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.
Cancers. 2023 Sep 29*** epublish ***
Mariaconsiglia Ferriero, Francesco Prata, Umberto Anceschi, Serena Astore, Alfredo Maria Bove, Aldo Brassetti, Fabio Calabrò, Silvia Chiellino, Cosimo De Nunzio, Gaetano Facchini, Elisena Franzese, Michela Izzo, Riccardo Mastroianni, Leonardo Misuraca, Richard Naspro, Rocco Papalia, Annalisa Pappalardo, Giorgia Tema, Gabriele Tuderti, Beatrice Turchi, Andrea Tubaro, Giuseppe Simone
Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy., Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy., Department of Medical Oncology, San Camillo-Forlanini Hospital, 00149 Rome, Italy., Department of Oncology, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy., Department of Urology, Faculty of Health Sciences, "Sapienza" University, Ospedale Sant'Andrea, 00185 Rome, Italy., Medical Oncology Complex Unit, "Santa Maria della Grazie" Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy., Department of Urology, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy.