A prognostic model for stratifying clinical outcomes in chemotherapy-naive metastatic castration-resistant prostate cancer patients treated with abiraterone acetate

D. J. Khalaf, C. M. Avilés, A. A. Azad, K. Sunderland, T. Todenhöfer, B. J. Eigl, D. Finch, L. Le, A. Atwell, B. Keith, C. Kollmannsberger, K. N. Chi

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Abstract

Introduction: Recently, a prognostic index including six risk factors (RFs) (unfavourable ECOG performance status [PS], presence of liver metastases, short response to luteinizing hormone-releasing hormone [LHRH] agonists/antagonists, low albumin, increased alkaline phosphatase [ALP] and lactate dehydrogenase [LDH]) was developed from the COU-AA-301 trial in post-chemotherapy metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate. Our primary objective was to evaluate this model in a cohort of chemotherapy-naive mCRPC patients receiving abiraterone. Methods: We identified 197 chemotherapy-naive patients who received abiraterone at six BC Cancer Agency centres and who had complete information on all six RFs. Study endpoints were prostate-specific antigen (PSA) response rate (RR), time to PSA progression, time on treatment, and overall survival (OS). PSA RR and survival outcomes were compared using ?2 test and log-rank test. Multivariable Cox proportional hazard analysis was performed to identify RFs independently associated with OS. Results: Patients were classified into good (0?1 RFs), intermediate (2?3 RFs), and poor (4?6 RFs) prognostic groups (33%, 52%, and 15%, respectively). For good, intermediate, and poor risk patients, PSA RR (≥50% decline) was 60% vs. 42% vs. 40% (p=0.05); median time to PSA progression was 7.3 vs. 5.3 vs. 5.0 months (p=0.02); and median OS was 29.4 vs. 13.8 vs. 8.7 months (p<0.0001). Conclusions: The six-factor prognostic index model stratifies clinical outcomes in chemotherapy-naive mCRPC patients treated with abiraterone. Identifying patients at risk of poor outcomes is important for informing clinical practice and clinical trial design.

Original languageEnglish
Pages (from-to)E47-E52
Number of pages6
JournalCanadian Urological Association
Volume12
Issue number2
DOIs
Publication statusPublished - 1 Feb 2018

Cite this

Khalaf, D. J. ; Avilés, C. M. ; Azad, A. A. ; Sunderland, K. ; Todenhöfer, T. ; Eigl, B. J. ; Finch, D. ; Le, L. ; Atwell, A. ; Keith, B. ; Kollmannsberger, C. ; Chi, K. N. / A prognostic model for stratifying clinical outcomes in chemotherapy-naive metastatic castration-resistant prostate cancer patients treated with abiraterone acetate. In: Canadian Urological Association. 2018 ; Vol. 12, No. 2. pp. E47-E52.
@article{bd48b2380ec5427aa5b3927ceb61f371,
title = "A prognostic model for stratifying clinical outcomes in chemotherapy-naive metastatic castration-resistant prostate cancer patients treated with abiraterone acetate",
abstract = "Introduction: Recently, a prognostic index including six risk factors (RFs) (unfavourable ECOG performance status [PS], presence of liver metastases, short response to luteinizing hormone-releasing hormone [LHRH] agonists/antagonists, low albumin, increased alkaline phosphatase [ALP] and lactate dehydrogenase [LDH]) was developed from the COU-AA-301 trial in post-chemotherapy metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate. Our primary objective was to evaluate this model in a cohort of chemotherapy-naive mCRPC patients receiving abiraterone. Methods: We identified 197 chemotherapy-naive patients who received abiraterone at six BC Cancer Agency centres and who had complete information on all six RFs. Study endpoints were prostate-specific antigen (PSA) response rate (RR), time to PSA progression, time on treatment, and overall survival (OS). PSA RR and survival outcomes were compared using ?2 test and log-rank test. Multivariable Cox proportional hazard analysis was performed to identify RFs independently associated with OS. Results: Patients were classified into good (0?1 RFs), intermediate (2?3 RFs), and poor (4?6 RFs) prognostic groups (33{\%}, 52{\%}, and 15{\%}, respectively). For good, intermediate, and poor risk patients, PSA RR (≥50{\%} decline) was 60{\%} vs. 42{\%} vs. 40{\%} (p=0.05); median time to PSA progression was 7.3 vs. 5.3 vs. 5.0 months (p=0.02); and median OS was 29.4 vs. 13.8 vs. 8.7 months (p<0.0001). Conclusions: The six-factor prognostic index model stratifies clinical outcomes in chemotherapy-naive mCRPC patients treated with abiraterone. Identifying patients at risk of poor outcomes is important for informing clinical practice and clinical trial design.",
author = "Khalaf, {D. J.} and Avil{\'e}s, {C. M.} and Azad, {A. A.} and K. Sunderland and T. Todenh{\"o}fer and Eigl, {B. J.} and D. Finch and L. Le and A. Atwell and B. Keith and C. Kollmannsberger and Chi, {K. N.}",
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Khalaf, DJ, Avilés, CM, Azad, AA, Sunderland, K, Todenhöfer, T, Eigl, BJ, Finch, D, Le, L, Atwell, A, Keith, B, Kollmannsberger, C & Chi, KN 2018, 'A prognostic model for stratifying clinical outcomes in chemotherapy-naive metastatic castration-resistant prostate cancer patients treated with abiraterone acetate', Canadian Urological Association, vol. 12, no. 2, pp. E47-E52. https://doi.org/10.5489/cuaj.4600

A prognostic model for stratifying clinical outcomes in chemotherapy-naive metastatic castration-resistant prostate cancer patients treated with abiraterone acetate. / Khalaf, D. J.; Avilés, C. M.; Azad, A. A.; Sunderland, K.; Todenhöfer, T.; Eigl, B. J.; Finch, D.; Le, L.; Atwell, A.; Keith, B.; Kollmannsberger, C.; Chi, K. N.

In: Canadian Urological Association, Vol. 12, No. 2, 01.02.2018, p. E47-E52.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A prognostic model for stratifying clinical outcomes in chemotherapy-naive metastatic castration-resistant prostate cancer patients treated with abiraterone acetate

AU - Khalaf, D. J.

AU - Avilés, C. M.

AU - Azad, A. A.

AU - Sunderland, K.

AU - Todenhöfer, T.

AU - Eigl, B. J.

AU - Finch, D.

AU - Le, L.

AU - Atwell, A.

AU - Keith, B.

AU - Kollmannsberger, C.

AU - Chi, K. N.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Introduction: Recently, a prognostic index including six risk factors (RFs) (unfavourable ECOG performance status [PS], presence of liver metastases, short response to luteinizing hormone-releasing hormone [LHRH] agonists/antagonists, low albumin, increased alkaline phosphatase [ALP] and lactate dehydrogenase [LDH]) was developed from the COU-AA-301 trial in post-chemotherapy metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate. Our primary objective was to evaluate this model in a cohort of chemotherapy-naive mCRPC patients receiving abiraterone. Methods: We identified 197 chemotherapy-naive patients who received abiraterone at six BC Cancer Agency centres and who had complete information on all six RFs. Study endpoints were prostate-specific antigen (PSA) response rate (RR), time to PSA progression, time on treatment, and overall survival (OS). PSA RR and survival outcomes were compared using ?2 test and log-rank test. Multivariable Cox proportional hazard analysis was performed to identify RFs independently associated with OS. Results: Patients were classified into good (0?1 RFs), intermediate (2?3 RFs), and poor (4?6 RFs) prognostic groups (33%, 52%, and 15%, respectively). For good, intermediate, and poor risk patients, PSA RR (≥50% decline) was 60% vs. 42% vs. 40% (p=0.05); median time to PSA progression was 7.3 vs. 5.3 vs. 5.0 months (p=0.02); and median OS was 29.4 vs. 13.8 vs. 8.7 months (p<0.0001). Conclusions: The six-factor prognostic index model stratifies clinical outcomes in chemotherapy-naive mCRPC patients treated with abiraterone. Identifying patients at risk of poor outcomes is important for informing clinical practice and clinical trial design.

AB - Introduction: Recently, a prognostic index including six risk factors (RFs) (unfavourable ECOG performance status [PS], presence of liver metastases, short response to luteinizing hormone-releasing hormone [LHRH] agonists/antagonists, low albumin, increased alkaline phosphatase [ALP] and lactate dehydrogenase [LDH]) was developed from the COU-AA-301 trial in post-chemotherapy metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate. Our primary objective was to evaluate this model in a cohort of chemotherapy-naive mCRPC patients receiving abiraterone. Methods: We identified 197 chemotherapy-naive patients who received abiraterone at six BC Cancer Agency centres and who had complete information on all six RFs. Study endpoints were prostate-specific antigen (PSA) response rate (RR), time to PSA progression, time on treatment, and overall survival (OS). PSA RR and survival outcomes were compared using ?2 test and log-rank test. Multivariable Cox proportional hazard analysis was performed to identify RFs independently associated with OS. Results: Patients were classified into good (0?1 RFs), intermediate (2?3 RFs), and poor (4?6 RFs) prognostic groups (33%, 52%, and 15%, respectively). For good, intermediate, and poor risk patients, PSA RR (≥50% decline) was 60% vs. 42% vs. 40% (p=0.05); median time to PSA progression was 7.3 vs. 5.3 vs. 5.0 months (p=0.02); and median OS was 29.4 vs. 13.8 vs. 8.7 months (p<0.0001). Conclusions: The six-factor prognostic index model stratifies clinical outcomes in chemotherapy-naive mCRPC patients treated with abiraterone. Identifying patients at risk of poor outcomes is important for informing clinical practice and clinical trial design.

UR - http://www.scopus.com/inward/record.url?scp=85040340324&partnerID=8YFLogxK

U2 - 10.5489/cuaj.4600

DO - 10.5489/cuaj.4600

M3 - Article

VL - 12

SP - E47-E52

JO - Canadian Urological Association

JF - Canadian Urological Association

SN - 1920-1214

IS - 2

ER -