Survival benefits of second-line chemotherapy in metastatic castrate-resistant prostate cancer (CRPC) in a southeastern oncology community practice
| Autor: | Sally Haislip, Satish Valluri, James Gilmore, Stephen Szabo, Susan Boklage, Charles Kreilick, Kenneth M. Shermock, Carl V. Asche, Sean D. Sullivan, Kai Sun, Scott D. Ramsey, Brian S. Seal, Syam Sarma |
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| Rok vydání: | 2012 |
| Předmět: | |
| Zdroj: | Journal of Clinical Oncology. 30:e15183-e15183 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | e15183 Background: Clinical studies showed that chemotherapy (CT) yields survival benefits for Metastatic Castrate resistant prostate cancer (CRPC) patients. This study investigated the relationship between patients with 2nd CT and OS using a real-world data. Methods: TheGeorgia Cancer Specialist Database containing chemotherapy, medical and pharmacy information, and lab results for patients with various types of cancer (2005-2011) was used. Patients (PTs) over 18 years of age with initial stage IV CRPC were followed from the first administration of CT (index date, ID) to the earlier of death or loss to follow-up (FU). PTs with one type of CT protocol (PL) were defined as first line CT PTs (1st), those with two types were identified as second line PTs (2nd), and those with three or more types were (3rd) line PTs. Kaplan-Meier survival curve was compared across the three groups using log-rank test. The impact of line of therapy on OS was further examined using multivariate Cox model with adjustment of PTs’ baseline age, race, Charlson Comorbidity Index (CCI), bisphosphonate use, and ECOG performance scores. Sensitivity analyses (SA) was conducted using different definition to define CT lines. Results: The study included148 PTs, with 86 (58.1%) as 1st, 38 (25.7%) as 2nd, and 24 (16.2%) as 3rd, 29 (19.6%) median age 73 with a range from 18 to over 82, 52.7% as race White, 33.8% African American, and 13.5% other or unknown race, average weight was 179 LB (range 100-279), average baseline PSA was 694 ng/ml (range: 0.05-21,743), 14 (9.5%) patients ECOG score of 3 or 4, 131 (88.5%) with one or more CCI comorbid conditions. Median survival was 17 months for overall, and 12, 19, and 23 months for 1st, 2nd, and 3rd line PTs, respectively (P=0.0355). Multivariate COX model found a higher likelihood of survival for 2nd line PTs (HR=0.361, P=0.006), but not for 3rd line PTs (HR=1.25, P=0.648). SA showed same results. Conclusions: This study suggested that second line of CT was associated with prolonged OS in metastatic CRPC. 3rd line CT survival benefit was not observed. Limitations include potential channeling bias and small sample size. |
| Databáze: | OpenAIRE |
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