CLINICAL RESPONSE AND TIME TO PROSTATE-SPECIFIC ANTIGEN (PSA) PROGRESSION IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER (MCRPC) RECEIVING SECOND-LINE CHEMOTHERAPY VERSUS ALTERNATIVE ANDROGEN RECEPTOR-TARGETED AGENTS (ARTA) AFTER A LACK OF RESPONSE TO FIRST-LINE ARTA IN US COMMUNITY ONCOLOGY PRACTICES

OBJECTIVES: The relationship between treatment sequence and outcomes in mCRPC is unclear. This retrospective cohort study assessed if second-line taxanebased chemotherapy vs alternative ARTA is associated with improved clinical response and time to PSA progression in patients with a lack of response...

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Bibliographic Details
Published in:Value in health 2017-05, Vol.20 (5), p.A89
Main Authors: Oh, WK, Cheng, WY, Miao, R, Vekeman, F, Gauthier-Loiselle, M, Duh, MS, Drea, E, Szatrowski, T
Format: Article
Language:English
Subjects:
Alkaline phosphatase
Alternatives
Androgen receptors
Androgens
Castration
Chemotherapy
Cohort analysis
Computerized medical records
Electronic medical records
Hemoglobin
L-Lactate dehydrogenase
Lactic acid
Medical prognosis
Medical records
Metastases
Metastasis
Oncology
Opioids
Patients
Prostate
Prostate cancer
Prostate-specific antigen
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Summary:OBJECTIVES: The relationship between treatment sequence and outcomes in mCRPC is unclear. This retrospective cohort study assessed if second-line taxanebased chemotherapy vs alternative ARTA is associated with improved clinical response and time to PSA progression in patients with a lack of response to first-line ARTA in the US community oncology setting. METHODS: Using Altos electronic medical records, 345 mCRPC patients were identified who lacked response to first-line ARTA (abiraterone: N=289; enzalutamide: N=56) and received second-line chemotherapy (docetaxel: N=128; cabazitaxel: N=19), or alternative ARTA (enzalutamide: N=170; abiraterone: N=28) from 05/2011 to 10/ 2014. Outcomes were evaluated from second-line therapy initiation and compared between the two cohorts using one-sided tests. Clinical response (clinical note, ECOG performance status (PS) reduction by ≥1, ≥5% weight increase, or ≥2g/dl hemoglobin (Hb) increase over ≥3 months) and time to PSA progression (≥25% increase over nadir concentration) were assessed using logistic and Cox regressions adjusted for year, age, metastases, opioid use, ECOG PS, PSA, Hb, alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and albumin (Alb) levels. RESULTS: At start of second-line therapy, patients receiving chemotherapy vs ARTA were younger (median age, 74 vs 79 years) and had a poorer prognosis: higher mean PSA (439 vs 231 ng/mL), LDH (344 vs 234 Mg/L) and ALP (241 vs 166 p/L) levels, lower mean Hb levels (11 vs 12 g/dL), higher mean Halabi risk score (159 vs 137; JCO 2014:32;671-7), and more patients had Alb levels
ISSN:1098-3015
1524-4733
DOI:10.1016/j.jval.2017.05.005