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The clinical benefit of sequential therapy with androgen receptor axis‐targeted agents alone in patients with castration‐resistant prostate cancer: A propensity score‐matched comparison study
Author(s) -
Naito Yushi,
Kato Masashi,
Kawanishi Hideji,
Yuguchi Yuri,
Yuba Takuma,
Ishikawa Tomohiro,
Hattori Kyosuke,
Yamamoto Akiyuki,
Sano Tomoyasu,
Matsukawa Yoshihisa,
Kimura Toru,
Nishikimi Toshinori,
Hattori Ryohei,
Tsuzuki Toyonori,
Gotoh Momokazu
Publication year - 2020
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.24069
Subject(s) - propensity score matching , enzalutamide , docetaxel , prostate cancer , medicine , oncology , androgen deprivation therapy , confounding , combination therapy , androgen receptor , cancer
Background The optimal sequential therapy for castration‐resistant prostate cancer (CRPC) remains unknown. In recent years, some doubts have emerged regarding the clinical benefit of sequential therapy with androgen receptor axis‐targeted agents (ART) such as abiraterone (ABI) or enzalutamide (ENZ) for patients with CRPC. We compared the effect of ART‐to‐ART (AA) sequential therapy after castration resistance with that of docetaxel (DTX)‐combined sequential therapy (ART to DTX or DTX to ART) in patients with CRPC. Methods We retrospectively identified and analyzed the data of 315 patients with CRPC treated in our seven affiliated institutions between 2009 and 2019. All patients received either DTX or ART (ABI or ENZ) as the first‐ or second‐line therapy after castration resistance. We compared the overall survival (OS) and the second progression‐free survival (PFS2), calculated from the initiation of first‐line therapy after castration resistance, between the AA sequence group and the DTX‐combined sequence group. PFS2 was defined as the period from the start of first‐line treatment after castration resistance to progression on second‐line treatment. To minimize selection bias from possible confounders, we performed propensity score matching using one‐to‐one nearest neighbor matching without replacement. Results Overall, 106 and 209 patients were administered the AA sequential therapy and DTX‐combined sequential therapy, respectively. The clinicopathological variables of patients were well balanced after propensity score matching, and there were no significant differences between the two groups. In the propensity score‐matched cohort, OS was not significantly different between the two groups (median, 37.9 vs. 45.4 months; hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.68–1.79; p = .701), while PFS2 was significantly shorter in the AA group than in the DTX‐combined group (median, 12.9 vs. 21.6 months; HR, 1.70; 95% CI, 1.16–2.48; p = .007). Conclusions Certain patients with CRPC can benefit from ART‐to‐ART sequential therapy in a daily clinical setting.