Real-world Characteristics and Outcomes of Patients wth Metastatic Castration-resistant Prostate Cancer Receiving Chemotherapy versus Androgen Receptor-targeted Therapy after Failure of First-line Androgen Receptor-targeted Therapy in the Community Setting
Clinical Genitourinary Cancer. 2017 Jun 19. pii: S1558-7673(17)30170-2
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 patientsreceiving 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-docetaxelpatients 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.