Orazio Caffo1, Ugo De Giorgi2, Lucia Fratino3, Daniele Alesini4, Vittorina Zagonel5, Gaetano Facchini6, Donatello Gasparro7, Cinzia Ortega8, Marcello Tucci9, Francesco Verderame10, Enrico Campadelli11, Giovanni Lo Re12, Giuseppe Procopio13, Roberto Sabbatini14, Maddalena Donini15, Franco Morelli16, Donata Sartori17, Paolo Zucali18, Francesco Carrozza19, Alessandro D'Angelo20, Giovanni Vicario21, Francesco Massari22, Daniele Santini23, Teodoro Sava24, Caterina Messina25, Giuseppe Fornarini26, Leonardo La Torre27, Riccardo Ricotta28, Michele Aieta29, Claudia Mucciarini30, Fable Zustovich5, Sveva Macrini31, Salvatore Luca Burgio2, Sandra Santarossa3, Carmine D'Aniello6, Umberto Basso5, Sara Tarasconi7, Enrico Cortesi4, Consuelo Buttigliero9, Fiorella Ruatta8, Antonello Veccia32, Vincenza Conteduca2, Francesca Maines32, Enzo Galligioni32. 1. Medical Oncology Department, Santa Chiara Hospital, Trento, Italy. Electronic address: orazio.caffo@apss.tn.it. 2. Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. 3. Medical Oncology Department, National Cancer Institute, Aviano, Italy. 4. Department of Radiological, Oncological and Anatomopathological Sciences, La Sapienza, University of Rome, Rome, Italy. 5. Medical Oncology Unit 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy. 6. Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy. 7. Medical Oncology Department, General Hospital, Parma, Italy. 8. Medical Oncology I - Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy. 9. Medical Oncology Department, University of Torino, San Luigi Hospital, Orbassano, Italy. 10. Medical Oncology Department, Villa Sofia Cervello Hospital, Palermo, Italy. 11. Medical Oncology Department, General Hospital, Lugo di Romagna, Italy. 12. Medical Oncology Department, Santa Maria degli Angeli Hospital, Pordenone, Italy. 13. Medical Oncology Department, Fondazione Istituto Nazionale Tumori, Milan, Italy. 14. Medical Oncology Division, Azienda Ospedaliero Universitaria, Policlinico di Modena, Modena, Italy. 15. Medical Oncology Department, General Hospital, Cremona, Italy. 16. Medical Oncology Department, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. 17. Medical Oncology Department, General Hospital, Mirano, Italy. 18. Department of Medical Oncology and Haematology, Humanitas Clinical and Research Center, Rozzano, Italy. 19. Medical Oncology Department, General Hospital, Faenza, Italy. 20. Medical Oncology Department, San Vincenzo Hospital, Taormina, Italy. 21. Division of Medical Oncology, San Giacomo Hospital, Castelfranco Veneto, Italy. 22. Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy. 23. Medical Oncology Department, University Campus bio-Medico, Rome, Italy. 24. Medical Oncology Department, General Hospital, Verona, Italy. 25. Medical Oncology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy. 26. Medical Oncology Department, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy. 27. Medical Oncology Department, General Hospital, Imola, Italy. 28. Medical Oncology Department, Niguarda Cancer Centre, Ospedale Niguarda Ca' Granda, Milan, Italy. 29. Medical Oncology Department, Referral Cancer Centre of Basilicata-IRCCS, Rionero in Vulture, Italy. 30. Medical Oncology Department, General Hospital, Carpi, Italy. 31. Medical Oncology Department, Santa Maria della Misericordia University Hospital, Udine, Italy. 32. Medical Oncology Department, Santa Chiara Hospital, Trento, Italy.
Abstract
BACKGROUND: The availability of new agents (NAs) active in patients with metastatic castration-resistant prostate cancer (mCRPC) progressing after docetaxel treatment (abiraterone acetate, cabazitaxel, and enzalutamide) has led to the possibility of using them sequentially to obtain a cumulative survival benefit. OBJECTIVE: To provide clinical outcome data relating to a large cohort of mCRPC patients who received a third-line NA after the failure of docetaxel and another NA. DESIGN, SETTING, AND PARTICIPANTS: We retrospectively reviewed the clinical records of patients who had received at least two successive NAs after the failure of docetaxel. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The independent prognostic value of a series of pretreatment covariates on the primary outcome measure of overall survival was assessed using Cox regression analysis. RESULTS AND LIMITATIONS: We assessed 260 patients who received one third-line NA between January 2012 and December 2013, including 38 who received a further NA as fourth-line therapy. The median progression-free and overall survival from the start of third-line therapy was, respectively, 4 mo and 11 mo, with no significant differences between the NAs. Performance status, and haemoglobin and alkaline phosphatase levels were the only independent prognostic factors. The limitations of the study are mainly due its retrospective nature and the small number of patients treated with some of the sequences. CONCLUSIONS: We were unable to demonstrate a difference in the clinical outcomes of third-line NAs regardless of previous NA therapy. PATIENT SUMMARY: It is debated which sequence of treatments to adopt after docetaxel. Our data do not support the superiority of any of the three new agents in third-line treatment, regardless of the previously administered new agent.
BACKGROUND: The availability of new agents (NAs) active in patients with metastatic castration-resistant prostate cancer (mCRPC) progressing after docetaxel treatment (abiraterone acetate, cabazitaxel, and enzalutamide) has led to the possibility of using them sequentially to obtain a cumulative survival benefit. OBJECTIVE: To provide clinical outcome data relating to a large cohort of mCRPC patients who received a third-line NA after the failure of docetaxel and another NA. DESIGN, SETTING, AND PARTICIPANTS: We retrospectively reviewed the clinical records of patients who had received at least two successive NAs after the failure of docetaxel. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The independent prognostic value of a series of pretreatment covariates on the primary outcome measure of overall survival was assessed using Cox regression analysis. RESULTS AND LIMITATIONS: We assessed 260 patients who received one third-line NA between January 2012 and December 2013, including 38 who received a further NA as fourth-line therapy. The median progression-free and overall survival from the start of third-line therapy was, respectively, 4 mo and 11 mo, with no significant differences between the NAs. Performance status, and haemoglobin and alkaline phosphatase levels were the only independent prognostic factors. The limitations of the study are mainly due its retrospective nature and the small number of patients treated with some of the sequences. CONCLUSIONS: We were unable to demonstrate a difference in the clinical outcomes of third-line NAs regardless of previous NA therapy. PATIENT SUMMARY: It is debated which sequence of treatments to adopt after docetaxel. Our data do not support the superiority of any of the three new agents in third-line treatment, regardless of the previously administered new agent.
Authors: Ravi A Madan; Keith T Schmidt; Fatima Karzai; Cody J Peer; Lisa M Cordes; Cindy H Chau; Seth M Steinberg; Helen Owens; Joel Eisner; William R Moore; William L Dahut; James L Gulley; William D Figg Journal: Clin Genitourin Cancer Date: 2020-03-29 Impact factor: 2.872
Authors: Keith T Schmidt; Fatima Karzai; Marijo Bilusic; Lisa M Cordes; Cindy H Chau; Cody J Peer; Susan Wroblewski; Alwin D R Huitema; Jan H M Schellens; James L Gulley; William L Dahut; William D Figg; Ravi A Madan Journal: Oncologist Date: 2022-09-02 Impact factor: 5.837