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. 2018 Feb;12(2):E47-E52.
doi: 10.5489/cuaj.4600. Epub 2017 Dec 1.

A prognostic model for stratifying clinical outcomes in chemotherapy-naive metastatic castration-resistant prostate cancer patients treated with abiraterone acetate

Daniel Joseph Khalaf  1 , Claudia M Avilés  1 , Arun A Azad  2 , Katherine Sunderland  1 , Tilman Todenhöfer  3 , Berhard J Eigl  1 , Daygen Finch  4 , Lyly Le  5 , Andrew Atwell  6 , Bruce Keith  7 , Christian Kollmannsberger  1 , Kim N Chi  1   3
Affiliations

A prognostic model for stratifying clinical outcomes in chemotherapy-naive metastatic castration-resistant prostate cancer patients treated with abiraterone acetate

Daniel Joseph Khalaf et al. Can Urol Assoc J. 2018 Feb.

Abstract

Introduction: Recently, a prognostic index including six risk factors (RFs) (unfavourable Eastern Cooperative Oncology Group performance status [ECOG PS], presence of liver metastases, short response to luteinizing hormone-releasing hormone [LHRH] agonists/antagonists, low albumin, increased alkaline phosphatase [ALP] and lactate dehydrogenase [LDH]) was developed from the COU-AA-301 trial in post-chemotherapy metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate. Our primary objective was to evaluate this model in a cohort of chemotherapy-naive mCRPC patients receiving abiraterone.

Methods: We identified 197 chemotherapy-naive patients who received abiraterone at six BC Cancer Agency centres and who had complete information on all six RFs. Study endpoints were prostate-specific antigen (PSA) response rate (RR), time to PSA progression, time on treatment, and overall survival (OS). PSA RR and survival outcomes were compared using Χ2 test and log-rank test. Multivariable Cox proportional hazard analysis was performed to identify RFs independently associated with OS.

Results: Patients were classified into good (0-1 RFs), intermediate (2-3 RFs), and poor (4-6 RFs) prognostic groups (33%, 52%, and 15%, respectively). For good-, intermediate-, and poor-risk patients, PSA RR (≥50% decline) was 60% vs. 42% vs. 40% (p=0.05); median time to PSA progression was 7.3 vs. 5.3 vs. 5.0 months (p=0.02); and median OS was 29.4 vs. 13.8 vs. 8.7 months (p<0.0001).

Conclusions: The six-factor prognostic index model stratifies clinical outcomes in chemotherapy-naive mCRPC patients treated with abiraterone. Identifying patients at risk of poor outcome is important for informing clinical practice and clinical trial design.

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Conflict of interest statement

Competing interests: Dr. Azad has been an advisor for Astellas, AstraZeneca, Novartis, Sanofi, and Tolmar; a speaker for Janssen; has received grants/honoraria from Astellas; and has participated in clinical trials supported by AstraZeneca, GSK, MedImmune, Medivation, Merck, Sanofi, and Serono. Dr. Todenhöfer has received speaker honoraria from Astellas and Janssen. Dr. Eigl has been an advisor for AstraZeneca, Janssen, and Roche; has received grants from Roche; and has participated in clinical trials supported by AstraZeneca, Novartis, Pfizer, and Roche. Dr. Finch has received speaker honoraria from and has participated in clinical trials supported by Astellas, AstraZeneca, Janssen, Pfizer, and Roche. Dr. Le has received speaker honoraria from Bayer; and was involved in the BC Cancer Agency Canadian Cancer Trials Group. Dr. Kollmannsberger has been an advisor for Astellas, BMS, Novartis, and Pfizer; has received speaker honoraria from Astellas, BMS, Novartis, Pfizer, and Sanofi; and has participated in clinical trials supported by Asetllas, BMS, Janssen, Novartis, and Pfizer. Dr. Chi has received grants/honoraria from Astellas, Bayer, Essai, Janssen, and Sanofi; and has participated in clinical trials supported by Astellas, AstraZeneca, Bayer, Essai, Lilly, Janssen, Merck, and Sanofi. The remaining authors report no competing personal or financial interests related to this work.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves for: (A) overall survival; (B) time on treatment; and (C) prostate-specific antigen (PSA) progression for good, intermediate, and poor prognosis groups.
See this image and copyright information in PMC

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