Androgen receptor signalling inhibitors (ARSIs) abiraterone acetate (AA) enzalutamide (Enza), are currently the standard first-line (L1) treatments for metastatic castration-resistant prostate cancer (mCRPC), and docetaxel (D) is reserved as second-line (L2) after ARSI failure.
Nonetheless, D use in men ≥ 75 years old is restricted owing to treatment toxicities and patient comorbidities, and a L2 alternative ARSI is frequently used. We aimed to evaluate real-life survival and toxicity outcomes of these elderly patients after failure of L1 ARSI treatment.
We retrospectively evaluated efficacy and safety in a real-world international cohort of consecutive patients ≥ 75 years old when starting L1 ARSI for mCRPC according to the choice of L2 treatment (D versus alternative ARSI).
Of the 122 identified patients, 57 (46.7%) had received L2 ARSI and 65 (53.3%) L2 D. No difference was found in the L1 overall survival (OS) for the ARSI and D groups (32.8 vs. 30.0 months, respectively; Hazard ratio [HR] = 1.22; 95% CI, 0.77-1.95; P = .40) or in the L2 OS (18.5 vs. 17.8 months, respectively; HR = 1.09; 95% CI, 0.69-1.74; P = .71). No difference was observed for rPFS from L2 (P = .12), although a trend was observed for a numerically improved rPFS on D.
Within the limitations of a retrospective design and small population, our study suggests that D or ARSI after failure of L1 alternative ARSI are clinically comparable L2 options for elderly patients with mCRPC.
Clinical genitourinary cancer. 2024 Oct 05 [Epub ahead of print]
Anna Patrikidou, Calogero Saieva, Richard Lee-Ying, Pier Vitale Nuzzo, Talal El Zarif, Heather McClure, Matthew Davidsohn, Marc Eid, Gian Paolo Spinelli, Fabio Catalano, Malvina Cremante, Giuseppe Fotia, Sabrina Rossetti, Loana Valenca, Charles Vauchier, Carlotta Ottanelli, Livia Andrade, Vincenzo Gennusa, Ricardo Pereira Mestre, Giuseppe Fornarini, Sandro Pignata, Giuseppe Procopio, Daniele Santini, Praful Ravi, Christopher Sweeney, Daniel Heng, Ugo De Giorgi, Karim Fizazi, Antonio Russo, Edoardo Francini, SPARTACUSS Group
Department of Medical Oncology and Early Drug Development Department, Gustave Roussy Institute, Villejuif, France., Cancer Risk Factors and Lifestyle Epidemiology Unit-ISPRO, Florence, Italy., Tom Baker Cancer Centre, Calgary, Alberta, Canada., Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY., Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA., Division of Medical Oncology, Casa della Salute di Aprilia, Latina, Sapienza University of Rome, Italy., Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy., Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy., Instituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy., Instituto D'Or de Pesquisa e Ensino, Salvador, Brazil., Department of Medical Oncology, Gustave Roussy Institute, Villejuif, France., University of Florence, Florence, Italy., Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy., Oncology Institute of Southern Switzerland, Bellinzona, Switzerland., Oncology Unit, Umberto I hospital, Rome, Italy., South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia., IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST), Meldola, Italy., Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/39461026