Clinical benefits of androgen receptor signaling inhibitors in patients with metastatic hormone-sensitive prostate cancer: real-world data from a multi-center study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: This study investigated clinical benefits of androgen receptor signaling inhibitor (ARSI) in patients with synchronous metastatic hormone-sensitive prostate cancer (mHSPC) based on real-world data from multiple centers. METHODS: Clinical records of 1107 mHSPC patients who commenced vintage (bicalutamide) (n = 801) or ARSI (n = 306) treatment in addition to androgen deprivation therapy between 1999 and 2024 were reviewed. Progression-free and overall survival (OS) were examined, and prognostic factors were analyzed using multivariate cox proportional hazard modeling. Propensity score matching (PSM) analysis was performed to balance background characteristics. RESULTS: Median age and initial prostate-specific antigen level were 73 years and 229 ng/ml, respectively. Kaplan-Meier analysis revealed that upfront ARSI treatment was associated with longer progression-free survival (P < 0.0001, hazard ratio [HR] = 0.37) and OS (P = 0.0088, HR = 0.58) than combined androgen blockade after PSM analysis. In particular, an OS benefit of upfront ARSI was observed in high-volume patients (P = 0.0052, HR = 0.56). ARSI use after castration-resistant prostate cancer (CRPC) development correlated with improved OS as compared to patients without ARSI use (P < 0.0001, HR = 0.52). Multivariate analysis identified ARSI therapy as an independent prognostic factor for OS both when used upfront (P = 0.0141, HR = 0.61) and after CRPC development (P < 0.0001, HR = 0.55). In addition, categorizing all patients into groups receiving no ARSI, ARSI after CRPC, or ARSI as upfront therapy revealed 5-year OS rates of 55.65%, 59.85%, and 65.01%, respectively. CONCLUSIONS: Early use of ARSI in Japanese patients with mHSPC appears clinically beneficial. Our findings suggest the prognostic importance for optimal treatment intensification.
DOI: 10.1093/jjco/hyaf079
Authors: Yosuke Kinoshita, Yasutaka Yamada, Takuya Tsujino, Zhao Xue, Kodai Sato, Sinpei Saito, Kazuki Nishimura, Tatsuo Fukushima, Ko Nakamura, Satoshi Yamamoto, Takayuki Arai, Hiroaki Sato, Kosuke Higuchi, Akinori Takei, Manato Kanesaka, Keisuke Ando, Sangjon Pae, Sanji Kanaoka, Nobushige Takeshita, Kei Yoneda, Daichi Hino, Tomokazu Sazuka, Yusuke Imamura, Kazuo Mikami, Kazuyoshi Nakamura, Satoshi Fukasawa, Akira Kurozumi, Yukio Naya, Maki Nagata, Atsushi Komaru, Toyofusa Tobe, Noriyuki Suzuki, Haruhito Azuma, Tomohiko Ichikawa, Shinichi Sakamoto
Institutions: Chiba University, Osaka Medical and Pharmaceutical University, Kimitsu Chuo Hospital, Chiba Rosai Hospital, Chibaken Saiseikai Narashino Hospital, Funabashi Municipal Medical Center, Matsudo City Hospital, Fukaya Red Cross Hospital, Chiba Cancer Center, Asahi General Hospital, Teikyo University Chiba Medical Center, Yokohama Rosai Hospital, Saiseikai Utsunomiya hospital
Language: English
Subfield: Cancer Research
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W4410459112