Patient characteristics and overall survival in patients with post-docetaxel metastatic castration-resistant prostate cancer in the community setting

• Published in: Medical oncology (Northwood, London, England) Vol. 34; no. 9; p. 160
• Main Authors: Oh, William K., Miao, Raymond, Vekeman, Francis, Sung, Jennifer, Cheng, Wendy Y., Gauthier-Loiselle, Marjolaine, Dhawan, Ravinder, Duh, Mei Sheng
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-09-2017; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Androstenes - therapeutic use; Antineoplastic Agents - therapeutic use; Docetaxel; Hematology; Humans; Internal Medicine; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Molecular Targeted Therapy - methods; Oncology; Original Paper; Pathology; Patients; Phenylthiohydantoin - analogs & derivatives; Phenylthiohydantoin - therapeutic use; Prostate cancer; Prostatic Neoplasms, Castration-Resistant - drug therapy; Prostatic Neoplasms, Castration-Resistant - mortality; Prostatic Neoplasms, Castration-Resistant - pathology; Receptors, Androgen - metabolism; Retrospective Studies; Taxoids - therapeutic use; Treatment Outcome; mCRPC; Chemotherapy; AR-targeted therapy; Cabazitaxel; Real-world
• ISSN: 1357-0560; 1559-131X
• DOI: 10.1007/s12032-017-1014-2

It is unclear how treatment sequencing for metastatic castration-resistant prostate cancer (mCRPC) affects real-world patient outcomes. We assessed treatment sequences, patient characteristics and overall survival (OS) in post-docetaxel mCRPC patients. mCRPC patients receiving second-line cabazitaxel or androgen receptor-targeted therapy (ART; abiraterone/enzalutamide) post-docetaxel were identified using electronic medical records. OS was assessed from second-line therapy initiation using Cox regressions adjusting for: metastases; prostate-specific antigen (PSA); hemoglobin; alkaline phosphatase (ALP); albumin; second-line therapy initiation year. Following docetaxel (
n
 = 629), 123 (19.6%) and 506 (80.4%) patients received cabazitaxel and ART, respectively. One hundred and ninety-five patients received additional treatments thereafter (54 following cabazitaxel; 141 following ART). Although patients receiving second-line cabazitaxel versus ART had similar disease characteristics at first-line therapy initiation, at second-line therapy initiation they had higher mean PSA (386.6 vs. 233.9 ng/mL) and ALP (182.0 vs. 167.3 u/L), lower mean hemoglobin (10.8 vs. 11.5 g/dL), and more frequently had intermediate/high-risk Halabi scores (61.8 vs. 48.4%); all
p
 < 0.05. Overall, crude survival was not significantly different. Among Halabi high-risk patients, adjusted median OS was significantly longer in patients receiving cabazitaxel versus ART (HR 0.48; 95% CI 0.24–0.93;
p
 = 0.030). Low albumin and hemoglobin led to similar findings (HR 0.43; 95% CI 0.23–0.80;
p
 = 0.0077; HR 0.60; 95% CI 0.40–0.90;
p
 = 0.014). Most post-docetaxel patients received second-line ART. Patients receiving second-line cabazitaxel had more high-risk features; however, second-line cabazitaxel administered after docetaxel may improve OS in patients with Halabi high-risk scores or low albumin/hemoglobin.