TEAM Study: Upfront Docetaxel Treatment in Patients With Metastatic Hormone-Sensitive Prostate Cancer: A Real-World, Multicenter, Retrospective Analysis

Metastatic hormone-sensitive prostate cancer benefits from upfront treatment intensification. To date, we do not have a validated prognostic model to guide treatment choice. In our study, docetaxel-treated patients with high Gleason score, high disease burden, pain or unfavorable laboratory parameters at baseline had worse outcomes. These results may be useful in tailoring treatment in this setting. Background: Treatment of metastatic hormone-sensitive prostate cancer (mHSPC) dramatically changed. PEACE-1 and ARASENS trials established triplet therapy efficacy. Identifying prognostic factors supporting treatment choice is pivotal. Methods: TEAM is an observational, retrospective study to evaluate prognostic role of variables in mHSPC patients receiving upfront docetaxel in 11 Italian centers. Outcome measures were progression-free survival (PFS) and overall-survival (OS). Results: From September 2014 to December 2020, 147 patients were included. Median PFS and OS were 11.6 and 37.4 months. At univariate analysis, PFS-related variables were Gleason Score (GS) ( P = .001), opioid use ( P = .004), bone metastases number ( P < .001), baseline PSA ( P = .006), Hb ( P < .001), ALP ( P < .001) and LDH ( P = .002), time between ADT and docetaxel start ( P = .018), 3-month PSA ( P < .001) and ALP ( P < .001), and number of docetaxel cycles ( P < .001). OS-related variables were PSA at diagnosis ( P = .024), primary tumor treatment ( P = .022), baseline pain ( P = .015), opioid use ( P < .001), bone metastases number ( P < . 001), baseline Hb ( P < .001), ALP ( P < .001) and LDH ( P = .001), NLR ratio ( P = .039), 3 -month PSA ( P < .001) and ALP ( P < .001) and docetaxel cycles number ( P < .001). At multivariate analysis, independent prognostic variables were GS, opioid use, baseline LDH and time between ADT and docetaxel initiation for PFS, and baseline Hb and LDH for OS. Conclusion: Patients receiving upfront docetaxel with high GS, high disease burden, pain or opioid use, baseline unfavorable laboratory values had worse outcomes. Patients had greater docetaxel benefit when initiated early after ADT start. These parameters could be taken into account when selecting candidates for triplet therapy.