Impact of progression at baseline ... on-treatment progression ...

[pjoshea13]

Interesting new study below [1].

"There is a discussion about the optimal timing to initiate or switch treatment in metastatic castration-resistant prostate cancer (mCRPC). This post hoc analysis of 3 large trials for men with mCRPC {VENICE, TAX327 & FIRSTANA} examined the influence of the type of progression at initiation of first-line chemotherapy, as well as the type of progression during treatment, on treatment outcomes."

"Type of progression was defined as follows: prostate-specific antigen (PSA) only (group 1), radiological (±PSA) (group 2) or pain (±PSA, ± radiological) progression (group 3)."

"The median OS {overall survival } (arms combined) from treatment initiation in VENICE was 28.6, 26.3 and 16.9 months for G1, G2 and G3, respectively"

"Similar findings were observed in ... TAX327 and FIRSTANA"

"During treatment, pain and/or radiological progression preceded PSA progression as the first progression event in ~55% of the patients. This finding has the prospect to be incorporated in clinical guidelines and to be practice changing because it implies the need for regular imaging and not to rely on PSA progression alone."

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/318...

Eur J Cancer. 2019 Dec 11. pii: S0959-8049(19)30801-9. doi: 10.1016/j.ejca.2019.10.029. [Epub ahead of print]

Impact of progression at baseline and on-treatment progression events in three large prostate cancer trials.

Robbrecht DG1, Delanoy N2, Tannock IF3, Tombal B4, Eisenberger M5, Fizazi K6, Sartor O7, Mercier F8, Oudard S9, de Wit R10.

Author information

1

Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. Electronic address: [e-mail].

2

Medical Oncology, European Georges Pompidou Hospital, Paris, France. Electronic address: [e-mail].

3

Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, CA, USA. Electronic address: [e-mail].

4

Urology, Cliniques Universitaires St. Luc, Brussels, Belgium. Electronic address: [e-mail].

5

Medical Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, USA. Electronic address: [e-mail].

6

Department of Cancer Medicine, Gustave Roussy Institute, Villejuif, France. Electronic address: [e-mail].

7

Medicine and Urology, Tulane Cancer Center, New Orleans, LA, USA. Electronic address: [e-mail].

8

Stat Process, Sanofi, Paris, France. Electronic address: [e-mail].

9

Medical Oncology, European Georges Pompidou Hospital, Paris, France. Electronic address: [e-mail].

10

Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. Electronic address: [e-mail].

Abstract

BACKGROUND:

There is a discussion about the optimal timing to initiate or switch treatment in metastatic castration-resistant prostate cancer (mCRPC). This post hoc analysis of 3 large trials for men with mCRPC examined the influence of the type of progression at initiation of first-line chemotherapy, as well as the type of progression during treatment, on treatment outcomes.

METHODS:

Data from the phase III studies VENICE (n = 1224), TAX327 (n = 1006) and FIRSTANA (n = 1168) were used as independent data sets. Type of progression was defined as follows: prostate-specific antigen (PSA) only (group 1), radiological (±PSA) (group 2) or pain (±PSA, ± radiological) progression (group 3). The impact of baseline type of progression on overall survival (OS) was evaluated in multivariate Cox regression analysis with backward elimination, stratified for the Eastern Cooperative Oncology Group performance score and treatment arm.

RESULTS:

The median OS (arms combined) from treatment initiation in VENICE was 28.6, 26.3 and 16.9 months for G1, G2 and G3, respectively (hazard ratio: 1.14 [95% confidence interval {CI}: 0.92-1.41%] in G2 and 2.13 [95% CI: 1.75-2.59%] in G3 compared with G1). Multivariate analysis (arms combined) showed that pain progression at baseline was an independent predictor of poor OS. Similar findings were observed in the TAX327 and FIRSTANA data sets. During treatment, pain or radiological progression preceded PSA progression in ~55% of the patients. The retrospective characteristic of this study is a limitation.

CONCLUSIONS:

The type of progression at baseline strongly predicts OS in men with mCRPC treated with first-line chemotherapy. During treatment, pain and/or radiological progression preceded PSA progression as the first progression event in ~55% of the patients. This finding has the prospect to be incorporated in clinical guidelines and to be practice changing because it implies the need for regular imaging and not to rely on PSA progression alone.

Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

KEYWORDS:

Castration-resistant prostate cancer; Survival; Treatment; Type of progression

PMID: 31837907 DOI: 10.1016/j.ejca.2019.10.029

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