High Tumor Burden Predicts Poor Response to Enzalutamide in Metastatic Castration-Resistant Prostate Cancer Patients

SIMPLE SUMMARY: Several available medications are involved in the treatment of metastatic castration-resistant prostate cancer (mCRPC). In this Taiwanese mCRPC cohort receiving enzalutamide patients with high tumor burden (HTB) were defined as those with either appendicular bony metastasis or visceral metastasis. A high tumor burden reduced the PSA response rate, radiological response rate, and progression-free survival duration. In addition, patients’ comorbidities and laboratory data—such as ALP, LDH, ALT, and hemoglobin—were correlated with the treatment efficacy of enzalutamide. Our study revealed a tumor burden before the use of enzalutamide was associated with treatment outcomes. The physician can use this information to estimate the response rate of enzalutamide and help formulate a personalized treatment plan for mCRPC patients. ABSTRACT: To assess the predictive value of tumor burden on the biochemical response, and radiological response in Taiwanese metastatic castration-resistant prostate cancer (mCRPC) patients receiving enzalutamide. The mCRPC patients treated with enzalutamide were recruited from three hospitals. High tumor burden (HTB) was classified as metastases at either appendicular bone or visceral organ. Good prostate-specific antigen (PSA) response was defined as PSA reduction of 80%. In this cohort, there were 104 (54.2%) HTB patients and 88 (45.8%) with low tumor burden (LTB). Compared to LTB patients, fewer HTB patients had good PSA response (odds ratio: 0.43, range: 0.22–0.87, p = 0.019) and fewer radiological response (complete and partial remission) (odds ratio: 0.78, range: 0.36–1.68, p = 0.52) to enzalutamide. The disease control rate which also contained stable disease, was still lower in HTB (76.0%) than LTB group (92.9%, OR: 0.24, range: 0.07–0.77, p = 0.016) in the multivariable model. In addition, HTB patients had significantly shorter progression–free survival duration than did LTB patients (median: 8.3 vs. 21.6 months, log-rank test p = 0.003) in the univariable analysis. The tumor burden before the use of enzalutamide was associated with treatment outcomes. HTB reduced PSA response rate, radiological response rate and progression-free survival duration.