Impact of new systemic therapies on overall survival of patients with metastatic castration-resistant prostate cancer in a hospital-based registry

Edoardo Francini; Kathryn P Gray; Grace K Shaw; Carolyn P Evan; Anis A Hamid; Caitlin E Perry; Philip W Kantoff; Mary-Ellen Taplin; Christopher J Sweeney

doi:10.1038/s41391-018-0121-2

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Impact of new systemic therapies on overall survival of patients with metastatic castration-resistant prostate cancer in a hospital-based registry

Journal article

Peer reviewed

Impact of new systemic therapies on overall survival of patients with metastatic castration-resistant prostate cancer in a hospital-based registry

Edoardo Francini, Kathryn P Gray, Grace K Shaw, Carolyn P Evan, Anis A Hamid, Caitlin E Perry, Philip W Kantoff, Mary-Ellen Taplin and Christopher J Sweeney

Prostate cancer and prostatic diseases, Vol.22(3), pp.420-427

09/01/2019

DOI: 10.1038/s41391-018-0121-2

PMID: 30643173

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Abstract

In 2004, docetaxel was shown to prolong the overall survival (OS) of patients with metastatic castration-resistance prostate cancer (mCRPC). Since 2010, five new systemic therapies have been shown to prolong OS in men with mCRPC. We sought to evaluate the aggregate impact of these newer therapies on the OS of patients with mCRPC. Two cohorts of patients diagnosed with mCRPC between 2004 and 2007, treated with drugs used in the limited treatment era only (A), and between 2010 and 2013, treated also with newer therapies (B), were identified from the Dana-Farber Cancer Institute database. The analysis endpoint was OS within 5 years after mCRPC diagnosis. Kaplan-Meier method assessed time-to-event distributions with median (95% confidence interval (CI)). A piece-wise regression model assessed the association between endpoint and treatment cohorts with estimate of hazard ratio (HR) with 95% CI within two time segments in univariate and multivariable analyses adjusting for relevant covariates. Compared to cohort A (n = 318), cohort B (n = 272) patients in newer therapy era demonstrated an OS advantage (2.8 vs. 2.2 years) with a 41% decreased risk of death (HR = 0.59; 95% CI, 0.47-0.74; P < 0.0001), and a 3-year OS rate of 46% vs. 33%. This benefit was accentuated (median OS 2.7 vs. 2.1 years; HR = 0.46; 95% CI, 0.32-0.67; P < 0.0001) in patients who initially presented with de-novo metastatic disease (de-novo). On multivariable analysis, longer OS was associated with cohort B vs. A and performance status 0 vs. 1. Using a single-institution registry, mCRPC patients treated since 2010 had a significant survival improvement vs. those treated before 2010. Although the median survival was only modestly improved and less than predicted when simply adding each newer drug survival advantage, the cumulative benefit from the new therapies was more pronounced in longer-term survivors and de-novo patients.

Aged

Antineoplastic Combined Chemotherapy Protocols - therapeutic use

Cancer Care Facilities - statistics & numerical data

Disease-Free Survival

Follow-Up Studies

Humans

Kaplan-Meier Estimate

Male

Middle Aged

Neoplasm Recurrence, Local - blood

Neoplasm Recurrence, Local - epidemiology

Neoplasm Recurrence, Local - prevention & control

Prognosis

Prospective Studies

Prostate-Specific Antigen - blood

Prostatic Neoplasms, Castration-Resistant - blood

Prostatic Neoplasms, Castration-Resistant - drug therapy

Prostatic Neoplasms, Castration-Resistant - mortality

Registries - statistics & numerical data

Retrospective Studies

Survival Rate

Time Factors

Details

Title: Subtitle: Impact of new systemic therapies on overall survival of patients with metastatic castration-resistant prostate cancer in a hospital-based registry
Creators: Edoardo Francini - Harvard University
Kathryn P Gray - Harvard University
Grace K Shaw - Harvard University
Carolyn P Evan - Harvard University
Anis A Hamid - Dana-Farber Cancer Institute
Caitlin E Perry - Harvard University
Philip W Kantoff - Memorial Sloan Kettering Cancer Center
Mary-Ellen Taplin - Dana-Farber Cancer Institute
Christopher J Sweeney - Harvard University
Resource Type: Journal article
Publication Details: Prostate cancer and prostatic diseases, Vol.22(3), pp.420-427
DOI: 10.1038/s41391-018-0121-2
PMID: 30643173
ISSN: 1365-7852
eISSN: 1476-5608
Grant note: P30 CA008748 / NCI NIH HHS
Language: English
Date published: 09/01/2019
Academic Unit: Internal Medicine
Record Identifier: 9985221147402771

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