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Comment
. 2014 Nov;28(11):974-80.

Visceral metastases and prostate cancer treatment: 'die hard,' 'tough neighborhoods,' or 'evil humors'?

Charles G Drake
Comment

Visceral metastases and prostate cancer treatment: 'die hard,' 'tough neighborhoods,' or 'evil humors'?

Charles G Drake. Oncology (Williston Park). 2014 Nov.

Abstract

Men with metastatic castration-resistant prostate cancer have multiple treatment options, and the expanding palate of available therapies renders careful patient selection imperative. Men with visceral (especially hepatic) metastases have a particularly poor prognosis, regardless of the treatment selected. Retrospective analyses of datasets from large phase III randomized trials showed that men with visceral metastases appear to derive clinical benefit from second-generation antiandrogens as well as from docetaxel chemotherapy, but not from immunotherapy. The mechanistic underpinnings of these observations are currently not clear, but could involve factors that are intrinsic to the tumor cell, the tumor microenvironment, and/or systemic factors. Regardless of the underlying mechanism(s), a better understanding of the basic biology of visceral vs bone metastases will be critical in improving prostate cancer treatment in the setting of advanced disease.

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Figures

Figure 1
Figure 1. Overall Survival (OS) as a Function of the Site of Metastases in Men With mCRPC
Data are from a meta-analysis of 5 randomized trials of docetaxel-containing regimens.[6]
Figure 2
Figure 2. Overall Survival as a Function of the Presence or Absence of Visceral Metastases in Men With mCRPC Treated With Abiraterone Acetate With or Without Prednisone
Kaplan-Meier estimates of overall survival. The study was a post-hoc exploratory analysis of data from the COU-AA-301 trial.[12] Patients who had been treated with docetaxel were randomized to AA 1,000 mg (n = 797) or to placebo (n = 398), each with 5 mg prednisone twice a day. AA = abiraterone acetate; mCRPC = metastatic castration-resistant prostate cancer; OS = overall survival; P = prednisone; VD = visceral disease. Adapted from Goodman et al. Prostate Cancer Prostatic Dis. 2014.[12] Used with permission.
Figure 3
Figure 3. Overall Survival as a Function of the Presence or Absence of Visceral Metastases in Men With mCRPC Treated With Docetaxel Plus Prednisone or Mitoxantrone Plus Prednisone
Kaplan-Meier estimates of overall survival. Data are from the TAX 327 study. DP = docetaxel plus prednisone; MP = mitoxantrone plus prednisone. Courtesy of Andrew Armstrong, MD, Duke University. Used with permission.
Figure 4
Figure 4. Overall Survival as a Function of the Presence or Absence of Visceral Metastases in Men With mCRPC Treated With Ipilimumab
Kaplan-Meier estimates of overall survival. Data are from the CA184-043 study. Ipi = ipilimumab; OS = overall survival; Pbo = placebo.[46]
See this image and copyright information in PMC

Comment on

References

    1. Petrylak DP, Tangen CM, Hussain MH, et al. Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. N Engl J Med. 2004;351:1513–20. - PubMed
    1. Tannock IF, de Wit R, Berry WR, et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med. 2004;351:1502–12. - PubMed
    1. Bubendorf L, Schopfer A, Wagner U, et al. Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients. Hum Pathol. 2000;31:578–83. - PubMed
    1. Fizazi K, Massard C, Smith MR, et al. Baseline covariates impacting overall survival (OS) in a phase III study of men with bone metastases from castration-resistant prostate cancer. J Clin Oncol. 2012;30(suppl) abstr 4642.
    1. Drake CG, Kwon ED, Fizazi K, et al. Results of subset analyses on overall survival (OS) from study CA184-043: Ipilimumab (Ipi) versus placebo (Pbo) in post-docetaxel metastatic castration-resistant prostate cancer (mCRPC) J Clin Oncol. 2014;32(suppl 4) abstr 2.

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