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The site of visceral metastases (mets) to predict overall survival (OS) in castration-resistant prostate cancer (CRPC) patients (pts): A meta-analysis of five phase III trials.
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).
Background: Recent studies have shown that metastatic site is an important predictor of overall survival, but the reports were based on small sample sizes and as such the estimates were unstable. We sought to test two hypotheses: 1) CRPC pts with lung mets have worse survival than pts with non-visceral mets; and 2) pts with liver mets have worse survival than pts with lung mets. Methods: We combined individual patient data from 3,993 chemotherapy-naive mets CRPC pts randomized to receive docetaxel (D) based therapy on 5 phase III trials: CALGB 90401 (D +/- Bevacizumab): SWOG 0421(D +/-atrasentan),ENTHUSE 33 (D +/- zibotentan), TAX327 (D 3 wks, D weekly) and SWOG 9916 (D + estramustine). Site of mets at baseline was categorized as: lymph node (LN) only, bone +/- LN with no visceral mets, any lung mets (but no liver), any liver mets, and other visceral. We used fixed-effects meta-analysis to estimate the pooled hazard ratios (pHR) and 95% confidence intervals (CI) for comparing pts with lung mets vs. non-visceral mets and liver mets vs. lung mets. Results: The pHR for death for pts with lung mets compared to pts with non-visceral mets was 1.3 (95% CI= 1.1-1.5, p<0.001) and the pHR for pts with any liver mets compared with pts with lung mets was 1.4 (1.2-1.7, p<0.001). The median overall survival by site of mets is presented in table below. f mets at baseline was categorized as: lymph node (LN) only, bone +/- LN with no visceral mets, any lung mets (but no liver), any liver mets, and other visceral. Conclusions: As anticipated, CRPC patients with liver mets had the worst OS (12.1 m). While pts with lung mets had better OS (16.5 months) compared to liver mets pts, they had significantly worse survival than pts with non-visceral bone mets (20 months). These data may help in treatment decisions and in the design of future clinical trials in mCRPC pts. Clinical trial information: NCT00110214.
|Metastatic Site||N (%)||Median OS in months (95% CI)|
|LN only||187 (5)||27.0 (24.7-32.4)|
|Bone/Bone with LN||3334 (83)||20.3 (19.7-21.0)|
|Lung (+/- bone), no liver||300 (7)||16.5 (14.8-18.4)|
|Liver (LM) (+/- bone)||280 (7)||12.1 (10.1-13.5)|
|Other Visceral (adrenal, brain)||55 (1)||14.4 (12.6-19.1)|
Abstracts by Susan Halabi:
A phase 2 multimodality trial of docetaxel/prednisone with sunitinib followed by salvage radiation therapy (RT) in men with PSA recurrent prostate cancer (PC) after radical prostatectomy (RP).Meeting: 2015 Genitourinary Cancers Symposium | Abstract No: 35
Final clinical results of a randomized phase II international trial of everolimus vs. sunitinib in patients with metastatic non-clear cell renal cell carcinoma (ASPEN).Meeting: 2015 ASCO Annual Meeting | Abstract No: 4507
Phase II trial of the PI3 kinase inhibitor BKM120 with or without enzalutamide in men with metastatic castration resistant prostate cancer (mCRPC).Meeting: 2015 ASCO Annual Meeting | Abstract No: 5025