Outcomes of Second-Line Therapies in Patients With Metastatic de Novo and Treatment-Emergent Neuroendocrine Prostate Cancer: A Multi-Institutional Study.

De novo neuroendocrine prostate cancer (NEPC) and treatment-emergent neuroendocrine prostate cancer (T-NEPC) are rare diseases with a poor prognosis. After first-line platinum chemotherapy, there is no consensus on second-line treatments.

Patients with a pathologic diagnosis of de novo NEPC or T-NEPC between 2000 and 2020 who received first-line platinum and any second-line systemic therapy were selected and standardized clinical data was collected via the electronic health record at each institution. The primary endpoint was overall survival (OS) based on second-line therapy. Secondary endpoints included objective response rate (ORR) to second-line therapy, PSA response, and time on treatment.

Fifty-eight patients (32 de novo NEPC, 26 T-NEPC) from 8 institutions were included. At de novo NEPC or T-NEPC diagnosis, the overall cohort had a median age of 65.0 years (IQR 59.2-70.3) and median PSA of 3.0 ng/dL (IQR 0.6-17.9). Following first-line platinum chemotherapy, 21 patients (36.2%) received platinum chemotherapy, 10 (17.2%) taxane monotherapy, 11 (19.0%) immunotherapy, 10 (17.2%) other chemotherapy, and 6 (16.2%) other systemic therapy. Among 41 evaluable patients, the ORR was 23.5%. The mOS after start of second-line therapy was 7.4 months (95% CI 6.1-11.9).

In this retrospective study, patients with de novo NEPC or T-NEPC who received second-line therapy were treated with wide variety of treatment regimens, reflecting the lack of consensus in this setting. Most patients received chemotherapy-based treatments. Overall prognosis was poor and ORR was low in the second line regardless of treatment choice.

Clinical genitourinary cancer. 2023 Apr 24 [Epub ahead of print]

Corbin J Eule, Junxiao Hu, Sulaiman Al-Saad, Katharine Collier, Patrick Boland, Akeem R Lewis, Rana R McKay, Vivek Narayan, Dominick Bosse, Amir Mortazavi, Tracy L Rose, Brian A Costello, Alan H Bryce, Elaine T Lam

Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO., Biostatistics and Bioinformatics, University of Colorado Cancer Center Biostatistics Core, Aurora, CO., Division of Medical Oncology, The Ottawa Hospital Cancer Center, Ottawa, Ontario, Canada., Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University, and the Comprehensive Cancer Center, Columbus, OH., Division of Medical Oncology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC., Division of Medical Oncology, Mayo Clinic Cancer Center, Rochester, MN., Division of Medical Oncology, Moores Cancer Center, University of California San Diego, San Diego, CA., Division of Medical Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA., Division of Medical Oncology, Mayo Clinic, Phoenix, AZ., Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO. Electronic address: .

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