Anticancer Effect of Second-line Treatment for Castration-Resistant Prostate Cancer Following First-line Treatment with Androgen Receptor Pathway Inhibitors
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- Matsumoto Takashi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- Shiota Masaki
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- Yamada Shigetomo
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- Blas Leandro
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- Naganuma Hidekazu
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- Lee Ken
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- Monji Keisuke
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- Kashiwagi Eiji
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- Takeuchi Ario
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- Inokuchi Junichi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- Shiga Ken-ichiro
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
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- Yokomizo Akira
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
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- Eto Masatoshi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Description
<p>Introduction: Studies on the effect of androgen receptor pathway inhibitors (ARPI), docetaxel (DTX), and radium-223 (Ra-223) after first-line treatment with ARPI in patients with castration-resistant prostate cancer (CRPC) are scarce. This study compared the efficacy of treatment after ARPI for CRPC.</p><p>Methods: Patients with CRPC who received ARPI as first-line treatment and different second-line treatments were retrospectively reviewed. Clinicopathological backgrounds and treatment outcomes, including maximum prostate-specific antigen (PSA) decrease, progression-free survival (PFS), and overall survival (OS), were compared between second-line treatments.</p><p>Results: In total, 88 patients were enrolled. Forty-one (46.6%), 37 (42.0%), and 10 (11.4%) patients were treated with ARPI, DTX, and Ra-223, respectively. Patients whose PSA levels were not adequately reduced by first-line treatment with ARPI were eventually enrolled in the DTX treatment (P = 0.030). PSA decrease was not significantly different when comparing treatments. PFS in the DTX group was significantly better than in the other two groups (P = 0.023). In multivariate analysis, DTX was an independent prognostic factor for better PFS compared to ARPI (hazard ratio, 95% confidence interval; 0.44, 0.25-0.79, P = 0.006). Subgroup analysis showed a favorable impact of DTX on PFS in patients with Gleason score >8 (interaction P = 0.027) and a PSA decline >50% (interaction P = 0.019) during first-line treatment with ARPI. However, no significant difference in OS was observed between groups of different second-line treatments.</p><p>Conclusions: This study suggests that in patients with CRPC, second-line treatment with DTX following progression in patients who received ARPI as first-line treatment is more beneficial compared with second-line treatment with ARPI or Ra-233.</p>
Journal
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- JMA Journal
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JMA Journal 5 (1), 83-90, 2022-01-17
Japan Medical Association / The Japanese Associaiton of Medical Sciences
