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Survival following upfront chemotherapy for treatment-naïve metastatic prostate cancer: a real-world retrospective cohort study

Prostate Cancer and Prostatic Diseases volume 24, pages 261–267 (2021)Cite this article

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Abstract

Background

Upfront chemotherapy prolongs overall survival for men with metastatic, hormone-sensitive prostate cancer (mHSPC) based on data from clinical trials. We sought to assess the association between upfront chemotherapy and overall survival in men with mHSPC in a real-world cohort.

Methods

We performed a retrospective cohort study of men with de novo, treatment-naïve metastatic prostate cancer from a large, national cancer database in the United States (2014–2015). Men in the upfront chemotherapy group received chemotherapy within 4 months of diagnosis (n = 1033, 28%) versus no chemotherapy or chemotherapy later than 12 months after diagnosis (controls; n = 2704, 72%). Overall survival was assessed using Kaplan–Meier estimates and compared using multivariable Cox regression analysis.

Results

After a median follow-up of 23 months, median overall survival was 35.7 months in the upfront chemotherapy group and 32.5 months for controls (log-rank p < 0.001). After adjusting for patient and clinical variables, upfront chemotherapy was associated with longer overall survival (hazard ratio 0.78, 95% confidence interval 0.68–0.89, p < 0.001). In exploratory analyses, the association between upfront chemotherapy and overall survival did not differ by age groups, race, or number of comorbidities (all interaction p > 0.2).

Conclusions

In this real-world cohort, upfront chemotherapy for mHSPC was associated with longer overall survival. These data support the continued use of chemotherapy for men with mHSPC regardless of race or age if they are fit for chemotherapy and underscore the importance of evaluating cancer therapeutics outside of clinical trials to demonstrate treatment efficacy in populations that may be underrepresented in clinical trials.

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Fig. 1: CONSORT diagram for study population.
Fig. 2: Kaplan–Meier survival estimate of overall survival based on upfront chemotherapy.

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Funding

This work was supported in part by the Russell Scott, Jr., MD Urology Research Fund (ABW). The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Adam B. Weiner, Oliver S. Ko, Eric V. Li, Amanda X. Vo, Anuj S. Desai, Kieran J. Breen & Robert B. Nadler

  2. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Alicia K. Morgans

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  1. Adam B. Weiner
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  2. Oliver S. Ko
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  7. Robert B. Nadler
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  8. Alicia K. Morgans
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Contributions

Conception and design: ABW, MD; RBN, MD; AKM, MD, MPH. Acquisition of data: ABW, MD; OSK, MD. Analysis and interpretation of data: ABW, MD; OSK, MD; AXV, MD; ASD, MD. Drafting of Manuscript: ABW, MD; OSK, MD; EVL, MD; AXV, MD; ASD, MD. Critical revision of the manuscript for important intellectual content: ABW, MD; OSK, MD; EVL, MD; ASD, MD. Statistical analysis: ABW, MD. Obtaining funding: ABW, MD. Administrative, technical, or material support: RBN, MD; AKM, MD, MPH. Supervision: RBN, MD; AKM, MD, MPH. Other: none.

Corresponding author

Correspondence to Adam B. Weiner.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

Data were obtained from the National Cancer Database. The Institutional Review Board at Northwestern University determined this work to be exempt (STU00212973). The study was performed in accordance with the Declaration of Helsinki.

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Weiner, A.B., Ko, O.S., Li, E.V. et al. Survival following upfront chemotherapy for treatment-naïve metastatic prostate cancer: a real-world retrospective cohort study. Prostate Cancer Prostatic Dis 24, 261–267 (2021). https://doi.org/10.1038/s41391-020-00278-0

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