Effect of upfront intensive therapy on oncological outcomes in older patients with high tumor burden metastatic castration‐sensitive prostate cancer: A multicenter retrospective study

Miura, Yuki; Narita, Shintaro; Kimura, Takahiro; Hata, Kenichi; Yanagisawa, Takafumi; Tanaka, Toshikazu; Ishi, Noritaka; Kawamura, Sadafumi; Hoshi, Senji; Ishidoya, Shigeto; Mitsuzuka, Koji; Ito, Akihiro; Tsuchiya, Norihiko; Egawa, Shin; Habuchi, Tomonori; Οhyama, Chikara

doi:10.1002/pros.24404

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…Miura Y. et al reported that upfront intensive therapy with Docetaxel or AA did prolong CRPC-free survival (p = 0.022) after stratification for age ≥75 years [16]. On the contrary, Narita S. et al showed how upfront AA provided better CRPC-free survival than upfront chemotherapy (p = 0.002); however, no significant differences in second-line PFS or OS were observed between the two groups (p = 0.254 and p = 0.444, respectively) [17].…”

Section: Discussionmentioning

confidence: 99%

Oncological Outcomes of Patients with High-Volume mCRPC: Results from a Longitudinal Real-Life Multicenter Cohort

Ferriero,

Prata,

Anceschi

et al. 2023

Cancers

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Registrative trials recommended the use of upfront chemotherapy in high-volume metastatic prostate cancer. We reported survival outcomes of patients with high-volume mCRPC treated with ARTA in a chemo-naïve setting compared to patients treated with chemotherapy as first-line from a longitudinal real-life multicenter series. We retrospectively collected data on mCRPC patients treated at six centers. The dataset was queried for high-volume disease (defined as more than 6 bone lesions or bulky nodes ≥ 5 cm). We compared the main clinical features of chemo-naïve versus chemo-treated patients. The Mann–Whitney U test and Chi-squared test were used to compare continuous and categorial variables, respectively. The Kaplan–Meier method was used to compare differences in terms of progression-free survival (PFS), cancer specific survival (CSS) and overall survival (OS) in an upfront ARTA or chemo-treated setting. Survival probabilities were computed at 12, 24, 48, and 60 months. Out of 216 patients, 88 cases with high-volume disease were selected. Sixty-nine patients (78.4%) received upfront ARTA, while 19 patients received chemotherapy as the first-line treatment option. Forty-eight patients received Abiraterone (AA), 21 patients received Enzalutamide (EZ) as the first-line treatment. The ARTA population was older (p = 0.007) and less likely to receive further lines of treatment (p = 0.001) than the chemo-treated cohort. The five-year PFS, CSS and OS were 60%, 73.3%, and 72.9%, respectively. Overall, 28 patients (31.8%) shifted after their first-line therapy to a second-line therapy: EZ was prescribed in 17 cases, AA in seven cases and radiometabolic therapy in four patients. Sixteen cases (18.2%) developed significant progression and were treated with chemotherapy. At Kaplan–Meyer analysis PFS, CSS and OS were comparable for upfront ARTA vs chemo-treated patients (log rank p = 0.10, p = 0.64 and p = 0.36, respectively). We reported comparable survival probabilities in a real-life series of high-volume mCRPC patients who either received upfront ARTA or chemotherapy. Patients primarily treated with chemotherapy were younger and more likely to receive further treatment lines than the upfront ARTA cohort. Our data support the use of novel antiandrogens as first line treatment regardless tumor burden, delaying the beginning of a more toxic chemotherapy in case of significant disease progression.

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Section: Discussionmentioning

confidence: 99%

Oncological Outcomes of Patients with High-Volume mCRPC: Results from a Longitudinal Real-Life Multicenter Cohort

Ferriero,

Prata,

Anceschi

et al. 2023

Cancers

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Trends in novel antiandrogen receptor signal inhibitor use and medical costs in prostate cancer

Miura,

Yamamoto,

Okuyama

et al. 2024

Cancer Medicine

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ObjectiveWe aimed to examine trends in novel antiandrogen receptor signal inhibitor (ARSI) usage and medical costs by collecting real‐world big data included in The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data, covering most of the clinical practices throughout Japan.MethodsUsage data for outpatient prescriptions from 2016 to 2021 were extracted from the NDB Open Data. Among the 459,610 million tablets/capsules prescribed, prostate cancer‐specific agents (bicalutamide, estramustine phosphate, flutamide, abiraterone, enzalutamide, apalutamide, and darolutamide) were selected to investigate the trends of usage and medical costs.ResultsIn total, 764.8 billion medications were recorded. Among these, standard dose‐adjusted prescriptions for bicalutamide, abiraterone, enzalutamide, apalutamide, darolutamide, and other vintages (estramustine phosphate, flutamide) was 276, 14.2, 18.1, 2.19, 0.34, and 20.3 million, respectively. The usage of ARSI increased significantly from 6.1% in 2016 to 16% in 2021. The medical costs for prostate cancer‐specific agents increased significantly (1.8‐fold) from 2016 to 2021. Despite the limited usage of ARSIs, a majority of the medical costs had been spent on ARSIs. Medical costs associated with ARSIs increased significantly from 59% to 89% (p < 0.001).ConclusionARSI usage and medical costs associated with prostate cancer increased significantly from 2016 to 2021. Despite the limited use of ARSIs, a considerable proportion of the medical costs for prostate cancer‐specific agents had been spent on ARSIs.

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Efficacy and safety of triple or dual therapies for metastatic hormone-sensitive prostate cancer: a systematic review and Bayesian network meta-analysis

Jiang,

Wang,

Bai

et al. 2024

Future Oncology

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Effect of upfront intensive therapy on oncological outcomes in older patients with high tumor burden metastatic castration‐sensitive prostate cancer: A multicenter retrospective study

Cited by 3 publications

References 25 publications

Oncological Outcomes of Patients with High-Volume mCRPC: Results from a Longitudinal Real-Life Multicenter Cohort

Oncological Outcomes of Patients with High-Volume mCRPC: Results from a Longitudinal Real-Life Multicenter Cohort

Trends in novel antiandrogen receptor signal inhibitor use and medical costs in prostate cancer

Efficacy and safety of triple or dual therapies for metastatic hormone-sensitive prostate cancer: a systematic review and Bayesian network meta-analysis

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