Survival outcomes and prognostic factors for first-line abiraterone acetate or enzalutamide in patients with metastatic castration-resistant prostate cancer
Abstract Purpose To investigate the survival outcomes of metastatic castration-resistant prostate cancer (mCRPC) patients receiving first-line novel androgen receptor axis-targeted therapies (ARATs) and prognostic factors for patient survival. Methods This retrospective study obtained data from 202...
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | BMC Cancer |
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| Online Access: | https://doi.org/10.1186/s12885-023-10885-4 |
| _version_ | 1797795624359297024 |
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| author | Chi-Shin Tseng Jui-Han Yang Shi-Wei Huang Yu-Jen Wang Chung-Hsin Chen Yeong-Shiau Pu Jason Chia-Hsien Cheng Chao-Yuan Huang |
| author_facet | Chi-Shin Tseng Jui-Han Yang Shi-Wei Huang Yu-Jen Wang Chung-Hsin Chen Yeong-Shiau Pu Jason Chia-Hsien Cheng Chao-Yuan Huang |
| author_sort | Chi-Shin Tseng |
| collection | DOAJ |
| description | Abstract Purpose To investigate the survival outcomes of metastatic castration-resistant prostate cancer (mCRPC) patients receiving first-line novel androgen receptor axis-targeted therapies (ARATs) and prognostic factors for patient survival. Methods This retrospective study obtained data from 202 patients who started abiraterone acetate or enzalutamide as first-line therapy for mCRPC between 2016 and 2021 from a single academic center. The primary endpoint was overall survival (OS) defined as the interval from the start of ARAT to death, loss to follow-up, or the end of the study period. The secondary endpoints were PSA decline, PSA nadir, and time to nadir (TTN) after ARATs. Kaplan–Meier survival analyses were applied for depicting OS. Cox proportional hazards model with inversed probability of treatment weighing-adjustment was used to validate the effect of patient, disease, and treatment response factors on OS. Results Among 202 patients, 164 patients were treated with first-line ARATs alone and 38 patients received second-line chemotherapy. The median OS was not reached in patients with first-line ARATs alone and was 38.8 months in those with subsequent chemotherapy after failure from ARATs. OS was not different between the use of abiraterone and enzalutamide, though enzalutamide showed a higher rate of PSA decline ≧ 90% (56% versus 40%, p = 0.021) and longer TTN (5.5 versus 4.7 months, p = 0.019). Multivariable analysis showed that PSA nadir > 2 ng/mL [hazard ratio (HR) 7.04, p < 0.001] and TTN<7 months (HR 2.18, p = 0.012) were independently associated with shorter OS. Patients with both of these poor prognostic factors had worse OS compared to those who had 0–1 factors (HR 9.21, p < 0.001). Conclusions Patients with mCRPC who received first-line ARATs had better survival if they had a PSA nadir $$\leqq$$ 2 ng/mL or a TTN $$\geqq$$ 7 months. Further study is needed to determine if an early switch in therapy for those in whom neither is achieved may impact OS. |
| first_indexed | 2024-03-13T03:20:49Z |
| format | Article |
| id | doaj.art-0cc1ebbcaba04751be8ffdc1816adad9 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-03-13T03:20:49Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
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| series | BMC Cancer |
| spelling | doaj.art-0cc1ebbcaba04751be8ffdc1816adad92023-06-25T11:19:53ZengBMCBMC Cancer1471-24072023-06-0123111010.1186/s12885-023-10885-4Survival outcomes and prognostic factors for first-line abiraterone acetate or enzalutamide in patients with metastatic castration-resistant prostate cancerChi-Shin Tseng0Jui-Han Yang1Shi-Wei Huang2Yu-Jen Wang3Chung-Hsin Chen4Yeong-Shiau Pu5Jason Chia-Hsien Cheng6Chao-Yuan Huang7Graduate Institute of Clinical Medicine, National Taiwan University College of MedicineDepartment of Education, National Taiwan University HospitalDepartment of Urology, National Taiwan University Hospital Yun-Lin BranchDivision of Radiation Oncology, Department of Oncology, National Taiwan University Hospital and National Taiwan University College of MedicineDepartment of Urology, National Taiwan University Hospital, National Taiwan UniversityDepartment of Urology, National Taiwan University Hospital, National Taiwan UniversityGraduate Institute of Clinical Medicine, National Taiwan University College of MedicineDepartment of Urology, National Taiwan University Hospital, National Taiwan UniversityAbstract Purpose To investigate the survival outcomes of metastatic castration-resistant prostate cancer (mCRPC) patients receiving first-line novel androgen receptor axis-targeted therapies (ARATs) and prognostic factors for patient survival. Methods This retrospective study obtained data from 202 patients who started abiraterone acetate or enzalutamide as first-line therapy for mCRPC between 2016 and 2021 from a single academic center. The primary endpoint was overall survival (OS) defined as the interval from the start of ARAT to death, loss to follow-up, or the end of the study period. The secondary endpoints were PSA decline, PSA nadir, and time to nadir (TTN) after ARATs. Kaplan–Meier survival analyses were applied for depicting OS. Cox proportional hazards model with inversed probability of treatment weighing-adjustment was used to validate the effect of patient, disease, and treatment response factors on OS. Results Among 202 patients, 164 patients were treated with first-line ARATs alone and 38 patients received second-line chemotherapy. The median OS was not reached in patients with first-line ARATs alone and was 38.8 months in those with subsequent chemotherapy after failure from ARATs. OS was not different between the use of abiraterone and enzalutamide, though enzalutamide showed a higher rate of PSA decline ≧ 90% (56% versus 40%, p = 0.021) and longer TTN (5.5 versus 4.7 months, p = 0.019). Multivariable analysis showed that PSA nadir > 2 ng/mL [hazard ratio (HR) 7.04, p < 0.001] and TTN<7 months (HR 2.18, p = 0.012) were independently associated with shorter OS. Patients with both of these poor prognostic factors had worse OS compared to those who had 0–1 factors (HR 9.21, p < 0.001). Conclusions Patients with mCRPC who received first-line ARATs had better survival if they had a PSA nadir $$\leqq$$ 2 ng/mL or a TTN $$\geqq$$ 7 months. Further study is needed to determine if an early switch in therapy for those in whom neither is achieved may impact OS.https://doi.org/10.1186/s12885-023-10885-4Prostatic neoplasmsAbiraterone acetateEnzalutamideAndrogensCastration |
| spellingShingle | Chi-Shin Tseng Jui-Han Yang Shi-Wei Huang Yu-Jen Wang Chung-Hsin Chen Yeong-Shiau Pu Jason Chia-Hsien Cheng Chao-Yuan Huang Survival outcomes and prognostic factors for first-line abiraterone acetate or enzalutamide in patients with metastatic castration-resistant prostate cancer BMC Cancer Prostatic neoplasms Abiraterone acetate Enzalutamide Androgens Castration |
| title | Survival outcomes and prognostic factors for first-line abiraterone acetate or enzalutamide in patients with metastatic castration-resistant prostate cancer |
| title_full | Survival outcomes and prognostic factors for first-line abiraterone acetate or enzalutamide in patients with metastatic castration-resistant prostate cancer |
| title_fullStr | Survival outcomes and prognostic factors for first-line abiraterone acetate or enzalutamide in patients with metastatic castration-resistant prostate cancer |
| title_full_unstemmed | Survival outcomes and prognostic factors for first-line abiraterone acetate or enzalutamide in patients with metastatic castration-resistant prostate cancer |
| title_short | Survival outcomes and prognostic factors for first-line abiraterone acetate or enzalutamide in patients with metastatic castration-resistant prostate cancer |
| title_sort | survival outcomes and prognostic factors for first line abiraterone acetate or enzalutamide in patients with metastatic castration resistant prostate cancer |
| topic | Prostatic neoplasms Abiraterone acetate Enzalutamide Androgens Castration |
| url | https://doi.org/10.1186/s12885-023-10885-4 |
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