Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
World J Urol. 2010 Jun;28(3):391-8. doi: 10.1007/s00345-010-0527-5. Epub 2010 Mar 14.
There is no proven, effective, standard second-line chemotherapy for castration- and docetaxel-resistant prostate cancer (DRPC). Recent data suggest that carboplatin may be effective in combination with docetaxel in this setting; however, the optimal docetaxel/carboplatin-based regimen is still unclear.
We identified 43 consecutive patients with DRPC treated with carboplatin (AUC5 d1) and docetaxel (35 mg/m(2) d1, 8, 15 q4w i.v.) as a second-line or subsequent salvage chemotherapy until discontinuation of therapy due to disease progression or unacceptable toxicity.
Decreased prostate-specific antigen (> or =50% PSA) was observed in 22/43 (51.2%, 95% CI, 35.5, 66.7%) patients, with > or =90% reduction in 12/43 patients (27.9%). At the time of analysis, the median follow-up time for all patients was 10.4 months. Median progression-free survival (PFS) for all patients was 6.5 months (95% CI 4.1, 8.9), and median overall survival (OS) was 15.8 months (95% CI 12.1, 18.5). In PSA responders, PFS was 9.5 (95% CI 8.2, 19.0) months versus 3.3 (95% CI 2.6, 4.0) months in PSA non-responders (P < 0.0001; hazard ratio (HR) 0.108) and OS was 24.4 months (95% CI 19.5, 29.4) versus 7.8 (95% CI 5.2, 10.3) months (P = 0.001; HR 0.232). Established prognostic factors were associated with survival. This regimen was reasonably well tolerated, with leukopenia/neutropenia as the most common reversible grade 3/4 toxicity (41.9/39.5%).
These data suggest that weekly docetaxel plus carboplatin may be an important therapeutic second-line treatment option for patients with DRPC.
目前尚无针对去势抵抗性和多西他赛耐药性前列腺癌（DRPC）的经证实、有效、标准的二线化疗药物。最近的数据表明，卡铂联合多西他赛可能对此种情况下有效；然而，最佳的多西他赛/卡铂方案仍不明确。
我们对 43 例 DRPC 患者进行了研究，这些患者接受了二线或后续解救化疗，方案为卡铂（AUC5 d1）联合多西他赛（35 mg/m² d1、8、15 q4w 静脉滴注），直至因疾病进展或不可接受的毒性而停止治疗。
43 例患者中，有 22 例（51.2%，95%CI，35.5，66.7%）患者的前列腺特异性抗原（PSA）下降≥50%，其中 12 例（27.9%）患者的 PSA 下降≥90%。截至分析时，所有患者的中位随访时间为 10.4 个月。所有患者的中位无进展生存期（PFS）为 6.5 个月（95%CI，4.1，8.9），中位总生存期（OS）为 15.8 个月（95%CI，12.1，18.5）。在 PSA 应答者中，PFS 为 9.5 个月（95%CI，8.2，19.0），而 PSA 无应答者为 3.3 个月（95%CI，2.6，4.0）（P<0.0001；风险比（HR）0.108），OS 为 24.4 个月（95%CI，19.5，29.4），而 PSA 无应答者为 7.8 个月（95%CI，5.2，10.3）（P=0.001；HR 0.232）。既定的预后因素与生存相关。该方案耐受性良好，最常见的 3/4 级毒性为白细胞减少/中性粒细胞减少（41.9%/39.5%）。
这些数据表明，每周多西他赛联合卡铂可能是 DRPC 患者重要的二线治疗选择。
