(UroToday.com) The 2023 ESMO annual meeting included a session on prostate cancer, featuring a presentation by Dr. Nishita Tripathi discussing the impact of intensified ADT in the metastatic castration-sensitive prostate cancer (mCSPC) setting on metastatic castration-resistant prostate cancer (mCRPC) disease characteristics and survival outcomes. ADT intensification is the standard of care treatment for mCSPC.
Survival outcomes, such as progression free survival (PFS) and overall survival (OS), are improved when associated with use of ADT intensification in the mCSPC setting, improving to 47.6 months and 81.1 months, respectively. Dr. Tripathi and colleagues hypothesized that patients who received ADT intensification in mCSPC and progressed to mCRPC would have different disease characteristics and survival than those treated with ADT monotherapy in the mCSPC setting.
For this study, patient-level data were collected retrospectively. Eligibility included a confirmed diagnosis of mCRPC, treated with first line approved treatment, and with follow up data available. Patients were stratified based on whether they received ADT intensification (docetaxel or novel hormonal therapies) or ADT monotherapy in the mCSPC setting. The study endpoints included PFS, as well as OS from time of mCRPC diagnosis. A multivariate analysis using the Cox proportional hazards model was used adjusting for potential confounders.
There were 519 consecutive patients (368 receiving ADT monotherapy and 151 receiving ADT intensification) seen at the University of Utah between 2009 to 2022 that were eligible.
mCRPC patients who received ADT intensification compared to ADT monotherapy had lower PSA (10.3 vs. 21.5 ng/ml, p = 0.003), more visceral metastases (20.5 vs. 11.1%, p = 0.005), higher alkaline phosphatase (110.5 vs. 96 U/L, p = 0.034). The baseline characteristics are as follows:
Moreover, patients treated with ADT intensification in the mCSPC setting had significantly worse median PFS (5.3 vs. 8.6 months, p < 0.001) and OS (21.2 vs. 31.7 months, p < 0.001) compared to those with ADT monotherapy in both univariate and multivariate analysis:
The limitations of this study include the retrospective nature and the single institutional experience.
Dr. Tripathi concluded her presentation discussing the impact of intensified ADT in the mCSPC setting on mCRPC disease characteristics and survival outcomes with the following take-home points:
- Patients who were treated with ADT intensification had poorer survival outcomes in the mCRPC setting compared to those treated with ADT monotherapy
- These data may aid patient counseling, prognostication, and clinical trial design in mCRPC in the current era
Presented by: Nishita Tripathi, MD, University of Utah, Salt Lake City, UT
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2023 European Society of Medical Oncology (ESMO) Annual Meeting, Madrid, Spain, Fri, Oct 20 – Tues, Oct 24, 2023.