Two randomized trials demonstrated a survival benefit of triplet therapy (androgen deprivation therapy [ADT]) plus androgen receptor pathway inhibitor [ARPI] plus docetaxel) over doublet therapy (ADT plus docetaxel), thus changing treatment strategies in metastatic hormonesensitive prostate cancer (mHSPC).
We conducted the first real-world analysis comprising 97 mHSPC patients from 16 Austrian medical centers, among them 79.4% of patients received abiraterone and 17.5% darolutamide treatment. Baseline characteristics and clinical parameters during triplet therapy were documented. Mann-Whitney U test for continuous or X²-test for categorical variables was used. Variables on progression were tested using logistic regression analysis and tabulated as hazard ratios (HR), 95% confidence interval (CI).
Of 83.5% patients with synchronous and 16.5% with metachronous disease were included. 83.5% had high-volume disease diagnosed by conventional imaging (48.9%) or PSMA PET-CT (51.1%). While docetaxel and ARPI were administered consistent with pivotal trials, prednisolone, prophylactic gCSF and osteoprotective agents were not applied guideline conform in 32.5%, 37%, and 24.3% of patients, respectively. Importantly, a nonsimultaneous onset of chemotherapy and ARPI, performed in 44.3% of patients, was associated with significantly worse treatment response (P = .015, HR 0.245). Starting ARPI before chemotherapy was associated with significantly higher probability for progression (P = .023, HR 15.781) than vice versa. Strikingly, 15.6% (abiraterone) and 25.5% (darolutamide) low-volume patients as well as 14.4% (abiraterone) and 17.6% (darolutamide) metachronous patients received triplet therapy. Adverse events (AE) occurred in 61.9% with grade 3 to 5 in 15% of patient without age-related differences. All patients achieved a PSA decline of 99% and imaging response was confirmed in 88% of abiraterone and 75% of darolutamide patients.
Triplet therapy arrived in clinical practice primarily for synchronous high-volume mHSPC. Regardless of selected therapy regimen, treatment is highly effective and tolerable. Preferably therapy should be administered simultaneously, however if not possible, chemotherapy should be started first.
Clinical genitourinary cancer. 2024 Jan 04 [Epub ahead of print]
Mona Kafka, Giulia Giannini, Nastasiia Artamonova, Hannes Neuwirt, Heidemarie Ofner, Gero Kramer, Thomas Bauernhofer, Ferdinand Luger, Thomas Höfner, Wolfgang Loidl, Hubert Griessner, Lukas Lusuardi, Antonia Bergmaier, Andreas Berger, Thomas Winder, Sarah Weiss, Severin Bauinger, Steffen Krause, Martin Drerup, Elmar Heinrich, Magdalena Schneider, Stephan Madersbacher, Sonia Vallet, Franz Stoiber, Sarah Laimer, Stephan Hruby, Gert Schachtner, Udo Nagele, Sebastian Lenart, Anton Ponholzer, Jacob Pfuner, Clemens Wiesinger, Christoph Kamhuber, Ecan Müldür, Jasmin Bektic, Wolfgang Horninger, Isabel Heidegger
Department of Urology, Medical University Innsbruck, Innsbruck, Austria., Department of Internal Medicine IV, Medical University Innsbruck, Innsbruck, Austria., Department of Urology, Medical University Vienna, Vienna, Austria., Department of Oncology, Medical University Graz, Graz, Austria., Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria., Department of Urology, PMU Salzburg, Salzburg, Austria., Department of Urology, Landeskrankenhaus Feldkirch, Feldkirch, Austria., Department of Oncology, Landeskrankenhaus Feldkirch, Feldkirch, Austria., Department of Urology, Kepler University Linz, Linz, Austria., Department of Urology, Barmherzige Brüder Salzburg, Salzburg, Austria., Department of Urology, Clinic Favoriten, Vienna, Austria., Division of Internal Medicine 2, Karl Landsteiner University of Health Sciences, University Hospital Krems, Krems, Austria., Department of Urology, Salzkammergut Klinikum Vöcklabruck, Vöcklabruck, Austria., Department of Urology, Tauernklinikum, Zell am See, Austria., Department of Urology, Landeskrankenhaus Hall, Innsbruck, Austria., Department of Urology, Barmherzige Brüder Vienna, Vienna, Austria., Department of Urology, Klinikum Wels-Grieskirchen, Wels, Austria., Department of Oncology, Kardinal Schwarzenberg Klinikum, Schwarzach, Austria., Department of Oncology, Klinik Ottakring, Vienna, Austria., Department of Urology, Medical University Innsbruck, Innsbruck, Austria. Electronic address: .