A quick overview of recent real-world studies of abiraterone acetate——Expert interpretations of Professor Zeng Hao and Professor Li Yonghong

I grew up in the South.
I eat rice all year round and three meals a day.
As I rarely eat steamed buns and dumplings, this kind of food often has something to do with festivals
.

When I was young, when I saw the surgeon’s father walking home with a piece of pork and a bag of flour in his hand, I knew what day it was
.

When I was a child, there were many holidays.
May 1 is Labor Day, June 1 is Children’s Day, July 1 is the birthday of the Communist Party, August 1 is the birthday of the Communist Army, and October 1 is the birthday of the Communist Party of China.
, And New Year's Day and Spring Festival, because my father is from the north, I can eat steamed buns or dumplings these days
.

I grew up in the South.
I eat rice all year round and three meals a day.
As I rarely eat steamed buns and dumplings, this kind of food often has something to do with festivals
.

When I was young, when I saw the surgeon’s father walking home with a piece of pork in his hand and a bag of flour, I knew what day it was
.

When I was a child, there were many holidays.
May 1 is Labor Day, June 1 is Children’s Day, July 1 is the birthday of the Communist Party, August 1 is the birthday of the Communist Army, and October 1 is the birthday of the Communist Party of China.
, And New Year's Day and Spring Festival, because my father is from the north, I can eat steamed buns or dumplings these days
.

I grew up in the South.
I eat rice all year round and three meals a day.
As I rarely eat steamed buns and dumplings, this kind of food often has something to do with festivals
.

When I was young, when I saw the surgeon’s father walking home with a piece of pork and a bag of flour in his hand, I knew what day it was
.

When I was a child, there were many holidays.
May 1 is Labor Day, June 1 is Children’s Day, July 1 is the birthday of the Communist Party, August 1 is the birthday of the Communist Army, and October 1 is the birthday of the Communist Party of China.
, And New Year's Day and Spring Festival, because my father is from the north, I can eat steamed buns or dumplings these days
.

Click on the "blue word" above to follow us! A quick overview of recent real-world studies of Abiraterone Acetate Professor Hao Zeng and Professor Yonghong Li Expert Interpretation In August, three articles on the real-world study of Abiraterone acetate were published, and the three articles focused on precise pathological classification in clinical practice.
——The treatment response of different subtypes of intraductal carcinoma of the prostate (IDC-P) and the efficacy and safety of abiraterone acetate hormone conversion.
We are fortunate to have Professor Zeng Hao and Professor Li Yonghong for interpretation and analysis from the perspective of researchers.
With a view to promoting clinical practice supported by real-world data research and evidence-based support
.

Precise pathology to guide treatment decisions: Intraductal cancer classification and mCRPC treatment selection The first article was completed by the Department of Urology, West China Hospital, and was published in Prostate on August 26.
Study 1 explored different types of prostate intraductal cancers (IDC-P) subtypes of mCRPC patients respond differently to treatment with abiraterone acetate and docetaxel
.

A review of the results of the previous study 2 of the Huaxi team showed that intraductal cancer in mCRPC patients was detected again by puncture, indicating a poor prognosis.
Abiraterone acetate as a first-line treatment for IDC-P(+) mCRPC patients has a better curative effect than docetaxel
.

IDC-P is not only related to the rapid progress of PSA, but also significantly related to shorter OS
.

In IDC-P(-) patients, there were no significant differences in PSA response, PSA-PFS and OS between the abiraterone acetate treatment group and the docetaxel treatment group
.

In contrast, among IDC-P(+) patients, the PSA response rate of the abiraterone acetate treatment group was higher than that of the docetaxel treatment group (52.
4% vs.
21.
7%; p=0.
035)
.

In addition, among IDC-P(+) patients, PSA-PFS and OS in the abiraterone acetate treatment group were longer than those in the docetaxel treatment group (PSA-PFS: 13.
5 months and 6.
0 months, P=0.
012; OS : Less than 14.
7 months, p=0.
128)
.

Continuing to explore the response of each subtype of IDC-P to treatment, this study retrospectively analyzed the data of 170 patients with mCRPC who received first-line treatment with abiraterone acetate or docetaxel
.

The results showed that 53.
5% (91/170) of the enrolled patients were diagnosed with IDP-C, and IDC-P type 1 and type 2 accounted for 39.
6% (36/91) and 60.
4% (55/91), respectively
.

Regardless of the standard treatment, compared with IDC-P(-) or IDC-P1 type patients, IDC-P type 2 patients are treated with abiraterone acetate (mPSA-PFS:11.
9 vs.
11.
1 vs.
6.
1 Month, P<0.
001; mrPFS: 18.
9 vs.
19.
4 vs.
9.
6 months, p<0.
001) or docetaxel (mPSA-PFS: 6.
2 vs.
6.
6 vs.
3.
0 months, p<0.
001; mrPFS: 15.
1 vs.
.
12.
6 vs.
5.
5 months, p<0.
001) The prognosis during treatment was significantly worse
.

In the treatment of abiraterone acetate and docetaxel, patients with IDC-P1 and IDC-P(-) patients have similar clinical outcomes
.

However, for IDC-P1 type (mPSA-PFS: 6.
6 vs.
11.
1 months, P=0.
021; mrPFS: 12.
6 vs.
19.
4 months, P = 0.
027) or type 2 (mPSA-PFS: 3.
0 vs.
6.
1 months, P = 0.
003; mrPFS: 5.
5 vs.
9.
6 months, P = 0.
007) In patients, the efficacy of docetaxel was significantly inferior to that of abiraterone acetate
.

Figure 2 Cohort with abiraterone acetate as the first-line treatment (A) PSA response; (B) PSA-PFS; (C) rPFS; (D) OS Figure 3 Cohort with docetaxel as the first-line treatment (A) PSA Response; (B) PSA-PFS; (C) rPFS; (D) OS The author said: At the beginning of the topic, Professor Zeng Hao aimed to explore the benefits of pathological level precision medicine that can bring patient diagnosis and treatment.
Organizing and the team’s previous work accumulation, pathology showed that IDC-P showed a poor prognosis, which strengthened our team’s confidence in exploring and practicing precision medicine at the level of pathological classification
.

Our team’s series of studies revealed the predictive value of IDC-P in mCRPC, that is, IDC-P subtypes have prognostic effect and potential therapeutic guidance value in mCRPC patients, and mCRPC patients with different IDC-P subtypes respond and There are differences in prognosis
.

The research results published this year further confirm that IDC-P2 has a worse prognosis than IDC-P1 and IDC-P(-)
.

Whether receiving abiraterone acetate or docetaxel treatment, IDC-P1 and IDC (-) patients have similar clinical outcomes.
However, compared with docetaxel, abiraterone acetate is in the two subtypes IDC-P patients showed better curative effect, which provides more basis for IDC-P to guide treatment decision-making clinical path and IDC-P classification to optimize treatment options
.

In addition, this research also fully reflects the importance of our team's precise diagnosis under the MDT cooperation mode for personalized treatment of patients
.

What should I do if there is pure biochemical progress after treatment with abiraterone acetate in the mCRPC stage? Hormone conversion prolongs patient benefits.
Recently, the Urology team of West China Hospital and the Department of Urology of Sun Yat-sen University Cancer Center have published important research results in Asian Journal of Andrology and BMC Cancer.
These two real-world studies explored from different perspectives.
Efficacy and safety of abiraterone acetate combined with dexamethasone in the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC)
.

The Department of Urology, Sun Yat-sen University Cancer Center 3 retrospectively analyzed 130 mCRPC patients with a median follow-up time of 15 months.
The patients received abiraterone acetate + prednisone (A+P) treatment, and the asymptomatic biochemical progress (PCWG3) Standard) after switching to A+dexamethasone (D) treatment, the median progression-free survival (PFS) and overall survival (OS) of A+D after conversion reached 5.
0 months (95% CI, 3.
9–6.
1 months) ) And 18.
7 months (95% CI, 15.
7-21.
5 months)
.

The proportion of patients whose prostate specific antigen (PSA) decreased by ≥50% (PSA50) and ≥30% (PSA30) was 29.
2% and 46.
2%, respectively
.

The median PFS and OS of PSA30 patients reached 8.
1 months and 28.
3 months, respectively, while the median PFS and OS of PSA50 patients reached 8.
9 months and 29.
8 months, respectively, which were significantly longer than those of patients who did not respond effectively
.

(Figure 1-1) Figure 1-1 Kaplan-Meier survival curves of PFS and OS stratified by different PSA responses during hormone conversion (A: PSA50 PFS; B: PSA50 OS; C: PSA30 PFS; D: PSA30 OS) The results showed lower PSA (≤20 ng/mL; median PFS, hazard ratio [HR] 0.
63, p=0.
019; median OS, HR0.
38, p=0.
001) during hormone conversion and longer without mCRPC Survival (≥18 months; median PFS, HR 0.
61, p=0.
013; median OS, HR 0.
51, p=0.
015) is related to longer PFS and OS, and is an independent prognostic predictor (see Figure 1 -2 and Table 1-1)
.

Figure 1-2 Kaplan-Meier survival curve of PFS and OS stratified by PSA during hormone conversion (A: PFS; B: OS), mCRPC-free survival (C: PFS; D: OS) Table 1-1 Multivariate Cox analysis predicted hormone conversion PFS and OS West China Hospital Urology Team4 retrospectively analyzed 101 cases of mCRPC patients undergoing hormone conversion
.

All patients received A+P as the first-line treatment during the treatment period and switched to A+D treatment after progression.
42 (41.
6%) and 25 (24.
8%) patients had PSA drops of 30% and 50%, respectively
.

The median biochemical progression-free survival (bPFS) and median OS of patients treated with A+D were 4.
9 (95% CI: 3.
7-6.
0) months and 18.
8 (95% CI: 16.
2-30.
2) months, respectively
.

The results of multivariate analysis showed that the expression of C3 (AKR1C3), a member of aldoketone reductase family 1 (HR: 2.
15, 95% Cl: 1.
22-3.
80, P=0.
008) and baseline serum alkaline phosphatase (ALP; HR: 4.
95, 95%Cl:2.
40-10.
19, P<0.
001) is an independent predictor of biochemical progression-free survival (bPFS) after hormone conversion (Table 2-1)
.

Table 2-1: Univariate and multivariate analysis predicts the biochemical progression-free survival and overall survival of hormone switch therapy.
Based on the multivariate analysis of bPFS, we defined 4 factors according to whether they have poor prognosis Risk stratification: low-risk group (no baseline ALP>160 IU/L or AKR1C3 positive expression), intermediate-risk group A (AKR1C3 positive expression), intermediate-risk group B (baseline ALP>160 IU/L) and high-risk group ( Baseline ALP>160 IU/L and AKR1C3 positive expression)
.

The results of univariate analysis showed that compared with the low-risk group, the bPFS and OS of the medium-risk group and the high-risk group were significantly shortened, suggesting that this risk stratification is helpful for screening patients who can benefit from hormone conversion
.

(See Figure 2-1 for details) Figure 2-1: KM survival curve based on risk stratification (a) bPFS; (b) OS author said: Professor Li Yonghong since 2010, more and more studies have shown that mCRPC stage Patients receiving abiraterone acetate+P treatment can switch from P to D through hormones after biochemical progress, which prolongs the clinical benefit of patients
.

In 2016, abiraterone acetate was approved to enter China, and we began to try to use hormone conversion in some patients.
With the accumulation of clinical practice experience, we found that patients did have different responses to different combination hormones, so we reviewed Analysis of relevant clinical data in order to provide more evidence-based evidence
.

Consistent with previous studies, the real-world research results of our center confirm that hormone conversion brings significant survival benefits to some patients.
mCRPC patients undergo A+P biochemical progress and switch to A+D treatment, which can prolong abiraterone acetate Clinical benefits for patients
.

Further exploration found that we may choose more people who benefit from hormone transformation from multiple dimensions, and provide more evidence for clinical practice
.

On the other hand, we chose this topic considering that hormone conversion is a cost-effective treatment strategy, which is suitable for patients who cannot afford other effective sequential therapies (such as chemotherapy or other AR signal-targeted drugs), or Patients with few sequential therapy drugs have practical clinical management significance
.

Expert introduction Zeng Hao | Professor Sichuan University, West China Hospital, Deputy Director of Medicine, Doctoral Supervisor, Member of the Youth Committee of the Chinese Medical Association Urology Branch, Chairman of the Oncology Group of the Youth Committee of the Chinese Medical Association Urology Branch, Member of the International Exchange Committee of the Chinese Medical Association Urology Branch Member of the Youth Committee of the Cancer Society Urinary and Male Reproductive Tumor Special Committee Member and Deputy Secretary-General of the Urinary Health Promotion Branch of the China Medical Care International Exchange and Promotion Association Deputy Chairman of the Youth Committee of the Urinary Health Promotion Branch of the China Medical Care International Exchange Promotion Committee CSCO Prostate Cancer Expert Committee Committee Member of CSCO Urothelial Cancer Expert Committee Member of Sichuan Urological Specialty Committee Standing Committee Member of Sichuan Urological Specialty Committee Li Yonghong, Deputy Leader of Oncology Group of Sichuan Urological Specialty Committee District Chief, Deputy Chief Physician, Master's Supervisor Specialist in Prostate Cancer Single Disease, Guangdong Province Outstanding Young Medical Talent, Member of the Ethics Committee of Sun Yat-sen University Tumor Hospital, Member of the Standing Committee of the Asian Cryotherapy Society, Chinese Medical Doctors Association, Tumor Ablation Therapy Technical Expert Group Urinary Tract Tumor Ablation Professional Group Team Leader Chinese Society of Clinical Oncology (CSCO) Prostate Cancer Expert Committee Member, Guangdong Anti-Cancer Association Secretary of Urogenital Tumor Professional Committee Secretary of Guangdong Prostate Cancer Multidisciplinary Cooperation Group Secretary of South China Surgical Robot Training Center, specializing in the diagnosis and treatment of prostate cancer
.

As the first/corresponding author, he published 10 papers in "European Urology", "Prostate", "Urology" and other magazines.
The research results are cited in the NCCN Guidelines and "Campbell Urology".
1.
Wang Z, Zhu S, Zhao J, et al.
The heterogeneity of intraductal carcinoma of the prostate is associated with different efficacy of standard first-line therapy for patients with metastatic castration-resistant prostate cancer [published online ahead of print, 2021 Aug 26].
Prostate.
2021;10.
1002/pros .
24215.
doi:10.
1002/pros.
242152.
Zhao J, Shen P, Sun G, et al.
The prognostic implication of intraductal carcinoma of the prostate in metastatic castration-resistant prostate cancer and its potential predictive value in those treated with docetaxel or abiraterone as first-line therapy.
Oncotarget.
2017;8(33):55374-55383.
Published 2017 Jul 24.
doi:10.
18632/oncotarget.
195203.
Yang Z, Ni Y, Zhao D, et al.
Corticosteroid switch from prednisone to dexamethasone in metastatic castration-resistant prostate cancer patients with biochemical progression on abiraterone acetate plus prednisone.
BMC Cancer.
2021;21(1):919.
Published 2021 Aug 13.
doi:10.
1186/s12885-021-08670- 24.
Ni YC, Zhao JG, Zhang MN, et al.
Predictors of efficacy of corticosteroid switching from abiraterone plus prednisone to dexamethasone in patients with metastatic castration-resistant prostate cancer [published online ahead of print, 2021 Aug 6].
Asian J Androl .
2021;10.
4103/aja202143.
doi:10.
4103/aja202143Predictors of efficacy of corticosteroid switching from abiraterone plus prednisone to dexamethasone in patients with metastatic castration-resistant prostate cancer [published online ahead of print, 2021 Aug 6].
Asian J Androl.
2021;10.
4103/aja202143.
doi:10.
4103/aja202143Predictors of efficacy of corticosteroid switching from abiraterone plus prednisone to dexamethasone in patients with metastatic castration-resistant prostate cancer [published online ahead of print, 2021 Aug 6].
Asian J Androl.
2021;10.
4103/aja202143.
doi:10.
4103/aja202143