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Clinical Trial
. 2016 Apr;27(4):699-705.
doi: 10.1093/annonc/mdv545. Epub 2015 Nov 25.

Does Gleason score at initial diagnosis predict efficacy of abiraterone acetate therapy in patients with metastatic castration-resistant prostate cancer? An analysis of abiraterone acetate phase III trials

K Fizazi  1 , T W Flaig  2 , M Stöckle  3 , H I Scher  4 , J S de Bono  5 , D E Rathkopf  4 , C J Ryan  6 , T Kheoh  7 , J Li  8 , M B Todd  9 , T W Griffin  10 , A Molina  11 , C H Ohlmann  3
Affiliations
Clinical Trial

Does Gleason score at initial diagnosis predict efficacy of abiraterone acetate therapy in patients with metastatic castration-resistant prostate cancer? An analysis of abiraterone acetate phase III trials

K Fizazi et al. Ann Oncol. 2016 Apr.

Abstract

Background: The usefulness of Gleason score (<8 or ≥8) at initial diagnosis as a predictive marker of response to abiraterone acetate (AA) plus prednisone in patients with metastatic castration-resistant prostate cancer (mCRPC) was explored retrospectively.

Patients and methods: Initial diagnosis Gleason score was obtained in 1048 of 1195 (COU-AA-301, post-docetaxel) and 996 of 1088 (COU-AA-302, chemotherapy-naïve) patients treated with AA 1 g plus prednisone 5 mg twice daily by mouth or placebo plus prednisone. Efficacy end points included radiographic progression-free survival (rPFS) and overall survival (OS). Distributions and medians were estimated by Kaplan-Meier method and hazard ratio (HR) and 95% confidence interval (CI) by Cox model.

Results: Baseline characteristics were similar across studies and treatment groups. Regardless of Gleason score, AA treatment significantly improved rPFS in post-docetaxel [Gleason score <8: median, 6.4 versus 5.5 months (HR = 0.70; 95% CI 0.56-0.86), P = 0.0009 and Gleason score ≥8: median, 5.6 versus 2.9 months (HR = 0.58; 95% CI 0.48-0.72), P < 0.0001] and chemotherapy-naïve patients [Gleason score <8: median, 16.5 versus 8.2 months (HR = 0.50; 95% CI 0.40-0.62), P < 0.0001 and Gleason score ≥8: median, 13.8 versus 8.2 months (HR = 0.61; 95% CI 0.49-0.76), P < 0.0001]. Clinical benefit of AA treatment was also observed for OS, prostate-specific antigen (PSA) response, objective response and time to PSA progression across studies and Gleason score subgroups.

Conclusion: OS and rPFS trends demonstrate AA treatment benefit in patients with pre- or post-chemotherapy mCRPC regardless of Gleason score at initial diagnosis. The initial diagnostic Gleason score in patients with mCRPC should not be considered in the decision to treat with AA, as tumour metastases may no longer reflect the histology at the time of diagnosis.

Clinical trials number: COU-AA-301 (NCT00638690); COU-AA-302 (NCT00887198).

Keywords: Gleason score; abiraterone acetate; chemotherapy-naïve; post-chemotherapy; prostate cancer.

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Figures

Figure 1.
Figure 1.
Radiographic progression-free survival (A) and overall survival (B) in post-docetaxel metastatic castration-resistant prostate cancer patients treated with abiraterone acetate (AA) plus prednisone (P) or placebo plus P as a function of Gleason score (<8 and ≥8) at initial diagnosis. AA, abiraterone acetate; CI, confidence interval; HR, hazard ratio; P, prednisone.
Figure 2.
Figure 2.
Radiographic progression-free survival (A) and overall survival (B) in chemotherapy-naïve metastatic castration-resistant prostate cancer patients treated with abiraterone acetate (AA) plus prednisone (P) or placebo plus P as a function of Gleason score (<8 and ≥8) at initial diagnosis. AA, abiraterone acetate; CI, confidence interval; HR, hazard ratio; P, prednisone.
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