Where Should Enzalutamide Be in The Metastatic Castration Resistant Prostate Cancer (mCRPC): A Multi-center Study

Sinan Koca¹, Ilker Nihat Okten¹, Mehmet Besiroglu², Tugba Akin Telli³, Ayse Demirci⁴, Mustafa Karaagac⁵, Ahmet Kucukarda⁶, Semiha Urvay⁷, Sedat Tarik Firat⁸, Zeynep Oruc⁹, Mehmet Murat Zerey¹⁰, Ezgi Coban¹¹, Ibrahim Cil¹², Mahmut Gumus¹

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¹ Department of Medical Oncology, Istanbul Medeniyet University, Goztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye

² Department of Medical Oncology, Istanbul Bezmialem Vakıf Universirty, Istanbul, Türkiye

³ Department of Medical Oncology, Marmara University, Istanbul, Türkiye

⁴ Department of Medical Oncology, Sakarya University Training and Research Hospital, Istanbul, Türkiye

⁵ Department of Medical Oncology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Türkiye

⁶ Department of Medical Oncology, Trakya University Faculty of Medicine, Edirne, Türkiye

⁷ Department of Medical Oncology, Acibadem MAA University, Acibadem Kayseri Hospital, Kayseri, Türkiye

⁸ Department of Medical Oncology, Erciyes Universirty Faculty of Medicine, Kayseri, Türkiye

⁹ Department of Medical Oncology, Dicle Universirty Faculty of Medicine, Diyarbakir, Türkiye

¹⁰ Department of Medical Oncology, Selçuk Universirty Faculty of Medicine, Konya, Türkiye

¹¹ Department of Medical Oncology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Türkiye

¹² Department of Medical Oncology, Umraniye Training and Research Hospital, Istanbul, Türkiye

EJMO 2023, 7(1), 34–41; https://doi.org/10.14744/ejmo.2023.69719

Submitted: 10 August 2022 | Revised: 31 January 2023 | Accepted: 16 February 2023 | Published: 8 March 2023

© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )

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Abstract

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

Conflict of interest

None declared.

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