Radiographic Progression Without Prostate-specific Antigen Progression in Metastatic Hormone-sensitive Prostate Cancer: A Retrospective Analysis of the ENZAMET Trial (ANZUP 1304).
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Inderjeeth Andrisha-Jade, Martin Andrew J, Zielinski Robert R, Begbie Stephen, Cheung Leanna, Chowdhury Simon, Frydenberg Mark, Horvath Lisa G, Joshua Anthony M, Lawrence Nicola J, Marx Gavin, McCaffrey John, McDermott Raymond S, McJannett Margaret, North Scott A, Parnis Francis, Parulekar Wendy R, Pook David W, Reaume Martin N, Sandhu Shahneen, Tan Alvin, Tan Thean H, Thomson Alastair H, Vera-Badillo Francisco, Williams Scott G, Thomas Hayley, Yip Sonia, Zhang Alison Y, Chi Kim N, Stockler Martin R, Sweeney Christopher J, Davis Ian D, ENZAMET Trial Investigators and the Australian and New Zealand Urogenital and Prostate Cancer Trials Group
Аннотация
METHODS: A multistate Cox proportional-hazards regression model was used to partition participants into four states: (1) event-free; (2) discordant progression (DP); (3) other types of progression (other progression; OP); and (4) death.
KEY FINDINGS AND LIMITATIONS: Enzalutamide prolonged OS in the entire cohort of 1125 participants (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.58-0.84; p < 0.0001). Radiographic progression occurred in 388/1125 (34%) participants, and DP in 114/1125 (10%), with similar proportions in the enzalutamide arm (55/114, 48%) and NSAA arm (59/114, 52%). Participant characteristics in the DP group were similar between the treatment arms. Enzalutamide delayed DP (HR 0.66, 95% CI 0.46-0.96; p = 0.03) and OP (HR 0.37, 95% CI 0.31-0.44; p < 0.001). The 5-yr OS rate was lower in the DP group (24%) than in the OP group (42%). Among participants whose cancer had not progressed (495/1125), 51/495 (10%) died of non-prostate cancer causes (median follow-up 68 mo). This exploratory analysis is limited by its post hoc nature.
CONCLUSIONS AND CLINICAL IMPLICATIONS: DP occurred in 10% of participants and accounted for 30% of progression events observed in ENZAMET. DP was associated with worse OS regardless of treatment. Enzalutamide delayed DP and reduced the risk of DP and OP. Regularly scheduled imaging may be preferable to for-cause imaging in metastatic hormone-sensitive prostate cancer.