Predictive role of peripheral blood erythroblasts for treatment intensification in metastatic hormone-sensitive prostate cancer.
Abstract
65 Background: Androgen deprivation therapy (ADT) combined with an androgen receptor pathway inhibitor (ARPI) represents the standard of care for metastatic hormone-sensitive prostate cancer (mHSPC). However, no consensus exists regarding which patients benefit from treatment intensification with docetaxel (triplet therapy). Circulating erythroblasts, a marker of bone marrow infiltration, represent a widely available yet unvalidated biomarker for treatment guidance. We investigated the predictive value of baseline erythroblasts in selecting mHSPC patients for triplet therapy. Methods: This multicenter retrospective study included patients treated between 2022 and 2024 for high-volume mHSPC according to CHAARTED criteria who received either doublet (ADT+ARPI) or triplet (docetaxel+ADT+ARPI) therapy. The primary endpoint was 2-year progression-free survival (PFS), defined as time from treatment initiation to clinical or radiological progression, initiation of new systemic therapy, or death from any cause. Cardinality matching at a 2:1 ratio was performed to balance potential confounding variables. Results: A total of 234 patients were included (141 triplet, 93 doublet). After matching, 122 patients remained in the triplet group and 61 in the doublet group. With median follow-up of 23.5 months for the triplet group and 33.9 months for the doublet group, 2-year PFS rates were 71.9% and 57.8%, respectively (HR 0.62, 95% CI 0.40-0.95, p=0.027). Subgroup analysis demonstrated significantly greater survival benefit from triplet therapy in patients with detectable baseline erythroblasts (PFS: HR 0.29, 95% CI 0.11-0.76; OS: HR 0.24, 95% CI 0.07-0.77) compared to those without erythroblasts (PFS: HR 0.66, 95% CI 0.37-1.19; OS: HR 0.52, 95% CI 0.26-1.06). Conclusions: The baseline presence of circulating erythroblasts serves as a strong predictive marker for benefit from docetaxel intensification in patients with high-volume mHSPC. This readily available biomarker may guide patient selection for triplet therapy, pending prospective validation.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (16)
Olesia Stativko
City Clinical Hospital named after S.S. Yudin, Moscow City Health Department (Moscow State Budgetary Healthcare Institution), Moscow, Russian Federation
Ilya Pokataev
Moscow State Budgetary Healthcare Institution "Moscow City Hospital Named After S.S. Yudin, Moscow Healthcare Department", Moscow, Russian Federation
Alexey Rumyantsev
Federal State Budgetary Institution (N.N. Blokhin National Medical Research Center of Oncology) оf the Ministry of Health of the Russian Federation, Moscow, Russian Federation
Irina Shangina
City Clinical Hospital named after S.S. Yudin, Moscow City Health Department (Moscow State Budgetary Healthcare Institution), Moscow, Russian Federation
Nikita Starostin
City Clinical Hospital named after S.S. Yudin, Moscow City Health Department (Moscow State Budgetary Healthcare Institution), Moscow, Russian Federation
Tatiana Antonova
City Clinical Hospital named after S.S. Yudin, Moscow City Health Department (Moscow State Budgetary Healthcare Institution), Moscow, Russian Federation
Albert Oskarev
City Clinical Hospital Named after S.S. Yudin, Moscow City Health Department (Moscow state budgetary healthcare institution), Moscow, Russian Federation
Vitalii Cherniaev
City Clinical Hospital named after S.S. Yudin, Moscow City Health Department (Moscow State Budgetary Healthcare Institution), Moscow, Russian Federation
Lyudmila Zhukova
Moscow Clinical Scientific Center Named After A.S. Loginov, Moscow, Russian Federation
Daniil Stroyakovskiy
Moscow City Oncology Hospital No. 62, Moscow
Mikhail Fedyanin
N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation
Irina Andreiashkina
SBIH Moscow Clinical Scientific and Practical Center Named After A.S. Loginov of DHM, Moscow, Russian Federation
Sergei Lebedev
Department of Earth Sciences, Bullard Laboratories, University of Cambridge
Yana Gridneva
City Clinical Hospital named after S.S. Yudin, Moscow City Health Department (Moscow State Budgetary Healthcare Institution), Moscow, Russian Federation
Maria Volkova
City Clinical Hospital named after S.S. Yudin, Moscow City Health Department (Moscow State Budgetary Healthcare Institution), Moscow, Russian Federation
Vsevolod Galkin
City Clinical Hospital named after S.S. Yudin, Moscow City Health Department (Moscow State Budgetary Healthcare Institution), Moscow, Russian Federation