ABSTRACT
BACKGROUND: To describe the patterns of second-line treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) after docetaxel treatment in a Spanish population, to identify the factors associated with those patterns, and to compare the efficacy and safety of the treatments most frequently administered. METHODS: Observational, prospective study conducted in patients with histologically or cytologically confirmed prostate adenocarcinoma; documented metastatic castration-resistant disease; progression after first-line, docetaxel-based chemotherapy with or without other agents. RESULTS: Of the 150 patients recruited into the study, 100 patients were prescribed abiraterone acetate plus prednisone (AAP), 44 patients received cabazitaxel plus prednisone (CP), and 6 patients received other treatments. Age (odds ratio [OR] 1.06, 95% [confidence interval] CI 1.01 to 1.11) and not elevated lactate dehydrogenase (LDH) levels (OR 0.33, 95% CI 0.14 to 0.76) were independently associated with the administration of AAP. Treatment with AAP was associated with significantly longer clinical/radiographic progression-free survival (hazard ratio [HR] 0.57, 95% CI 0.38 to 0.85) and overall survival (OS; HR 0.40, 95% CI 0.21 to 0.76) compared to CP, while no significant differences between the treatments were found regarding biochemical progression-free survival (PFS; HR 0.78 [95% CI 0.49 to 1.24]). However, in a post-hoc Cox regression analysis adjusted for potential confounders there were not differences between AAP and CP in any of the time-to-event outcomes, including overall survival. We observed no new safety signals related to either regimen. CONCLUSION: Second-line AAP for patients with mCRPC is the most common treatment strategy after progression with a docetaxel-based regimen. When controlling for potential confounders, patients receiving this treatment showed no differences in PFS and OS in comparison to those receiving CP, although these latter results should be confirmed in randomized controlled trials.
Subject(s)
Abiraterone Acetate/therapeutic use , Adenocarcinoma/drug therapy , Antineoplastic Agents, Hormonal/therapeutic use , Docetaxel/therapeutic use , Prednisone/therapeutic use , Prostatic Neoplasms, Castration-Resistant/drug therapy , Taxoids/therapeutic use , Abiraterone Acetate/adverse effects , Age Factors , Aged , Aged, 80 and over , Anemia/etiology , Antineoplastic Agents, Hormonal/adverse effects , Antineoplastic Combined Chemotherapy Protocols , Asthenia/etiology , Humans , Kaplan-Meier Estimate , L-Lactate Dehydrogenase/analysis , Male , Middle Aged , Multivariate Analysis , Pain/etiology , Prednisone/adverse effects , Progression-Free Survival , Proportional Hazards Models , Prospective Studies , Spain , Taxoids/adverse effects , Treatment OutcomeSubject(s)
Breast Neoplasms/radiotherapy , Carcinoma, Ductal, Breast/radiotherapy , Fibrosarcoma/etiology , Neoplasm Recurrence, Local/radiotherapy , Neoplasms, Radiation-Induced , Radiotherapy, Adjuvant/adverse effects , Thoracic Wall , Breast/pathology , Breast Neoplasms/drug therapy , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/drug therapy , Carcinoma, Ductal, Breast/mortality , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/surgery , Combined Modality Therapy , Female , Fibrosarcoma/surgery , Humans , Middle Aged , Neoplasm Recurrence, Local/surgery , Neoplasm Staging , Neoplasms, Radiation-Induced/diagnosis , Neoplasms, Radiation-Induced/surgery , Prognosis , Radiotherapy Dosage , Thoracic Wall/surgery , Time FactorsABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Radiotherapy/adverse effects , Chemotherapy, Adjuvant/methods , Tomography, Emission-Computed/methods , Rhabdomyosarcoma/radiotherapy , Carcinoma/chemically induced , Carcinoma , Chemotherapy, Adjuvant/trends , Immunohistochemistry/methods , Fibrosarcoma/complications , Fibrosarcoma , Osteosarcoma/complications , Chondrosarcoma/complications , Neurilemmoma/complications , Leiomyosarcoma/complicationsABSTRACT
Surgical resection of pulmonary metastasis is appropriate provided the general principals of oncological surgery are followed. Complete excision of the metastatic tumor is associated with long-term survival and low perioperative mortality. We present 2 cases of single pulmonary metastasis from osteosarcoma with cardiac involvement. In both cases, complete excision required left pneumonectomy by sternotomy with extracorporeal circulation. The outcomes were favorable, no perioperative complications were reported, and the patients remained free of disease at 14 and 17 months after surgery. In conclusion, we believe that the cases presented confirm that extended pneumonectomy with extracorporeal circulation if necessary is a valid approach for complete resection of pulmonary metastasis.
Subject(s)
Bronchial Neoplasms/secondary , Bronchial Neoplasms/surgery , Extracorporeal Circulation , Lung Neoplasms/secondary , Lung Neoplasms/surgery , Osteosarcoma/secondary , Osteosarcoma/surgery , Pneumonectomy/methods , Adult , Antineoplastic Agents/therapeutic use , Arm , Bronchial Neoplasms/diagnostic imaging , Chemotherapy, Adjuvant , Combined Modality Therapy , Femoral Neoplasms/drug therapy , Femoral Neoplasms/pathology , Femoral Neoplasms/surgery , Heart Atria/pathology , Heart Atria/surgery , Humans , Lung Neoplasms/diagnostic imaging , Male , Osteosarcoma/diagnostic imaging , Osteosarcoma/drug therapy , Pericardiectomy/methods , Pericardium/pathology , Pericardium/surgery , Pleura/pathology , Pleura/surgery , Pulmonary Veins/pathology , Pulmonary Veins/surgery , Sarcoma/pathology , Sarcoma/radiotherapy , Sarcoma/surgery , Thoracic Wall/pathology , Thoracic Wall/surgery , Tomography, X-Ray ComputedABSTRACT
La resección quirúrgica de las metástasis pulmonares es un tratamiento aceptado si se mantienen los principios generales de la cirugía oncológica, y la exéresis completa de las metástasis se asocia a una supervivencia a largo plazo y una mortalidad perioperatoría baja. Presentamos 2 casos de metástasis pulmonar única de osteosarcoma con infiltración cardíaca, que requirió para su exéresis completa neumonectomía izquierda por esternotomía, con utilización de circulación extracorpórea. El resultado fue favorable, sin que hubiera complicaciones perioperatorias y los pacientes permanecen indemnes a los 14 y 17 meses de la intervención quirúrgica. En conclusión, consideramos que en casos seleccionados la neumonectomía ampliada, con utilización de circulación extracorpórea si se precisa, para poder realizar la exéresis completa de metástasis pulmonares es un procedimiento válido
Surgical resection of pulmonary metastasis is appropriate provided the general principals of oncological surgery are followed. Complete excision of the metastatic tumor is associated with long-term survival and low perioperative mortality. We present 2 cases of single pulmonary metastasis from osteosarcoma with cardiac involvement. In both cases, complete excision required left pneumonectomy by sternotomy with extracorporeal circulation. The outcomes were favorable, no perioperative complications were reported, and the patients remained free of disease at 14 and 17 months after surgery. In conclusion, we believe that the cases presented confirm that extended pneumonectomy with extracorporeal circulation if necessary is a valid approach for complete resection of pulmonary metastasis
