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Real-world outcomes and risk stratification in patients with metastatic castration-sensitive prostate cancer treated with upfront abiraterone acetate and docetaxel

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Abstract

Purpose

We assessed clinical outcomes in patients with metastatic castration-sensitive prostate cancer (mCSPC) treated with two upfront therapies.

Methods

The medical records of 301 patients with mCSPC treated with androgen deprivation therapy plus upfront abiraterone acetate (ABI) or docetaxel (DOC) between 2014 and 2021 were retrospectively reviewed. Propensity score matching (PSM) was performed to compare survival outcomes. Subgroup analyses of risk factors for second progression were conducted.

Results

A total of 95 patients received upfront DOC, whereas 206 received upfront ABI. After PSM, the ABI group had a significantly better castration-resistant prostate cancer (CRPC)-free survival than the DOC group [hazard ratio (HR), 0.53; 95% confidence interval (CI), 0.34–0.82]. Second progression-free survival (PFS2) tended to be longer in the ABI group than in the DOC group, but the difference was not statistically significant (HR, 0.64; 95% CI, 0.33–1.22). No significant difference in overall survival (OS) was found between the two groups (HR, 0.92; 95% CI, 0.42–2.03). In the subgroup analysis, upfront ABI had significantly favorable PFS2 in patients aged ≥ 75 years compared with upfront DOC (p = 0.038). Four risk factors for second progression (primary Gleason 5, liver metastasis, high serum alkaline phosphatase level, and high serum lactate dehydrogenase level) successfully stratified patients into three risk groups.

Conclusions

Upfront ABI provided better CRPC-free survival than upfront DOC; however, no significant differences in PFS2 or OS were observed between the two groups. Personalized management based on prognostic risk factors may benefit patients with mCSPC treated with upfront intensified therapies.

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Acknowledgements

We express our appreciation to Yukiko Sugiyama, Ken Watanabe, Nana Tomatsu, and Saeko Nakamura for their assistance in performing this study.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-profit sectors.

Author information

Authors and Affiliations

  1. Department of Urology, Akita University School of Medicine, Akita, Japan

    Shintaro Narita, Hiromi Sato, Soki Kashima, Atsushi Koizumi, Ryohei Yamamoto & Tomonori Habuchi

  2. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan

    Takahiro Kimura, Kenichi Hata, Takafumi Yanagisawa & Shin Egawa

  3. Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan

    Shingo Hatakeyama & Chikara Ohyama

  4. Department of Urology, Atsugi City Hospital, Kanagawa, Japan

    Kenichi Hata

  5. Department of Urology, Iwate Prefectural Isawa Hospital, Mizusawa, Japan

    Shinya Maita & Jiro Shimoda

  6. Department of Urology, Yuri Kumiai General Hospital, Honjo, Japan

    Shuji Chiba

  7. Department of Urology, Yokote City Hospital, Yokote, Japan

    Koichiro Takayama

  8. Department of Urology, Akita Kosei Medical Center, Akita, Japan

    Katsumi Okane

  9. Department of Urology, Akita City Hospital, Akita, Japan

    Toshiya Ishida

  10. Department of Urology, Akita Red Cross Hospital, Akita, Japan

    Yohei Horikawa

  11. Department of Urology, Omagari Kosei Medical Center, Daisen, Japan

    Teruaki Kumazawa

  12. Department of Urology, Hiraka General Hospital, Yokote, Japan

    Takehiro Suzuki

Authors
  1. Shintaro Narita
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  2. Takahiro Kimura
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Contributions

Shintaro Narita: data collection, study design, statistical analysis, and manuscript writing. Takahiro Kimura and Shingo Hatakeyama: study design and data collection. Kenichi Hata, Takafumi Yanagisawa, Shinya Maita, Shuji Chiba, Hiromi Sato, Soki Kashima, Atsushi Koizumi, Ryohei Yamamoto, Koichiro Takayama, Katsumi Okane, Toshiya Ishida, Yohei Horikawa, Teruaki Kumazawa, Jiro Shimoda, and Takehiro Suzuki: data collection. Kyoko Nomura: statistical analysis. Chikara Ohyama and Shin Egawa: supervision. Tomonori Habuchi: supervision and manuscript writing. All authors had read and approve of the final manuscript.

Corresponding author

Correspondence to Shintaro Narita.

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Conflict of interest

Shintaro Narita received honoraria from Janssen Pharmaceutical K.K. Takahiro Kimura is a paid consultant/advisor of Astellas Pharma Inc., Bayer AG, Janssen Pharmaceutical K.K and Sanofi S.A. Shin Egawa is a paid consultant/advisor of Takeda, Astellas, AstraZeneca, Sanofi, Janssen, and Pfizer. Shingo Hatakeyama received honoraria from Janssen Pharmaceutical K.K. and Pfizer Inc. and Nipro Corporation. Chikara Ohyama received honoraria from Astellas Pharma Inc., NIPPON SHINYAKU Company Ltd., AstraZeneca K.K., Janssen Pharmaceutical K.K., Takeda Pharmaceutical Company Ltd., Novartis Pharma K.K., ONO Pharmaceutical Company Ltd., Chugai Pharmaceutical Company Ltd., Sanofi S.A., Bayer AG., Pfizer Inc., Bristol Myers Squibb, Otsuka Pharmaceutical Company Ltd., KISSEI Pharmaceutical Company Ltd., Kyowa Kirin Company Ltd., Daiichi Sankyo Company Ltd., KANEKA Corporation, and Nipro Corporation. Tomonori Habuchi also received honoraria from Janssen Pharmaceutical K.K., Takeda Pharmaceutical Company Ltd., Astellas Pharma Inc., Daiichi Sankyo Company, Ltd., AstraZeneca K.K., Sanofi S.A., and Bayer AG. The other authors have no disclosures.

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The retrospective multicenter study was approved by each institutional review board and representative facility (A2018-03).

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Narita, S., Kimura, T., Hatakeyama, S. et al. Real-world outcomes and risk stratification in patients with metastatic castration-sensitive prostate cancer treated with upfront abiraterone acetate and docetaxel. Int J Clin Oncol 27, 1477–1486 (2022). https://doi.org/10.1007/s10147-022-02203-y

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