无症状激素难治性前列腺癌的泼尼松单药治疗

Prednisone monotherapy in asymptomatic hormone refractory prostate cancer.

作者信息

Heng Daniel Y C, Chi Kim N

机构信息

Department of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.

出版信息

Can J Urol. 2006 Dec;13(6):3335-9.

PMID:17187697

Abstract

BACKGROUND

Patients with advanced prostate cancer eventually cease to respond to hormonal therapy and thus progress to hormone refractory prostate cancer (HRPC). Prednisone has been used in this setting; however, limited data is available for this monotherapy in the asymptomatic HRPC population.

OBJECTIVE

To evaluate the PSA response rate to prednisone in asymptomatic patients with hormone refractory prostate cancer (HRPC). Secondary objectives were to determine toxicity, predictors of response, and to determine overall survival of this population.

METHODS

Patients with asymptomatic HRPC that were treated with low dose prednisone from April 1998 to 2003 were identified from the British Columbia Cancer Agency patient and pharmacy registries. Inclusion criteria were an ECOG Performance Status of 2 at the time of prednisone initiation, prior medical or surgical orchidectomy, a rising PSA, and no symptoms from prostate cancer. Demographic data, lab values, serial PSAs, and survival data were collected. Univariate analyses were performed to evaluate potential predictors of response.

RESULTS

Forty-nine patients met the inclusion criteria. There was a 22.4% response rate to prednisone as defined by a 50% PSA decline. An additional 16.3% of patients had a PSA decline of < 50%. Ninety percent of patients had no documented side effects. PSA responders were more likely to have bony metastases (9/11 versus 17/38, p = 0.03) and lived longer (24.7 versus 15.4 months median survival p = 0.02). The median duration of response in the PSA responders was 4.3 months (0.89-30). Of all PSA responders, 27% had a time to progression greater than 1 year and 45% did not require chemotherapy for the duration of the study.

CONCLUSION

Prednisone monotherapy is well tolerated and is associated with a clinically relevant response rate in patients with asymptomatic HRPC. Prolonged time to progression and thus avoidance of more toxic chemotherapy is possible in some patients.

摘要

背景

晚期前列腺癌患者最终会对激素治疗产生耐药，从而进展为激素难治性前列腺癌（HRPC）。泼尼松已用于这种情况；然而，关于这种单一疗法在无症状HRPC患者群体中的数据有限。

目的

评估无症状激素难治性前列腺癌（HRPC）患者对泼尼松的PSA反应率。次要目标是确定毒性、反应预测因素，并确定该群体的总生存期。

方法

从不列颠哥伦比亚癌症机构患者和药房登记处识别出1998年4月至2003年期间接受低剂量泼尼松治疗的无症状HRPC患者。纳入标准为开始使用泼尼松时ECOG体能状态为2、先前接受过药物或手术去势、PSA升高且无前列腺癌症状。收集人口统计学数据、实验室值、系列PSA和生存数据。进行单因素分析以评估潜在的反应预测因素。

结果

49名患者符合纳入标准。以PSA下降50%定义，泼尼松的反应率为22.4%。另外16.3%的患者PSA下降<50%。90%的患者无记录的副作用。PSA反应者更可能有骨转移（9/11对17/38，p = 0.03）且生存期更长（中位生存期24.7对15.4个月，p = 0.02）。PSA反应者的中位反应持续时间为4.3个月（0.89 - 30）。在所有PSA反应者中，27%的患者疾病进展时间大于1年，45%的患者在研究期间不需要化疗。