Most Read Articles
Roshini Claire Anthony, 6 days ago

A genotype-guided approach to warfarin dosing may result in fewer dose adjustments in Asian patients, according to a study from Singapore.

6 days ago
Patients with coronary artery disease (CAD) treated in a poor Southeast Asian setting appear to have far too high short-term and medium-term mortality rates, according to a study.
Yesterday
Despite the absence of a substance use problem, regular cannabis use is associated with psychosocial impairment among adolescents and young adults, a study suggests. On the other hand, regular users with cannabis use disorder appear to exhibit high psychiatric comorbidity and more severe psychosocial impairment.
21 Jul 2018
Although many patients with atopic dermatitis (AD) use antihistamines, no high-level evidence exists to prove that nonsedating antihistamines reduce itch in patients with AD or provide benefit in controlling AD symptoms, except perhaps sleep and AD comorbidities such as allergic rhinitis, according to a study.

Real-world study: Better outcomes with earlier use of enzalutamide in Chinese mCRPC patients

Christina Lau
12 Feb 2018
Dr Darren Poon

Chinese patients with metastatic castration-resistant prostate cancer (mCRPC) have higher response rates, longer survival and a lower risk of fatigue when enzalutamide is used in earlier rather than later lines of treatment, a study by the Hong Kong Society of Uro-Oncology has shown.

The study included 117 patients with mCRPC treated with enzalutamide at all public oncology centres in Hong Kong between August 2015 and October 2017. Among these patients, 29.1 percent received enzalutamide as first-line therapy, 48.7 percent received enzalutamide as second-line therapy (after docetaxel or abiraterone), and 19.3 percent received enzalutamide at third line or above (after at least two of the following: docetaxel, abiraterone, cabazitaxel or radium-223). [ASCO GU 2018, abstract 330]

After a median follow-up of 7.8 months, median overall survival (OS) was not reached in patients who received enzalutamide as first-line therapy, 15.8 months in those who received enzalutamide as second-line therapy, and 7.4 months in those who received the agent at third line or above (p=0.0002). One-year OS rate was 82 percent.

Median progression-free survival (PFS) was 7.1 months, 3.9 months and 2.2 months in patients who received enzalutamide at first, second and third line or above, respectively (p=0.0002).

Similarly, rates of prostate-specific antigen (PSA) response (>50 percent decline in PSA from baseline) were also higher in patients treated with enzalutamide earlier in the course of their disease. PSA response rate was 73.5 percent in patients treated with first-line enzalutamide, 35.1 percent in patients who received enzalutamide as second-line therapy (post-docetaxel, 53.8 percent; post-abiraterone, 29.5 percent), and 19.2 percent in those who received enzalutamide at third line or above (p<0.001).

“The presence of PSA response was associated with favourable OS [hazard ratio (HR), 0.19; p<0.0001] and PFS [HR, 0.29; p<0.001] in multivariate analysis of the whole cohort,” said first author Dr Darren Poon of the Department of Clinical Oncology, Chinese University of Hong Kong.

The researchers also assessed fatigue in the cohort as real-world data on fatigue in enzalutamide-treated mCRPC patients were lacking. Overall, 54.7 percent and 9.4 percent of patients experienced grade 1/2 and grade 3/4 fatigue, respectively.

Grade 1/2 fatigue was experienced by 44.1 percent of patients treated with first-line enzalutamide, 59.6 percent of patients who received enzalutamide as second-line therapy (post-docetaxel, 47.1 percent; post-abiraterone, 59.1 percent), and 57.7 percent of patients who received enzalutamide at third line or above. The rate of grade 3/4 fatigue was 5.9 percent, 7 percent (post-docetaxel, 0 percent; post-abiraterone, 9.1 percent), and 19.2 percent, respectively.

“In multivariate analysis of the whole cohort, the use of enzalutamide at third line or above was significantly associated with grade 2 or above fatigue [HR, 8.05; p=0.01],” the investigators reported.

“In a real-world clinical setting, more frequent PSA response, longer OS and longer PFS were found in chemotherapy-naïve patients with mCRPC treated with enzalutamide. Patients who received enzalutamide at later lines of treatment had higher risk of fatigue,” they concluded.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 6 days ago

A genotype-guided approach to warfarin dosing may result in fewer dose adjustments in Asian patients, according to a study from Singapore.

6 days ago
Patients with coronary artery disease (CAD) treated in a poor Southeast Asian setting appear to have far too high short-term and medium-term mortality rates, according to a study.
Yesterday
Despite the absence of a substance use problem, regular cannabis use is associated with psychosocial impairment among adolescents and young adults, a study suggests. On the other hand, regular users with cannabis use disorder appear to exhibit high psychiatric comorbidity and more severe psychosocial impairment.
21 Jul 2018
Although many patients with atopic dermatitis (AD) use antihistamines, no high-level evidence exists to prove that nonsedating antihistamines reduce itch in patients with AD or provide benefit in controlling AD symptoms, except perhaps sleep and AD comorbidities such as allergic rhinitis, according to a study.