Double or Triple Trouble in Metastatic Hormone-sensitive Prostate Cancer?

Kostos, Louise; Murphy, Declan; Azad, Arun

doi:10.1016/j.euo.2022.07.001

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Based on recently published clinical trials and meta-analyses, initial management mHSPC usually consists of the doublet of ADT and androgen receptor pathway inhibitors (ARPI) with or without docetaxel [3,4,37,38]. However, the triplet strategy might represent overtreatment in a select group of patients [3,4,7,39]. Our multivariate joint model that comprised dynamic changes in PSA along with other laboratory-based markers showed net benefits at a threshold which is similar to the magnitude of relative survival benefit with triplet strategy in high risk or high volume mHSPC [4,40].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Role of Dynamic Changes in Serological Markers in Metastatic Hormone Naïve Prostate Cancer

Roy,

Sun,

Wallis

et al. 2023

Cancers

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We investigated whether inter-patient variation in the dynamic trajectory of hemoglobin (Hb), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), and prostate-specific antigen (PSA) can prognosticate overall survival (OS) in de novo mHSPC. This is a secondary analysis of the LATITUDE trial in which high-risk de novo mHSPC patients were randomly assigned to receive either androgen deprivation therapy (ADT) plus abiraterone or ADT plus placebo. We used a five-fold cross-validated joint model approach to determine the association of temporal changes in the serological markers with OS. Decision curve analysis was applied to determine the net benefit. When dynamic changes in Hb, LMR, NLR, PLR, and PSA were included in a multivariate joint model, an increase in the log of the current value of PSA (HR: 1.24 [1.20–1.28]) was associated with inferior OS. A multivariate joint model that captured dynamic trajectory of Hb, NLR, PLR, LMR, and PSA up to 24 months, showed a net benefit over the “treat all” strategy at a threshold of probability of approximately ≥30% while no net benefit was seen when dynamic change in PSA was omitted. Our joint model could be used for designing future adaptive trials investigating sequential treatment personalization.

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Section: Discussionmentioning

confidence: 99%

Prognostic Role of Dynamic Changes in Serological Markers in Metastatic Hormone Naïve Prostate Cancer

Roy,

Sun,

Wallis

et al. 2023

Cancers

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“…Our results should provoke further studies investigating the use of PSMA PET-CT for risk stratification to identify the optimal treatment regimes for newly diagnosed metastatic PCa. This is particularly pertinent given the introduction of duplet and triplet combination therapies using ADT, chemotherapy and novel androgen receptor pathway inhibitors for metastatic hormone sensitive PCa [ 18 ]. Many risk classifications made using conventional imaging need updating in the PSMA PET-CT era.…”

Section: Discussionmentioning

confidence: 99%

Distant Nodes Seen on PSMA PET-CT Staging Predicts Post-Treatment Progression in Men with Newly Diagnosed Prostate Cancer—A Prospective Cohort Study

Ong

Pascoe

Kelly

et al. 2022

Cancers

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PSMA PET-CT scans are now recommended in international urological guidelines for primary staging and re-staging of prostate cancer. However, there is little published literature on the clinical outcomes for patients after treatment decisions made using PSMA PET-CT results. This is a multisite, prospective cohort study investigating the clinical outcomes of men who received treatment plans based on PSMA PET-CT results for primary staging. Men with biopsy proven prostate cancer received a PSMA PET-CT scan for primary staging. Treatment plans were recommended by multidisciplinary teams (MDT). After treatment, these men were followed with 6 monthly PSA tests and imaging or biopsies if recommended by MDT. The primary outcome was treatment progression defined as the addition or change of any treatment modalities such as androgen deprivation therapy, radiation therapy or chemotherapy. In total, 80% of men did not have any treatment progression after enactment of treatment based on PSMA PET-CT primary staging results at 29 months of follow up. Men who had distant nodes seen on PSMA PET-CT had a 5 times increased risk of treatment progression. Larger studies with longer follow up are needed to validate our results and optimise the way clinicians use PSMA PET-CT results to guide management.

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“…These three trials were the first to assess the potential benefit of triplet therapy (ADT, docetaxel and an ARI) in mHSPC, however use of docetaxel was at physician discretion. Therefore, although no OS benefit was seen with triplet therapy, it is plausible that patients with more extensive disease would have a higher likelihood of receiving docetaxel, which could in turn reduce the perceived benefit of adding chemotherapy [12].…”

Section: Treatment Intensification – Triplet Versus Doublet Therapymentioning

confidence: 99%

Systemic therapy in metastatic hormone-sensitive prostate cancer

McDonald

O’Brien

Kostos

et al. 2022

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of reviewThe landscape of metastatic hormone sensitive prostate cancer (mHSPC) has evolved rapidly in recent years with new data from landmark trials supporting upfront treatment intensification. The developments come not only on the fronts of systemic agents but also in area of therapy to primary tumour and metastases. Recent findingsMore recently, the ARASENS and PEACE trials have taken the concept of treatment intensification further by demonstrating survival benefit from combination of chemotherapy (docetaxel) and androgen receptor pathway inhibitors (abiraterone and darolutamide) in addition to backbone therapy of androgen deprivation therapy (ADT). Intensification of treatment has also seen evidence supporting local therapy to the primary tumour with overall survival and biochemical recurrence-free survival although only evident in low volume synchronous metastases. There is emerging evidence for metastases-directed therapy as well with pooled data suggesting improved biochemical-free and ADT-free survival.

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Double or Triple Trouble in Metastatic Hormone-sensitive Prostate Cancer?

Cited by 3 publications

References 7 publications

Prognostic Role of Dynamic Changes in Serological Markers in Metastatic Hormone Naïve Prostate Cancer

Prognostic Role of Dynamic Changes in Serological Markers in Metastatic Hormone Naïve Prostate Cancer

Distant Nodes Seen on PSMA PET-CT Staging Predicts Post-Treatment Progression in Men with Newly Diagnosed Prostate Cancer—A Prospective Cohort Study

Systemic therapy in metastatic hormone-sensitive prostate cancer

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