TOPLINE: 

A new study indicated that the Bellmunt Risk Score can help stratify survival outcomes in patients with metastatic castration-resistant prostate cancer. Using data from more than 1700 patients across two phase 3 trials, the study found that a higher Bellmunt Risk Score was consistently associated with worse overall survival, with one cohort showing a median survival of 42.2 months for patients in the first-line setting with a score of 0 compared with 9.1 months for those with a score of 3.

METHODOLOGY:

• The Bellmunt Risk Score was developed to predict overall survival in patients with metastatic urothelial carcinoma experiencing failure on first-line platinum-based chemotherapy. Researchers wanted to validate this simple prognostic tool in metastatic castration-resistant prostate cancer using large, prospective cohorts of patients from two previous trials.
• Researchers conducted a post hoc validation analysis using data from two international, multicenter, phase 3 randomized clinical trials. The analysis included 1756 patients with metastatic castration-resistant prostate cancer: 678 in the first-line setting from the ACIS trial and 1078 who had progressed on or after docetaxel from the ELM-PC-5 trial.
• Bellmunt Risk Score relies on the variables: Eastern Cooperative Oncology Group Performance Status (ECOG PS) scores, hemoglobin level (< 10 g/dL), and the presence of liver metastases. At baseline, patients were assigned 1 point for each of three factors, with scores ranging from 0 to 3.
• Primary outcomes were overall survival and radiographic progression-free survival (PFS).

TAKEAWAY:

• In the ACIS trial, median overall survival was 33 months longer in patients with the lowest Bellmunt risk score compared with the highest: 42.2 months for those with score of 0 and 9.1 months in those with a score of 3. Similarly, in the ELM-PC-5 trial, median overall survival was about 20 months longer in patients with the lowest Bellmunt risk score vs the highest: 23 months for those with score of 0 and 3.2 months in those with a score of 3
• In the ACIS trial, higher risk scores were associated with progressively worse overall survival compared with a score of 0 (adjusted hazard ratios [aHRs], 1.37 for a score of 1; aHR, 2.64 for a score of 2; and 8.29 for a score of 3). Radiographic PFS was similarly stratified by Bellmunt risk score.
• In the ELM-PC-5 trial, higher risk scores were also associated with progressively worse overall survival compared with a score of 0 (aHRs, 1.65 for a score of 1; aHR, 2.93 for a score of 2; and 4.43 for a score of 3).

IN PRACTICE:

Bellmunt Risk Score “remained a robust and independent prognostic factor for both [overall survival] and [radiographic] PFS in all multivariable models across both cohorts,” the authors concluded.

SOURCE:

The study, led by Thomas Büttner, MD, Department of Urology and Pediatric Urology, University Hospital Bonn in Bonn, Germany, was published online on March 6 in JAMA Network Open.

LIMITATIONS:

The analysis was limited by data collected in the original trials, with factors such as genetic germline testing, family history, and detailed racial and ethnic demographics either not systematically assessed or removed during deidentification. The cohorts represented only 8.6% of the ACIS population and 16.4% of the ELM-PC-5 population, with narrow inclusion criteria such as ECOG PS score of 0-1 and hemoglobin greater than 9.0 g/dL in ACIS potentially limiting generalizability to broader clinical mCRPC populations. The 95% CIs for patients with risk scores of 3 were notably wide in both trials due to small sample sizes, indicating statistical imprecision. The concordance indices of 0.60 for ACIS and 0.65 for ELM-PC-5 were lower than those reported from clinical cohorts in this patient population.

DISCLOSURES:

The Open Access Publication Fund of the University of Bonn provided support for this publication. Thomas Büttner, MD, disclosed receiving personal fees from Astellas and Merck, along with nonfinancial support from Ipsen and MSD outside the submitted work. Niklas Klümper, MD, disclosed receiving personal fees and grants from Bicycle Therapeutics, as well as personal fees from Astellas, Eisai, MSD, Merck, and BMS outside the submitted work. No other conflicts of interest were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.