Researchers validate prognostic model for mCRPC
Researchers have developed and validated a clinically useful prognostic model for men with metastatic castration-resistant prostate cancer, which can be used in the front-line setting.
Andrew Armstrong, MD, ScM, of Duke Cancer Institute, Durham, NC, presented on the model at the Genitourinary Cancers Symposium in Orlando, FL.
“Determining prognosis is of utmost importance to patients and their significant others, for life planning and decisions on the appropriateness of therapy and the need for aggressive actions,” Dr. Armstrong told Urology Times.
Prior work by Dr. Armstrong and others have identified a number of prognostic factors in men with advanced prostate cancer, but these new data were needed in order to provide updated data to men that reflect contemporary practice in patients receiving front-line androgen receptor inhibitor therapy and prior to chemotherapy.
Dr. Armstrong and co-authors identified prognostic factors for overall survival in chemotherapy-naive men with metastatic castration-resistant prostate cancer by analyzing the phase III PREVAIL trial (enzalutamide [XTANDI] vs. placebo). His team identified traditional risk factors such as the pattern of spread, the level of PSA, and the presence of pain and other factors, but also identified novel factors such as the neutrophil-to-lymphocyte ratio, each of which independently predicted survival over time. The trial’s dataset is readily applicable to patients in the front-line setting with metastatic castration-resistant prostate cancer, who are considering front-line androgen-receptor directed therapy, he said.
“Importantly, we included enzalutamide treatment in this model, as it is important to communicate prognosis to patients both with and without therapy,” Dr. Armstrong said.
The authors randomly divided 1,159 men into the training set and 550 into the testing set. In the training group, they analyzed 23 prognostic factors, including treatment, and developed a multivariable model predicting overall survival based on the analysis. The final multivariable model, according to the study’s abstract, includes 11 prognostic factors: PSA, treatment, hemoglobin, neutrophil-lymphocyte ratio, liver metastases, time from diagnosis to randomization, lactate dehydrogenase, 10 or greater bone metastases, pain, albumin, and alkaline phosphatase.