Journal Article

Survival outcomes of real world patients with metastatic hormone-sensitive prostate cancer who do not achieve optimal PSA response with intensified androgen deprivation therapy with docetaxel or androgen receptor pathway inhibitors

Sahu, Kamal Kant, Thomas, Vinay Mathew, McFarland, Taylor, Sayegh, Nicolas, Agarwal, Neeraj, Srivastava, Ayana, Jo, Yeon Jung, Chigarira, Beverly, Li, Haoran, Maughan, Benjamin L., Tripathi, Nishita, Swami, Umang, Gebrael, Georges

2024

Overview

Introduction In patients with metastatic hormone-sensitive prostate cancer (mHSPC) undergoing intensified androgen deprivation therapy (ADT), not achieving an optimal PSA response, defined as PSA nadir >0.2 ng/ml (PSA subOR ) has been associated with worse survival outcomes in clinical trials (1)(10)(11) . Here, we externally evaluate, the impact of optimal PSA response on survival outcomes in these patients and provide absolute PFS and OS measures in those with PSA subOR in the context of ADT intensification in real world setting. Methods In this retrospective study, all consecutive patients with mHSPC who underwent intensified ADT treated at our institution, and whose outcomes data were available, were included. We classified patients based on their PSA nadir on treatment: those with a on treatment PSA OR (PSA nadir ≤0.2 ng/ml) versus PSA subOR . Results A total of 205 patients were eligible: 136 (66.3%) patients achieved PSA OR versus 69 (33.7%) patients had PSA subOR . Patients who experienced a PSA OR had significantly improved PFS and OS from the start of intensified ADT versus who did not: PFS was not reached (NR) versus 11 months (hazard ratio (HR) 0.20, P  < 0.001) and OS was NR versus 38.9 months (HR 0.21, P  < 0.001). Survival outcomes were poor with PSA subOR regardless of intensification with docetaxel or an ARPI (absolute PFS and OS measures for each group are provided in the text). Conclusion Our study is the first to explore the negative impact of PSA subOR in patients with mHSPC undergoing intensified ADT in the real-world setting, and is the first to provide absolute PFS and OS in patients with PSA subOR receiving ADT intensification with ARPIs or docetaxel outside of clinical trial setting. These data will aid with prognostication, patient counseling, and for designing future clinical trials for patients with PSA subOR .

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 631/67/1059 / 692/53/2422 / Aged / Aged, 80 and over / Androgen Antagonists - administration & dosage / Androgen Antagonists - therapeutic use / Androgen Receptor Antagonists - administration & dosage / Androgen Receptor Antagonists - therapeutic use / Androgen receptors / Androgens / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Biomedical and Life Sciences / Biomedicine / Cancer Research / Clinical outcomes / Clinical trials / Deprivation / Docetaxel - administration & dosage / Docetaxel - therapeutic use / Follow-Up Studies / Humans / Male / Metastases / Metastasis / Middle Aged / Neoplasm Metastasis / Patients / Prognosis / Prostate cancer / Prostate-Specific Antigen - blood / Prostatic Neoplasms - drug therapy / Prostatic Neoplasms - mortality / Prostatic Neoplasms - pathology / Reproductive Medicine / Retrospective Studies / Survival / Survival analysis / Survival Rate