Abiraterone in “High-” and “Low-risk” Metastatic Hormone-sensitive Prostate Cancer

Abstract

Background: Abiraterone acetate received licencing for use in only "high-risk" metastatic hormone-naïve prostate cancer (mHNPC) following the LATITUDE trial findings. However, a "risk"-related effect was not seen in the STAMPEDE trial. There remains uncertainty as to whether men with LATITUDE "low-risk" M1 disease benefit from androgen deprivation therapy (ADT) combined with abiraterone acetate and prednisolone (AAP). Objective: Evaluation of heterogeneity of effect between LATITUDE high-and low-risk M1 prostate cancer patients receiving ADT + AAP in the STAMPEDE trial. Design, setting, and participants: A post hoc subgroup analysis of the 2017 STAMPEDE "abiraterone comparison". Staging scans for M1 patients contemporaneously randomised to ADT or ADT + AAP within the STAMPEDE trial were evaluated centrally and blind to treatment assignment. Stratification was by risk according to the criteria set out in the LATITUDE trial. Exploratory subgroup stratification incorporated the CHAARTED criteria. Outcome measurements and statistical analysis: The primary outcome measure was overall survival (OS) and the secondary outcome measure was failure-free survival (FFS). Further exploratory analysis evaluated clinical skeletal-related events, progression-free survival (PFS), and prostate cancer-specific death. Standard Cox-regression and Kaplan-Meier survival estimates were employed for analysis.

Prostate-specific antigen dynamics predict individual responses to intermittent androgen deprivation

“…As PCaSCs are resistant to ADT, it may be beneficial to administer alternative therapies that do not work directly via the AR pathway. AA, enzalutamide, apalutamide, and docetaxel (DOC) have shown benefit when used concurrently with ADT in various PCa settings, including both high-and low-volume disease in metastatic hormone-sensitive PCa [27][28][29][30][31] . Thus, we sought to evaluate potential responses to combination therapy in the biochemically recurrent setting.…”

How many bone metastases may be defined as high‐volume metastatic prostate cancer in Asians: A retrospective multicenter cohort study

“…Median OS was 55.5 months in patients who met the CHAARTED “high” criteria (vs 33.1 months reported in the trial) and 56.8 months in those who met the LATITUDE “high” criteria (vs 34.7 months reported in the trial) (Figure 1A,B). 7,14 Median PFS was 12.3 months in patients who met the CHAARTED high criteria (vs 8.6 months reported in the trial) 7,13 …”

“…Among patients who met the “low” criteria, 3‐year OS rates were 87% in those meeting the CHAARTED low‐volume criteria (vs 77% reported in the trial) and 86% in those who met the LATITUDE “low‐risk” criteria (vs 78% reported in the trial) 7,14 …”

“…Various side effects (eg, bone health, sexual dysfunction, risk of cardiovascular events, metabolic dysfunction) due to long‐term ADT treatment have been reported, 29 and the benefits of local treatment for patients with low‐volume PCa should be further evaluated. On the other hand, the previous analysis showed that abiraterone acetate plus prednisone combined with ADT significantly also improved OS in low‐risk patients 14 . Treatment strategies for “low‐volume” patients are also expected to alter in the future.…”

“…Median OS was 55.5 months in patients who met the CHAARTED "high" criteria (vs 33.1 months reported in the trial) and 56.8 months in those who met the LATITUDE "high" criteria (vs 34.7 months reported in the trial) ( Figure 1A,B). 7,14 Median PFS was 12.3 months in patients who met the CHAARTED high criteria (vs 8.6 months reported in the trial). 7,13 Among patients who met the "low" criteria, 3-year OS rates were 87% in those meeting the CHAARTED low-volume criteria (vs 77% reported in the trial) and 86% in those who met the LATITUDE "lowrisk" criteria (vs 78% reported in the trial).…”