Predictors of outcomes of docetaxel treatment in de novo metastatic hormone-sensitive prostate cancer: A single-center cohort study

 Tomislav Omrčen, Davor Eterović, Tea Jozić, Eduard Vrdoljak

Abstract:

Six cycles of docetaxel in addition to androgen deprivation therapy (ADT) are currently one of the treatment options for patients with de novo metastatic hormone-sensitive prostate cancer (mHSPC). Since the outcomes in patients with high-volume (HV) disease remain modest, we aimed to identify patients for more intensified treatment. We report a cohort of 73 consecutive patients with de novo mHSPC treated with early docetaxel at the Department of Oncology and Radiotherapy, University Hospital of Split, Croatia, from October 2015 until March 2020. The outcomes analyzed were the occurrence of castration-resistant disease (CRPC) and death from any cause (OS). The median follow-up was 54 (50-73) months. Forty-six (63%) patients developed CRPC and 34 (47%) died during the follow-up. The median time to CRPC and median OS were 16.2 and 58.4 months, respectively. The risk of CRPC was higher for patients with high (above median) values of serum alkaline phosphatase (ALP) (HR=2.4; 95% CI [1.4–4.5]), lactate dehydrogenase (LDH) (HR=1.98; 95% CI [1.1–3.7]), prostate-specific antigen (PSA) (HR=1.8; 95% CI [1.1–3]), ECOG performance status >1 (HR=2; 95% CI [1.2–3.3]) and HV disease (HR=1.9; 95% CI [1.1–3.1]). The risk of any-cause death was higher in patients with high values of ALP, LDH, and ECOG performance status >1. The predictive value of LDH was independent of disease volume. A set of baseline characteristics could be used in conjunction with disease volume in deciding on the optimal treatment strategy for patients with de novo mHSPC.