Page 6 - CUA2019 Abstracts - Oncology-Prostate

Poster session 4: Prostate Cancer I

not been compared head-to-head and it remains unclear which regi- Conclusions: SC is likely an underused treatment modality with poten-
men should be offered as the initial treatment regimen. Our aim was to tial for significant cost-savings in the treatment of mPCa in Canada and
determine whether ADT with AA or ADT with DC resulted in improved abroad. Further study of patient attitudes toward SC is warranted.
quality adjusted life months (QALMs) among men with de novo mCSPC.
Methods: A Markov microsimulation model was constructed employing UP-4.3
two-dimensional Monte Carlo simulation. A lifetime horizon was used.
Our primary outcome was QALMs. Secondary outcomes included rates of Mental health and urinary outcomes in prostate cancer survivors
second- and third-line therapy, OS, and adverse events. A systematic lit- from the Maritimes 1 1 1
1,2,3
erature review was used to generate probabilities and utilities to populate Gabriela Ilie , Gregory Bailly , David Bell , Ross Mason , Ricardo A.
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the model. The base case was a 65-year-old patient with de novo mCSPC. Rendon , Tetteh Ago , Gavin M. Langille , David Bowes , Derek Wilke , Patil
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Results: A total of 100 000 microsimulations were generated. AA resulted Nikhilesh , Robert Thompson , Larry Pan , Joseph G. Lawen , Peter Massaro ,
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in a longer QALM of 36.8 months compared to 36.0 months with DC. Dave Padmore , Daniel F.G. Costa , John E. Grantmyre , Robert Rutledge
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Mean crude OS was 55.9 months with AA and 54.2 months with DC. A Urology, Dalhousie University, Halifax, NS, Canada; Radiation
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total of 44.9% and 45.6% of patients received second-line therapy and Oncology, Dalhousie University, Halifax, NS, Canada; Community
8.6% and 8.2% of patients received third-line therapy in the AA and DC Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
groups, respectively. Grade 3/4 adverse events were experienced in 56.4% Dalhousie Research Medical Foundation - Soillse Research Fund
of patients receiving initial AA and 26.4% of patients receiving initial DC. Introduction: We aimed to examine the burden of mental health and urinary
Conclusions: This study suggests that AA results in a higher QALM and problems in a population-based cohort of adult men with localized prostate
crude OS compared to DC. Until robust randomized trials can be com- cancer residing in one of three Maritimes provinces in Canada and to evalu-
pleted, the results of this study may help to guide treatment. However, the ate their associations with active (e.g., surgery, radiation, hormones, and
ultimate choice should be based on patient and tumour factors. combined forms) and non-active (active surveillance) treatment modalities.
This paper has a figure, which may be viewed online at: Methods: A total of 298 men, who were 47 years of age or older (M
https://2019.cua.events/webapp/lecture/125 68.53; standard deviation [SD] 7.16) with a history of clinically local-
References ized prostate cancer completed an online 20-minute survey from 2017–
1. Sweeney CJ, Chen YH, Carducci M, et al. Chemohormonal ther- 2018, assessing quality of life patient-reported outcomes. The primary
apy in metastatic hormone-sensitive prostate cancer. N Engl J Med outcome was mental health (assessed using Kessler Psychological Distress
2015;373:737-46. https://doi.org/10.1056/NEJMoa1503747 Scale-K10) and the secondary outcome was urinary function (assessed
2. Fizazi K, Tran N, Fein L, et al. Abiraterone plus prednisone in with the International Prostate Symptom Score [IPSS] questionnaire).
metastatic castration-sensitive prostate cancer. N Engl J Med Results: A total of 14.1% of men scored positive for mental health issues at
2017;377:352-60. https://doi.org/10.1056/NEJMoa1704174 the time the survey was completed. In this sample, 16.8% of participants
3. James ND, Sydes MR, Clarke NW, et al. Addition of docetaxel, were currently on active surveillance and 83.2% reported having been
zoledronic acid, or both to first-line long-term hormone therapy treated with one or more forms of active treatment. Half of the sample
in prostate cancer (STAMPEDE): Survival results from an adaptive, (54.7%) reported mild urinary problems, 38.6% reported moderate, and
multiarm, multistage, platform randomized controlled trial. Lancet 6.7% reported severe urinary problems. Odds ratios were 3.65 (95%
2016;387:1163-77. https://doi.org/10.1016/S0140-6736(15)01037-5 confidence interval [CI] 1.79, 7.47) times higher for screening positive for
mental health problems among survivors with moderate to severe urinary
problems compared with those with mild urinary problems. Odds ratios
UP-4.1 for screening positive for mental health issues when moderate to severe
Surgical castration in the management of metastatic prostate urinary problems were present, compared to mild urinary problems, were
cancer: Current trends in androgen-deprivation therapy 3.52 times higher and statistically significant (95% CI 1.55, 7.99) in the
Patrick Anderson , Christopher Langley , Neal E. Rowe 1,2 active treatment group of prostate cancer survivors.
1,2
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1 Department of Surgery, Division of Urology, The Ottawa Hospital, Conclusions: Survivors with a history of localized prostate cancer who
Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada received active forms of prostate cancer treatment had a statistically sig-
2
Introduction: The majority of cases of metastatic prostate cancer (mPCa) nificant burden of mental health issues. This data points to important
in North America are treated with medical androgen-deprivation therapy opportunities for prevention and intervention.
(ADT), rather than the gold standard treatment of surgical castration (SC).
A previous cost analysis by the same authors has identified the potential UP-4.4
for significant cost-savings through increased use of SC in the treatment
of mPCa. Here, we aim to identify current practice patterns and attitudes Expanding the use of ex-vivo tumour-derived 3D model to study
of urologists regarding the treatment of mPCa. treatment response in prostate cancer 1,2
1,2
4,5
Methods: An electronic survey was developed with the aim of assess- Kayla Simeone , Sylvie Clairefond , Benjamin Peant , Euridice
2
2
2,3
ing current practice patterns and attitudes in the treatment of mPCa. Carmona , Jennifer Kendall-Dupont , Thomas Gervais , Anne-Marie
1,2
1,2
Information collected included practice demographics and current prac- Mes-Masson , Fred Saad 2
1
tices in the treatment of mPCa. This survey was distributed via email to Medicine, Université de Montréal, Montréal, QC, Canada; Oncology,
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approximately 700 urologists across Canada. Responses were tabulated CRHCUM/ICM, Montréal, QC, Canada; Engineering, Polytechnique de
and quantitative and qualitative analyses were performed. Montréal, Montréal, QC, Canada
Results: Survey responses were obtained from urologists in all 10 Introduction: PARP inhibitors (PARPi) are currently in clinical trials to
Canadian provinces and included urologists practicing in both academic improve the treatment of castrate-resistant prostate cancer (CRPC) patients.
and community settings. Half (50%) of respondents indicated they only However, only 20% of CRPC patients respond to PARPi, thus our group
sometimes offer SC, while 37% of respondents stated that they do not is developing and adapting our novel ex-vivo tumour-derived model to
routinely offer SC as a treatment for metastatic prostate cancer; 81% of study the underlying DNA repair mechanisms to better understand patient
respondents estimated that currently <5% of their patients have been sensitivity to PARPi.
treated with SC. Factors preventing wider adoption of SC included per- Methods: Micro-dissected tissues (MDTs) of ~400 μm in diameter are
ceived negative attitudes of patients towards SC, invasiveness of surgery, derived from prostate cancer cell line xenografts (LNCaP, 22RV1, C4-2B,
and lack of operating room availability. Most (72%) of respondents felt DU145, and PC3), cultured and exposed to olaparib (0, 1, 10 and 100
that SC is an underused treatment and 66% agreed that urologists should nM for 72 hours) in microfluidic devices (containing a total of 32 MDTs).
more actively offer SC. Seventy-five percent of respondents stated they They are further analyzed immediately after the exposure time using a
would like to see more data on the cost-effectiveness of SC. technique based on formalin fixed paraffin embedding of MDTs named
MDT-micro array (MDTMA) to monitor MDT viability (cleaved caspase-3),
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S109