Optimal sequencing of systemic therapy in the management of m-CRPC remains poorly elucidated. The CHAARTED and STAMPEDE studies have proven that early chemotherapy in the hormone-sensitive setting is superior to later chemotherapy. In a retrospective study, we attempt to investigate the two most common treatment sequences and investigate whether this holds true in the hormone-resistant setting.
Retrospectively, we identified 112 patients with m-CRPC. 80 patients (Group-A) received full course docetaxel chemotherapy followed by 2nd generation hormone therapy (2ndADT; Abiraterone or Enzalutamide). 32 patients (Group-B) received docetaxel after 2ndADT failed. The primary endpoint evaluated was 3-year cancer-specific survival.
Median PSA was 5 in Group-A and 13.95 in Group-B. Bone-metastases were more prevalent in Group-B (87% vs 58%). All other clinicopathologic variables were statistically similar between Group-A and Group- B. (Table 1) Three-year cancer-specific survival was 87.4% and 64.1% for Group-A and Group-B, p=0.016. (Figure 1a) We report Hazard Ratio of 3.61 (95% CI 1.74-9.5,0 p=0.01). Three-year overall survival was 82.4% and 60.8% for Group-A and Group-B, p=0.01. (Figure 1b) These results held true when excluding patients with lymph node only metastasis.
Our data indicates that sequence of systemic therapy may influence outcomes for m-CRPC and that Docetaxel should be considered prior to 2nd generation ADT. Selection bias is inherent in retrospective studies such as this, however our results support the importance of earlier chemotherapy in the hormone-resistant state.
SYSTEMIC TREATMENT FOR METASTATIC CASTRATION RESISTANT PROSTATE CANCER (m-CRPC): DOES SEQUENCE MATTER?
Prostate Cancer > CRPC
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Poster #73 / Podium #
Poster Session I
2:00 PM - 5:30 PM
Presented By: Jack Andrews