Where Should Enzalutamide Be in The Metastatic Castration Resistant Prostate Cancer (mCRPC): A Multi-center Study
Sinan Koca1, Ilker Nihat Okten2, Mehmet Besiroglu3, Tugba Akın Telli4, Ayse Demirci5, Mustafa Karaagac61Department of Medical Oncology, Istanbul Medeniyet University, Goztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye Department of Medical Oncology, Istanbul Medeniyet University, Goztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye, 2Department of Medical Oncology, Istanbul Medeniyet University, Goztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye, 3Department of Medical Oncology, Istanbul Bezmialem Vakıf Universirty, Istanbul, Türkiye, 4Department of Medical Oncology, Marmara University, Istanbul, Türkiye, 5Department of Medical Oncology, Sakarya University Training and Research Hospital, Istanbul, Türkiye, 6Department of Medical Oncology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Türkiye,
Objectives: Enzalutamide(ENZ) is an effective hormonal treatment modality in mCRPC. It can be used before or after docetaxel(DTX) in this setting. Herein, we aimed to show the efficacy of ENZ before or after DTX use and the factors predicting the efficacy. Methods: We retrospectively collected the data of 320 patients from 12 centers who were treated with ENZ in mCRPC. The initial stage, age, line of treatment, serum prostate-specific antigen (PSA) levels before ENZ treatment and at nadir, site of metastasis, gleason score were evaluated. Results: Median age of 320 patients were 69. At a median follow-up of 56 months, 271/320 (84.7%) disease progression and 230/320(71.9%) death had been observed. Median PFS was 11(8.9-13)) and median OS was 25(22.1-27.8) months in all patients group. Median PFS was 10(7.4-12.5) months, 11(8-13.9) months in pre-DTX and post-DTX groups respectively. Median OS was higher in the post-DTX group than the pre-DTX group (28(25.7-30.2) vs 19(15.0-22.9-46.6) (p:0.000). Gleason score?8 (HR 0.59, 95%CI 0.46-0.77, p=0.00), presence of non-visceral metastasis (HR 0.72, 95%CI 0.53-0.97, p=0.031), initial PSA value<43(median) (HR 0.70, 95%CI 0.54-0.91, p=0.009), PSA at nadir <2 (HR 0.61, 95%CI 0.44-0.85, p=0.004), >50% decline in PSA (HR 0.27, 95%CI 0.19-0.36, p=0.000) significantly predicted ENZ response regarding rPFS. Conclusion: ENZ has shown equal efficacy before and after DTX treatment in mCRPC regarding rPFS. But OS rate was significantly better in the pre-DTX group. Therefore, we recommend starting with DTX in patients who can tolerate chemotherapy in mCRPC setting. Keywords: prostate cancer, enzalutamide, docetaxel, line of treatment
Cite This Article
Koca S, Okten I, Besiroglu M, Akın Telli T, Demirci A, Karaagac M. Where Should Enzalutamide Be in The Metastatic Castration Resistant Prostate Cancer (mCRPC): A Multi-center Study. EJMO. 2023; 7(1): 34-41
Corresponding Author: Sinan Koca