LHRH sparing therapy in patients with chemotherapy-naïve, mCRPC treated with abiraterone acetate plus prednisone: results of the randomized phase II SPARE trial

• Published in: Prostate cancer and prostatic diseases Vol. 25; no. 4; pp. 778 - 784
• Main Authors: Ohlmann, Carsten-Henning, Jäschke, Michelle, Jaehnig, Peter, Krege, Susanne, Gschwend, Jürgen, Rexer, Heidrun, Junker, Kerstin, Zillmann, Roger, Rüssel, Christoph, Hellmis, Eva, Suttmann, Henrik, Janssen, Martin, Marin, Jan, Hübner, Andreas, Mathers, Michael, Gleißner, Jochen, Scheffler, Michael, Feyerabend, Susan, Telle, Jens, Klier, Jörg, Stöckle, Michael
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.04.2022; Nature Publishing Group UK
• Subjects: Abiraterone Acetate - adverse effects; Acetic acid; Androgen Antagonists - therapeutic use; Androgens; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Asymptomatic; Cancer therapies; Castration; Chemotherapy; Deprivation; Gonadotropin-Releasing Hormone - therapeutic use; Hormones; Humans; Male; Metastases; Metastasis; Patients; Prednisone; Prostate cancer; Prostate-Specific Antigen; Prostatic Neoplasms, Castration-Resistant - pathology; Response rates; Testosterone; Testosterone - therapeutic use; Treatment Outcome; Urology
• ISSN: 1365-7852; 1476-5608
• DOI: 10.1038/s41391-022-00533-6

Although the benefit of androgen deprivation therapy (ADT) continuation in metastatic castration-resistant prostate cancer (mCRPC) remains controversial, clinical evidence is lacking. Recent results indicated that treatment with abiraterone acetate (AA) plus prednisone (P) further suppresses serum testosterone levels over ADT alone, suggesting that continuation of ADT in the treatment of mCRPC may not be necessary. In this exploratory phase 2 study, mCRPC patients were randomized with a 1:1 ratio to receive either continued ADT plus AA + P (Arm A) or AA + P alone (Arm B). The primary endpoint was the rate of radiographic progression-free survival (rPFS) at month 12. Secondary endpoints included PSA-response rate, objective response, time to PSA progression and safety. A total of 68 patients were equally randomized between the two study arms. Median testosterone-levels remained below castrate-levels throughout treatment in all patients. According to the intention-to-treat analysis the rPFS rate was 0.84 in Arm A and 0.89 in Arm B. Moderate and severe treatment-emergent adverse events were reported for 72% of the patients in Arm A and for 85% of the patients in Arm B. AA + P treatment without ADT may be effective in mCRPC patients and ADT may not be necessary in patients receiving AA + P.