28 / 32
Dr Brian Lewis discusses his top
abstracts on advanced prostate cancer
from ESMO 2016
Dr Lewis is Assistant Professor of Clinical Medicine in the Department of Hematology and Medical
Oncology, Tulane University School of Medicine in New Orleans, and Associate Editor of the
PracticeUpdate Advanced Prostate Cancer Center of Excellence.
Abstract 720PD
Long term efficacy and QOL data of chemohormonal
therapy (C-HT) in low and high volume hormone naïve metastatic prostate
cancer (PrCa): E3805 CHAARTED trial.
C Sweeney, Y Chen, G Liu, et al
•
In this study, 790 men with hormone-naive metastatic prostate cancer
were randomised to receive ADT alone or ADT plus docetaxel and
stratified by low- or high-volume disease to evaluate long-term efficacy
and quality of life.After a median follow-up of 53.7months, 299 of 513
high-volume patients and 100 of 277 low-volume patients had died.
Median OS was significantly longer in patients receiving ADT plus
docetaxel comparedwithADT alone (57.6 vs 47.2months; P= 0.0018).
There was no difference in OS in low-volume patients receiving either
treatment; however, high-volume patients receivingADT plus docetaxel
demonstrated significantly increased OS (P < 0.0001). Quality of life
was assessed by FACT-P score, revealing lower baseline quality of life
in high-volume patients; the lowest quality-of-life score at 12 months
was reported in high-volume patients receiving ADT alone.
•
Patients with a higher burden of metastatic prostate cancer exhibit
significant clinical benefit with ADT plus docetaxel.
Abstract 725PD
Pembrolizumab for patients with advanced prostate
adenocarcinoma: Preliminary results from the KEYNOTE-028 study.
A Hansen, C Massard, PA Ott, et al
•
This phase IB study included 23 patients with advanced PD-
L1-positive prostate adenocarcinoma to evaluate the safety and
efficacy of pembrolizumab; 74% of patients had received at least
two prior therapies. Pembrolizumab was dosed at 10 mg/kg every
2 weeks. After a median follow-up of 33 weeks, 14 patients had
treatment-related adverse effects, including nausea, grade 3 fatigue,
grade 3 peripheral neuropathy, grade 3 asthenia, and grade 4 lipase
increase, none of which resulted in treatment discontinuation or
death. The overall response rate was 13%, with 3 partial responses
and a 59-week median duration of response. The 6-month PFS and
stable disease rates were 39%, and the median OS was 8 months.
Exploratory analysis showed that a better clinical outcome was
associated with the putative T-cell inflamed signature, which
correlates with previous pembrolizumab data.
•
The study results demonstrated durable responses and tolerability of
pembrolizumab in patients with advanced PD-L1-positive prostate
adenocarcinoma.
Abstract 748P
Switch from abiraterone + prednisone to abiraterone +
dexamethasone after PSA progression under abiraterone + prednisone
in asymptomatic metastatic castration-resistant prostate cancer (mCRPC)
patients.
C Fenioux, C Louvet, D Prapotnich, et al
•
Of 120 patients with asymptomatic mCRPC enrolled in this study,
48 progressed biologically on abiraterone acetate (AA) + prednisone
10 mg daily. They were switched toAA + dexamethasone 0.5 mg daily
at the time of PSA increase to evaluate outcomes and to determine
predictive factors of switch efficiency. After a median follow-up of
14 months from switch, PFS rates were 14.5 and 23.1 months for
patients receiving AA + dexamethasone and AA + prednisone then
+ dexamethasone, respectively. PSA decreased in 45.8% of patients
following the switch. Significant predictive factors of switch efficiency
included hormone sensitivity >5 years, low PSA level at switch, and
<6 months to PSA progression on AA + prednisone.
•
Switching from prednisone to dexamethasone to reverse biological AA
+ prednisone resistance was successful in approximately half of patients
with mCRPC in this study, warranting further randomised trials.
Abstract 750P
Radium-223 with concomitant bone-targeting agents in
metastatic castration-resistant prostate cancer (CRPC) patients treated
in an international early access program (EAP).
F Saad, A Heidenreich,
D Heinrich, et al
•
This single-arm phase 3B study included 696 patients with CRPC
with bone metastases from 14 countries who received radium-223
50 kBq/kg. Of these patients, 127 received denosumab, 125
received bisphosphonates, and 435 received no bone-targeting
agents. Patients receiving radium-223 and denosumab had a
longer median OS and median time to first symptomatic skeletal
event compared with patients not receiving bone-targeting agents.
Patients receiving bisphosphonates exhibited prolonged time to
first symptomatic skeletal event compared with patients who did
not receive bone-targeting agents.
•
This study demonstrated that patients receiving radium-223 and bone-
targeting agents had a longer time to first symptomatic skeletal event
compared with patients who did not receive bone-targeting agents;
however, OS was only improved in patients receiving denosumab.
© ESMO 2016
EUROPEAN SOCIETY OF MEDICAL ONCOLOGY 2016 CONGRESS
28
PRACTICEUPDATE HAEMATOLOGY & ONCOLOGY