Multi-institutional Analysis of the Clinical and Genomic Characteristics of Black Patients with Metastatic Hormone-Sensitive Prostate Cancer. (24th February 2022)

• Record Type: Journal Article
• Authors: Freeman, Meredith N; Jang, Albert; Zhu, Jason; Sanati, Farhad; Nandagopal, Lakshminarayanan; Ravindranathan, Deepak; Desai, Arpita; Phone, Audrey; Nussenzveig, Roberto; Jaeger, Ellen; Caputo, Sydney A; Koshkin, Vadim S; Swami, Umang; Basu, Arnab; Bilen, Mehmet A; Agarwal, Neeraj; Sartor, Oliver; Burgess, Earle F; Barata, Pedro C
• Is Part Of: Oncologist. Volume 27:Number 3(2022)
• Page Start: 220
• Page End: 227
• Publication Date: 2022-02-24
• Subjects: prostatic neoplasms -- androgen deprivation therapy -- health care disparities -- African Americans -- steroid synthesis inhibitors -- DNA sequence analysis; Oncology -- Periodicals; Tumors -- Periodicals; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Oncology; Tumors; Neoplasms; Electronic journals; Periodicals; Periodicals; 616.994
• DOI: 10.1093/oncolo/oyab057
• Languages: English
• ISSNs: 1083-7159

Abstract

Abstract: Background: The outcomes of metastatic hormone-sensitive prostate cancer (mHSPC) have significantly improved through treatment intensification, yet Black representation in those studies is suboptimal. Methods: A multi-institutional, retrospective analysis of Black men with mHSPC was conducted, focusing on baseline demographics, treatment patterns, genomic profiles, clinical outcomes including prostate-specific antigen response, time to castrate-resistant prostate cancer (CRPC), and subsequent treatments. Results: A total of 107 patients, median age 64 years, 62% with de novo metastases at diagnosis and 64% with high-volume disease, were included. Twenty-nine patients (27%) were treated with androgen deprivation therapy (ADT) with and without first generation anti-androgens, while 20%, 38% and 5% received chemotherapy, abiraterone, and enzalutamide, respectively. At time of data cut-off, 57 (54%) patients had developed CRPC, with a median time to CRPC of 25.4 months (95% CI 20.3-30.4). The median time to CRPC was 46.3 months (18.9-73.7) and 23.4 months (18.6-28.2) for patients who received ADT with or without first-generation anti-androgens and treatment intensification, respectively. The 2-year survival rate was 93.3%, and estimated median overall survival of was 74.9 months (95% CI, 68.7-81.0). Most patients (90%) underwent germline testing; the most frequent known alterations were found within the DNA repair group of genes. Somatic testing revealed pathogenic alterations of interest, notably TP53 (24%) and CDK12 (12%). Conclusion: In our cohort, Black men with mHSPC presented with a high proportion of de novo metastases and high-volume disease. Treatment outcomes were very favorable with ADT-based regimens. The genomic landscape suggests different molecular profile relative to White patients with potential therapeutic implications. Abstract : Racial disparities play a role in clinical trial enrollment, treatment implications, and clinical outcomes of patients with prostate cancer. This article reports on clinical and treatment outcomes and provides additional insights on the somatic and germline profile of Black men with metastatic hormone-sensitive prostate cancer.