Oh William K, Manola Judith, Babcic Vladana, Harnam Neesha, Kantoff Philip W
Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA.
Urology. 2006 Jun;67(6):1235-40. doi: 10.1016/j.urology.2006.01.006.
Clinical trials have demonstrated a survival benefit with docetaxel chemotherapy, but limited data exist regarding the activity of second-line chemotherapy.
We retrospectively identified all patients at one institution who received at least two chemotherapy regimens for hormone-refractory prostate cancer, one mitoxantrone-based and the other taxane-based, either including docetaxel or paclitaxel. Patients were evaluated using criteria modified from the Prostate-Specific Antigen Working Group.
A total of 68 patients were analyzed; 33 patients received mitoxantrone followed by taxane-based treatment, and 35 received taxane-based chemotherapy followed by mitoxantrone. The median patient age was 66 and 58 years and the median prostate-specific antigen at the start of treatment was 23 and 24 ng/mL in the mitoxantrone-first and taxane-first group, respectively. The response rates to taxane-based chemotherapy were greater whether it was used first or second (P <0.0001). Progression-free survival (PFS) was longer with taxanes than with mitoxantrone, whether used first or second (P <0.05). However, the corresponding total PFS from start of the first regimen to progression during the second regimen was similar at 39.9 and 38.7 weeks (P = 0.67). Overall survival was also not significantly different (15.2 and 17.1 months, P = 0.97). Neither age nor the interval from diagnosis to chemotherapy influenced the differences in PFS.
Taxane-based chemotherapy is active before or after mitoxantrone. Although PFS was longer with taxane-based chemotherapy, the total PFS and overall survival were equivalent for both sequences in this retrospective analysis, suggesting that taxane-based chemotherapy retains activity, even if delayed. Although responses were seen with mitoxantrone after taxanes, the median PFS was short, and new agents are needed after taxane-based chemotherapy.
临床试验已证明多西他赛化疗可带来生存获益，但关于二线化疗活性的数据有限。
我们回顾性确定了一家机构中所有接受至少两种激素难治性前列腺癌化疗方案的患者，一种是以米托蒽醌为基础的，另一种是以紫杉烷为基础的，包括多西他赛或紫杉醇。使用从前列腺特异性抗原工作组修改而来的标准对患者进行评估。
共分析了68例患者；33例患者先接受米托蒽醌治疗，随后接受基于紫杉烷的治疗，35例患者先接受基于紫杉烷的化疗，随后接受米托蒽醌治疗。米托蒽醌优先组和紫杉烷优先组患者的中位年龄分别为66岁和58岁，治疗开始时的中位前列腺特异性抗原分别为23 ng/mL和24 ng/mL。无论紫杉烷类化疗是先使用还是后使用，其缓解率都更高（P<0.0001）。无论先使用还是后使用，紫杉烷类药物的无进展生存期（PFS）都比米托蒽醌更长（P<0.05）。然而，从第一个方案开始到第二个方案期间进展的相应总PFS在39.9周和38.7周时相似（P = 0.67）。总生存期也无显著差异（15.2个月和17.1个月，P = 0.97）。年龄和从诊断到化疗的间隔均未影响PFS的差异。
基于紫杉烷的化疗在米托蒽醌之前或之后均有活性。尽管基于紫杉烷的化疗PFS更长，但在这项回顾性分析中，两种顺序的总PFS和总生存期相当，这表明即使延迟使用，基于紫杉烷的化疗仍保持活性。尽管在紫杉烷类药物治疗后使用米托蒽醌观察到了缓解，但中位PFS较短，基于紫杉烷的化疗后需要新的药物。
