Mike Wenzel, Benedikt Hoeh, Clara Humke, Cristina Cano Garcia, Carolin Siech, Thomas Steuber, Markus Graefen, Miriam Traumann, Luis Kluth, Felix K H Chun, Philipp Mandel
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Finally, sequential therapies were compared regarding progression-free survival (PFS) and OS in first-line mCRPC.</p><p><strong>Results: </strong>Of 419 included mHSPC patients, 25% received docetaxel vs. 75% ARPI. ARPI patients were significantly older (71 vs. 66 years), and harbored lower baseline PSA (38 vs. 183 ng/ml, both p ≤ 0.002). Median ttCRPC was significantly longer for ARPI than for docetaxel-treated patients (30 vs. 17 months, hazard ratio [HR]: 0.49, p < 0.001). In OS analyses, ARPI patients also exhibited significantly longer OS, relative to docetaxel patients (96 vs. 50 months, HR: 0.67, p = 0.03). After multivariable adjustment in Cox regression models, no difference between both treatments remained in both analyses (all p > 0.05). In sensitivity analyses of high volume mHSPC patients only, also no ttCRPC or OS differences were observed for ARPI vs. docetaxel (all p > 0.05). Regarding sequential therapies, no PFS and OS differences were observed for all and specifically high volume mHSPC patients, when ARPI-ARPI vs. ARPI-docetaxel vs. docetaxel-ARPI treatments were compared (all p > 0.05).</p><p><strong>Conclusion: </strong>In real-world setting, ARPI treatment performs comparable to docetaxel chemotherapy in mHSPC. Therefore, docetaxel should only be used in triplet therapy. 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Moreover, few is known about the effect of sequential therapies in mHSPC and subsequent metastatic castration resistant prostate cancer (mCRPC).</p><p><strong>Methods: </strong>We relied on the FRAMCAP database and compared docetaxel vs. ARPI in mHSPC patients regarding time to mCRPC (ttCRPC) and overall survival (OS). Sensitivity analyses addressed high volume mHSPC patients. Finally, sequential therapies were compared regarding progression-free survival (PFS) and OS in first-line mCRPC.</p><p><strong>Results: </strong>Of 419 included mHSPC patients, 25% received docetaxel vs. 75% ARPI. ARPI patients were significantly older (71 vs. 66 years), and harbored lower baseline PSA (38 vs. 183 ng/ml, both p ≤ 0.002). Median ttCRPC was significantly longer for ARPI than for docetaxel-treated patients (30 vs. 17 months, hazard ratio [HR]: 0.49, p < 0.001). In OS analyses, ARPI patients also exhibited significantly longer OS, relative to docetaxel patients (96 vs. 50 months, HR: 0.67, p = 0.03). After multivariable adjustment in Cox regression models, no difference between both treatments remained in both analyses (all p > 0.05). In sensitivity analyses of high volume mHSPC patients only, also no ttCRPC or OS differences were observed for ARPI vs. docetaxel (all p > 0.05). Regarding sequential therapies, no PFS and OS differences were observed for all and specifically high volume mHSPC patients, when ARPI-ARPI vs. ARPI-docetaxel vs. docetaxel-ARPI treatments were compared (all p > 0.05).</p><p><strong>Conclusion: </strong>In real-world setting, ARPI treatment performs comparable to docetaxel chemotherapy in mHSPC. Therefore, docetaxel should only be used in triplet therapy. 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引用次数: 0
摘要
目的：目前没有III期试验比较多西紫杉醇与雄激素受体途径抑制剂（ARPI）在转移性激素敏感性前列腺癌（mHSPC）的癌症控制结果。此外，对mHSPC和随后的转移性去势抵抗性前列腺癌（mCRPC）的序贯治疗效果知之甚少。方法：我们依靠FRAMCAP数据库，比较多西他赛和ARPI在mHSPC患者中到mCRPC的时间（ttCRPC）和总生存期（OS）。敏感性分析针对高容量mHSPC患者。最后，比较序贯疗法对一线mCRPC的无进展生存期（PFS）和OS的影响。结果：在419例纳入的mHSPC患者中，25%接受了多西他赛，75%接受了ARPI。ARPI患者明显年龄较大（71岁vs 66岁），基线PSA较低（38 ng/ml vs 183 ng/ml, p≤0.002）。ARPI组的中位ttCRPC明显长于多西他赛组（30个月vs 17个月，风险比[HR]: 0.49, p 0.05）。仅在高容量mHSPC患者的敏感性分析中，ARPI与多西他赛也没有观察到ttCRPC或OS差异（均p < 0.05）。在顺序治疗方面，当比较ARPI-ARPI、arpi -多西紫杉醇、多西紫杉醇- arpi治疗时，所有mHSPC患者的PFS和OS均无差异（p < 0.05）。结论：在现实环境中，ARPI治疗mHSPC的效果与多西他赛化疗相当。因此，多西他赛只能用于三联治疗。此外，ARPI/多西他赛联合顺序治疗在一线mCRPC中没有差异。
Androgen receptor pathway inhibitors vs. docetaxel chemotherapy for metastatic hormone-sensitive and first-line castration resistant prostate cancer.
Purpose: No currently available phase III trial compared docetaxel vs. androgen receptor pathway inhibitors (ARPI) regarding cancer-control outcomes in metastatic hormone-sensitive prostate cancer (mHSPC). Moreover, few is known about the effect of sequential therapies in mHSPC and subsequent metastatic castration resistant prostate cancer (mCRPC).
Methods: We relied on the FRAMCAP database and compared docetaxel vs. ARPI in mHSPC patients regarding time to mCRPC (ttCRPC) and overall survival (OS). Sensitivity analyses addressed high volume mHSPC patients. Finally, sequential therapies were compared regarding progression-free survival (PFS) and OS in first-line mCRPC.
Results: Of 419 included mHSPC patients, 25% received docetaxel vs. 75% ARPI. ARPI patients were significantly older (71 vs. 66 years), and harbored lower baseline PSA (38 vs. 183 ng/ml, both p ≤ 0.002). Median ttCRPC was significantly longer for ARPI than for docetaxel-treated patients (30 vs. 17 months, hazard ratio [HR]: 0.49, p < 0.001). In OS analyses, ARPI patients also exhibited significantly longer OS, relative to docetaxel patients (96 vs. 50 months, HR: 0.67, p = 0.03). After multivariable adjustment in Cox regression models, no difference between both treatments remained in both analyses (all p > 0.05). In sensitivity analyses of high volume mHSPC patients only, also no ttCRPC or OS differences were observed for ARPI vs. docetaxel (all p > 0.05). Regarding sequential therapies, no PFS and OS differences were observed for all and specifically high volume mHSPC patients, when ARPI-ARPI vs. ARPI-docetaxel vs. docetaxel-ARPI treatments were compared (all p > 0.05).
Conclusion: In real-world setting, ARPI treatment performs comparable to docetaxel chemotherapy in mHSPC. Therefore, docetaxel should only be used in triplet therapy. Moreover, no differences for sequential therapies of ARPI/docetaxel combinations in first-line mCRPC were observed.
期刊介绍：
The WORLD JOURNAL OF UROLOGY conveys regularly the essential results of urological research and their practical and clinical relevance to a broad audience of urologists in research and clinical practice. In order to guarantee a balanced program, articles are published to reflect the developments in all fields of urology on an internationally advanced level. Each issue treats a main topic in review articles of invited international experts. Free papers are unrelated articles to the main topic.
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