Annual Meeting Proceedings Part 1 - American Society of Clinical ...

290s Genitourinary Cancer
4552 Poster Discussion Session (Board #6), Mon, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Development of a nomogram model using a very large sample of patients
(pts) to predict the risk of 99mTc-bone scan (BS) positivity in pts receiving
androgen deprivation therapy (ADT) for prostate cancer (PCa). Presenting
Author: Geoffrey Gotto, Southern Alberta Institute of Urology, Calgary, AB,
Canada
Background: Decisions to start imaging pts with PCa can be difficult due to
the heterogeneous nature of the disease. Nomograms can combine information
on multiple disease factors to improve predictive accuracy and are not
influenced by subjective confounders that may affect clinical judgment.
However, currently available nomograms for PCa predict current or future
risk of positive BS in ADT-naive pts only. We have developed a new
nomogram to predict current BS positivity in ADT-treated pts with PCa
using a very large pt sample. Methods: All BS records from 1650
ADT-treated pts who received treatment at the Memorial Sloan-Kettering
Cancer Center from 2000 to 2011 were analyzed. Pts were followed up
from the start of ADT until the first positive BS or last hospital visit.
Multivariate logistic regression analysis was used to model the variables
that could be used for predicting likelihood of metastases and the variables
were incorporated into the nomogram model. The current probability of
bone metastasis was generated by the nomogram using the pt variables at
each BS and the predictive accuracy was quantified by calculating the
concordance index (C-index). Results: In total, 3949 BS records were
analyzed and 950 pts had a positive scan. There was an average of 1.1 prior
negative scans before a positive result was recorded. Median prostatespecific
antigen (PSA) was 2.5 ng/mL and mean PSA doubling time
(PSADT) was 7.8 months. At the same time of the positive scans, 49.4% of
pts had a PSA �10 ng/mL. Based on clinical relevance and data
availability, 13 variables were included in the nomogram model: number of
previous negative BSs, PSA, PSADT, prostatectomy, radiotherapy, brachytherapy,
chemotherapy, immunotherapy, estrogen therapy, cryotherapy,
clinical trial enrollment, and most recent primary and secondary Gleason
grades. C-index for the nomogram was 0.76. Conclusions: This is the first
nomogram to predict current BS positivity in pts with PCa following ADT.
The nomogram was devised from a very large data set from a single center
and provides high predictive accuracy.
4554 Poster Discussion Session (Board #8), Mon, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Abiraterone in patients with metastatic castration-resistant prostate cancer
progressing after docetaxel and MDV3100. Presenting Author: Ecaterina
Ileana, Institut Gustave Roussy, Villejuif, France
Background: Chemotherapy with docetaxel is the standard first-line treatment
in patients with metastatic castration-resistant prostate cancer
(mCRPC). In patients progressing after docetaxel, both abiraterone and
MDV3100 have yielded improved survival for patients with mCRPC. The
efficacy of abiraterone in patients pre-treated with MDV 3100 is unknown.
Methods: We investigated abiraterone-prednisone in 24 patients with
cancer progression after docetaxel followed by MDV3100. All patients
received abiraterone 1000 mg/day plus prednisone 10mg/day. Prostatespecific
antigen (PSA) response, symptom response, and time to progression
were assessed. Results: Patient characteristics were as follows: median
age: 74 years (53-84), median PSA: 108 ng/mL (2-2541), metastatic
sites: bone: all 24 patients, liver/lung: 6 patients (25%), and lymph nodes :
9 patients (38%). Five patients (21%) had a PSA decrease on abirateroneprednisone.
Three patients (13%) achieved a PSA response, defined as a
decrease of �50% in PSA, confirmed after� 4 weeks. The duration of PSA
response was 2, 3 and 4.5 months. Six patients (29%) had a symptomatic
response on the pain score and analgesic consumption was decreased.
Treatment was well tolerated. Abiraterone-prednisone was discontinued in
one patient due to edema and hypokaliemia. Conclusions: This study shows
preliminary evidence that abiraterone-prednisone yields activity in patients
with mCRPC pretreated with docetaxel and MDV3100.
4553 Poster Discussion Session (Board #7), Mon, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Durable radiologic and clinical disease stability beyond PSA progression in
patients with metastatic castration-resistant prostate cancer (mCRPC)
treated with abiraterone acetate (AA). Presenting Author: Diletta Bianchini,
The Royal Marsden Hospital and The Institute of Cancer Research, Sutton,
United Kingdom
Background: AA, a potent oral CYP17A1 inhibitor is approved for treatment
of mCRPC with a survival advantage of 4.9 months. In clinical practice,
response evaluation remains challenging for pts with mCRPC. CTC conversion
from CTC � 5toCTC�5with treatment predicts for improved overall
survival in mCRPC. We hypothesized that pts continue to have durable
disease stability beyond PSA progression on AA. Methods: Prostate Specific
Antigen (PSA) responses, radiological responses and CTC conversion rates
were retrospectively analysed in pts treated on AA at our institution. CTCs,
PSA and imaging were obtained at predefined time points during these
studies. Radiological and PSA progression were defined by standard
Prostate Cancer Working Group Criteria II. Clinical progression consisted of
worsening disease related pain, skeletal events or declining performance
status.Pearson’s chi-squared test and the Kaplan-Meier method were used
for this analysis. Results: 141 patients [ECOG Performance Status 0-2;
Median Age: 69.7 (range 44.7-87.1); 85 post-docetaxel, 56 predocetaxel]
received AA. The median duration of clinical and radiological
stable disease (SD) was 16.8 months (n�55) and 5.6 months (n�75) in
patients with a baseline CTCs count of � 5 cells/7.5mls and � 5 cells/7.5
mls respectively. In the 105 patients with documented PSA progression on
AA there was a median 5.7-month delay in detecting radiological and/or
clinical progression (95% CI: 4.2, 8.4; range 0.3, 35.6 months). Radiological
and clinical SD of � 1 year, � 2 years and � 3 years on AA was observed
in 43/141 (30.5%), 21/141 (14.9%) and 12/141 (8.5%) respectively.
Conclusions: Radiological and clinical disease stabilization beyond PSA
progression is maintained in a high proportion of mCRPC patients treated
with AA. Future studies should evaluate whether continued AA treatment
beyond PSA and radiological progression can impact outcome.
4555 Poster Discussion Session (Board #9), Mon, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Association of metabolic syndrome with poorer prostate cancer and overall
survival in men receiving androgen deprivation therapy (ADT) for biochemical
relapse. Presenting Author: Sarah Maria Rudman, Division of Cancer
Studies, King’s College London, Guy’s Hospital, London, United Kingdom
Background: The metabolic syndrome (MS) has been implicated in the
development of prostate cancer (PC). In our previous study of a Veterans’
Administration (VA) cohort, MS was associated with a shorter duration of
PC control with ADT. We report the impact of MS on overall survival (OS)
and PC specific death for a cohort of patients with biochemical relapse.
Methods: 273 pts (64 VA pts and 209 pts from Health Professionals Follow
up Study) treated with ADT for biochemical recurrence post radiation or
prostatectomy for PC were included. The modified Adult Treatment Panel
III criteria for MS was used to identify patients with MS status prior to the
commencement of ADT. Cox models tested for association of MS status
with OS or time to PC specific death. With 42% overall death rate, 31% MS
prevalence, there was 90% power to detect HR� 1.81 (type I error rate
�0.05). Results: 31% pts (84/273) had MS and 15% pts (40/273) died of
PC. Median follow-up was 9.5 years. The median OS with and without MS
was 7.4 and 11.2 years respectively. Patients with hypertension, being
African American, having diabetes and age were associated with increased
risk of death from any causes, while hypertension and being African
American were also associated with increased risk of PC specific death. A
multivariate Cox regression model adjusted for age at diagnosis, race,
definitive local therapy (RT vs. RP), PSA at diagnosis and Gleason score
revealed MS was associated with a significantly increased risk of death from
any cause and PC specific death (Table). Conclusions: In men receiving ADT
for biochemically recurrent androgen dependent PC, the presence of MS at
the commencement of ADT is associated with an increased risk of death
from any cause as well as prostate cancer specifically.
Overall (N�273)
Comparison Median (years) Event Adjusted HR
Endpoint (MS status) OS, (95%CI) (patient) (95% CI) P value*
OS No (ref) 11.17 74 (189) 1
(10-13.9)
Yes 7.42 (5.33-12.1) 40 (84) 2.12
(1.42, 3.16) �0.001
PCa death No (ref) 25 (189) 1
Yes 15 (84) 2.03 0.036
(1.05, 3.94)
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