Visceral Metastasis Predicts Response to New Hormonal Agents in Metastatic Castration-Sensitive Prostate Cancer

This review evaluates the pooled data from phase III trials of androgen-receptor signaling inhibitors in patients with metastatic castration-sensitive prostate cancer to dissect the impact of abiraterone acetate plus prednisone versus non-steroidal anti-androgens on overall survival for metastatic castration-sensitive prostate cancer with visceral metastasis. Visceral metastasis (VM) and a higher number of bone metastasis generally define high volume/risk in patients with metastatic castration-sensitive prostate cancer (mCSPC). Subgroup analysis of pivotal trials did not show a clear benefit of second-generation non-steroidal anti-androgens (NSAAs) in patients with VM. However, subgroup analysis of the trial assessing abiraterone acetate, a CYP 17 inhibitor, plus prednisone (AAP) showed an improved overall survival (OS) in patients with mCSPC with VM. We searched MEDLINE, Web of Science, and congress abstracts for the phase III randomized controlled trials of second-generation NSAAs and AAP in patients with mCSPC. In this pooled analysis, we included 6485 patients from the 6 phase III trials. The rate of patients with VM was 15.2%. Interestingly, in contrast to NSAAs, AAP seems to be effective in improving OS among patients with VM (hazard ratio, HR: 0.89, 95% CI, 0.72-1.11, P = .30 for second-generation NSAAs; HR: 0.58, 95% CI, 0.40-0.84, P = .004 for AAP). In contrast, both second-generation NSAAs (HR: 0.63, 95% CI, 0.57-0.70, P < .001) and AAP (HR: 0.68, 95% CI, 0.57-0.81, P < .001) improved OS in patients without VM. In this pooled analysis, we demonstrate that while AAP provided an OS improvement in patients with VM, second-generation NSAAs did not demonstrate a similar OS benefit in this population.

Automated summary

This review evaluates the impact of abiraterone acetate plus prednisone versus non-steroidal anti-androgens on overall survival for metastatic castration-sensitive prostate cancer with visceral metastasis. The analysis shows that abiraterone acetate improves overall survival in patients with visceral metastasis, while second-generation non-steroidal anti-androgens do not provide the same benefit in this population. However, both abiraterone acetate and second-generation non-steroidal anti-androgens improve overall survival in patients without visceral metastasis.