Therapeutic Advances in Medical Oncology (Mar 2023)

Clinical outcomes of volume of disease on patients receiving enzalutamide abiraterone acetate plus prednisone as first-line therapy for metastatic castration-resistant prostate cancer

  • Pier Vitale Nuzzo,
  • Francesco Ravera,
  • Calogero Saieva,
  • Elisa Zanardi,
  • Giuseppe Fotia,
  • Andrea Malgeri,
  • Sabrina Rossetti,
  • Loana Bueno Valença,
  • Talal El Zarif,
  • Matthew P. Davidsohn,
  • Heather McClure,
  • Thiago Martins Oliveira,
  • Charles Vauchier,
  • Ricardo Pereira Mestre,
  • Mikol Modesti,
  • Praful Ravi,
  • Anna Patrikidou,
  • Sandro Pignata,
  • Giuseppe Procopio,
  • Giuseppe Fornarini,
  • Ugo De Giorgi,
  • Antonio Russo,
  • Edoardo Francini

DOI
https://doi.org/10.1177/17588359231156147
Journal volume & issue
Vol. 15

Abstract

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Background: Androgen receptor signaling inhibitors (ARSis) abiraterone acetate (AA) plus prednisone and enzalutamide (Enza), are currently the most administered first-line treatments for metastatic castration-resistant prostate cancer (mCRPC). AA and Enza have shown similar overall survival (OS) benefits and there is no consensus upon the best option for mCRPC first-line treatment. Volume of disease may represent a useful biomarker to predict response to therapy in such patients. Objectives: In this study, we seek to evaluate the impact of volume of disease on patients treated with first-line AA versus Enza for mCRPC. Design and methods: We retrospectively evaluated a cohort of consecutive patients with mCRPC categorized by volume of disease [high volume (HV) or low volume (LV) per E3805 criteria] at ARSi onset and treatment type (AA or Enza), assessing OS and radiographic progression-free survival (rPFS), from therapy start, as co-primary endpoints. Results: Of the 420 patients selected, 170 (40.5%) had LV and received AA (LV/AA), 76 (18.1%) LV and had Enza (LV/Enza), 124 (29.5%) HV and were given AA (HV/AA), and 50 (11.9%) HV and received Enza (HV/Enza). Among patients with LV, OS was significantly longer when treated with Enza [57.2 months; 95% confidence interval (CI): 52.1–62.2 months] versus AA (51.6 months; 95% CI, 42.6–60.6 months; p = 0.003). Consistently, those with LV receiving Enza showed increased rPFS (40.3 months; 95 CI, 25.0–55.7 months) than those having AA (22.0 months; 95% CI, 18.1–26.0 months; p = 0.004). No significant difference in OS or rPFS was observed in those with HV treated with AA versus Enza ( p = 0.51 and p = 0.73, respectively). In multivariate analysis of patients with LV, treatment with Enza was independently associated with better prognosis than AA. Conclusion: Within the intrinsic limitations of a retrospective design and small population, our report suggests that volume of disease could be a useful predictive biomarker for patients starting first-line ARSi for mCRPC.