Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
Beth Israel Deaconess Medical Center, Boston, MA.
Ann Oncol. 2010 Feb;21(2):312-318. doi: 10.1093/annonc/mdp308. Epub 2009 Jul 24.
Docetaxel is associated with prolonged survival in castration-resistant prostate cancer (CRPC). Platinum compounds have modest but distinct single-agent activity. Carboplatin may have greatest potential for benefit when combined with taxanes. We investigated whether there is a subset of patients with CRPC for whom the efficacy of combination taxane-estramustine-carboplatin (TEC) chemotherapy may be greatest.
Individual patient data (n = 310) were obtained from seven trials using TEC chemotherapy. Prostate-specific antigen (PSA) response was defined as > or = 50% post-therapy decline from baseline. Overall survival was defined from baseline to death from any cause. Logistic and Cox regression were used to investigate heterogeneity in outcome to TEC by patient and disease characteristics. Predicted survival probabilities were calculated from the Halabi Cancer and Leukemia Group B (CALGB) nomogram.
The pooled PSA response proportion was 69% [95% confidence interval (CI) 56% to 80%]. There was no evidence of differential PSA response by disease characteristics. Established prognostic factors were associated with survival. The pooled 12-month survival estimate of 79% (95% CI 71% to 84%) was higher than the median 59% 12-month nomogram-predicted survival.
TEC chemotherapy has significant clinical activity in CRPC. A randomized, controlled trial evaluating the addition of carboplatin to taxane-based chemotherapy is needed to elucidate the value of carboplatin in CRPC.
多西他赛可延长去势抵抗性前列腺癌（CRPC）患者的生存期。铂类药物具有一定的但独特的单药活性。卡铂与紫杉类药物联合应用可能具有最大的获益潜力。我们研究了是否存在一组 CRPC 患者，他们联合使用紫杉烷-雌莫司汀-卡铂（TEC）化疗的疗效可能最大。
从使用 TEC 化疗的 7 项试验中获得了 310 名患者的个体患者数据。前列腺特异性抗原（PSA）反应定义为治疗后 PSA 较基线下降≥50%。总生存期定义为从基线至任何原因导致的死亡。采用逻辑回归和 Cox 回归分析 TEC 治疗结局的异质性。从 Halabi 癌症和白血病组 B（CALGB）列线图中计算预测的生存概率。
汇总的 PSA 反应比例为 69%（95%CI 56%至 80%）。没有证据表明疾病特征与 PSA 反应存在差异。已确立的预后因素与生存相关。汇总的 12 个月生存率估计值为 79%（95%CI 71%至 84%），高于中位 59%的 12 个月列线图预测生存率。
TEC 化疗在 CRPC 中具有显著的临床活性。需要进行随机对照试验，评估卡铂联合紫杉烷类化疗在 CRPC 中的价值。
