La Roche Sur Yon. 11. Department of Medical Oncology, Centre Léon Bérard, Lyon. 12. Department of Medical Oncology, Hôpital Henri Mondor, Créteil, France.
Abstract
BACKGROUND: In the evolution of metastatic castration-resistant prostate cancer (mCRPC), patients present visceral metastases with or without neuroendocrine differentiation in 20% of cases. PATIENTS AND METHODS: We assessed the efficacy and toxicity of a platinum-based chemotherapy regimen in mCRPC patients with either neuroendocrine differentiation defined by high serum levels of chromogranin A (CgA) and neuron-specific enolase (NSE) or visceral metastases. Patients received the combination of carboplatin and etoposide every 3 weeks. Efficacy end points included prostate-specific antigen (PSA) and neuroendocrine marker response, objective response and toxicity. RESULTS: Of the 60 patients included from April 2005 to January 2008, 78.6% had bone metastases, 46.4% had lymph node involvement and 57.1% had liver and/or lung localizations. The objective response rate was 8.9% in the 46 patients with measurable disease. A neuroendocrine response was observed in 31% of cases for NSE and 7% for CgA. The PSA response rate was 8%. The most common grade 3-4 treatment-related toxic effects were neutropenia (65.5%), thrombocytopenia (32.7%) and anemia (27.3%). There was 7.2% febrile neutropenia, with one toxicity-related death. The median follow-up was 9.3 months [95% confidence interval (CI) 0.2-27.1] and the median overall survival 9.6 months (95% CI 8.7-12.7). CONCLUSION: The benefit-risk ratio of this regimen seems unfavorable due to poor response and high toxicity.
BACKGROUND: In the evolution of metastatic castration-resistant prostate cancer (mCRPC), patients present visceral metastases with or without neuroendocrine differentiation in 20% of cases. PATIENTS AND METHODS: We assessed the efficacy and toxicity of a platinum-based chemotherapy regimen in mCRPC patients with either neuroendocrine differentiation defined by high serum levels of chromogranin A (CgA) and neuron-specific enolase (NSE) or visceral metastases. Patients received the combination of carboplatin and etoposide every 3 weeks. Efficacy end points included prostate-specific antigen (PSA) and neuroendocrine marker response, objective response and toxicity. RESULTS: Of the 60 patients included from April 2005 to January 2008, 78.6% had bone metastases, 46.4% had lymph node involvement and 57.1% had liver and/or lung localizations. The objective response rate was 8.9% in the 46 patients with measurable disease. A neuroendocrine response was observed in 31% of cases for NSE and 7% for CgA. The PSA response rate was 8%. The most common grade 3-4 treatment-related toxic effects were neutropenia (65.5%), thrombocytopenia (32.7%) and anemia (27.3%). There was 7.2% febrile neutropenia, with one toxicity-related death. The median follow-up was 9.3 months [95% confidence interval (CI) 0.2-27.1] and the median overall survival 9.6 months (95% CI 8.7-12.7). CONCLUSION: The benefit-risk ratio of this regimen seems unfavorable due to poor response and high toxicity.
Authors: Álvaro Quintanal-Villalonga; Joseph M Chan; Helena A Yu; Dana Pe'er; Charles L Sawyers; Triparna Sen; Charles M Rudin Journal: Nat Rev Clin Oncol Date: 2020-03-09 Impact factor: 66.675
Authors: Rosa Nadal; Michael Schweizer; Oleksandr N Kryvenko; Jonathan I Epstein; Mario A Eisenberger Journal: Nat Rev Urol Date: 2014-02-18 Impact factor: 14.432