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Master Thesis

Impact de la séquence thérapeutique entre les taxanes et les inhibiteurs de l’axe du récepteur des androgènes dans la prise en charge du cancer de prostate résistant à la castration

Abstract : Background: the optimal sequence of life-extending therapies in metastatic castration-resistant prostate cancer (mCRPC) is unknown. Objective: to evaluate outcomes of mCRPC patients treated with DOC (DOC), CABA (CABA) and a novel androgen receptor-targeted agent (iARA) (abiraterone acetate or ENZA), according to 3 different sequences. Patients and methods Data from 669 consecutive mCRPC patients were retrospectively collected between November 2012 and October 2016. Primary endpoint was prostate-specific antigen (PSA) response (decrease ≥50% from baseline) with each therapy. Secondary endpoints included best clinical benefit, time to PSA progression, radiological progression-free survival (rPFS), overall survival (OS) and toxicity. Results: 158 patients received DOC®CABA®iARA (Group 1), 456 received DOC®iARA®CABA (Group 2), and 55 received iARA®DOC®CABA (Group 3). At baseline, PSA progression only and Gleason <8 were more common in Group 3. PSA response on DOC was lower in Group 3 than in other groups (p=0.02) and PSA response on CABA was higher in second than in third line (p=0.001). In Group 3, rPFS on iARA (6.6 months) and DOC (9.2 months) were also shorter than in other groups. OS calculated from the first lifeextending therapy reached 34.8, 35.8 and 28.9 months in Groups 1, 2 and 3, respectively (p=0.007). Toxicity was comparable between arms. Conclusions: in this retrospective trial, sequencing of DOC, CABA and one iARA, was associated with a median OS of up to 35.8 months. CABA seemed to retain its activity regardless treatment sequence. DOC activity after iARA appeared to be reduced, but data were insufficient to conclude cross-resistance.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02278699
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Nicolas Delanoy. Impact de la séquence thérapeutique entre les taxanes et les inhibiteurs de l’axe du récepteur des androgènes dans la prise en charge du cancer de prostate résistant à la castration. Médecine humaine et pathologie. 2018. ⟨dumas-02278699⟩

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