Thomsen Frederik Birkebaek, Røder Martin Andreas, Rathenborg Per, Brasso Klaus, Borre Michael, Iversen Peter
Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark ; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark.
Scand J Urol. 2014 Jun;48(3):268-75. doi: 10.3109/21681805.2013.860189. Epub 2013 Nov 21.
The aim of this study was to record prostate-specific antigen (PSA) response and overall survival (OS) for a group of metastatic castration-resistant prostate cancer (mCRPC) patients treated with enzalutamide following progression after abiraterone treatment in the post-chemotherapy setting.
Twenty-four mCRPC patients with progression after abiraterone treatment following primary docetaxel therapy received enzalutamide 160 mg/day. The percentage PSA response was recorded following first line docetaxel, abiraterone and enzalutamide treatment. Fischer's exact test, Mann-Whitney U test and linear regression model were used to test for differences in PSA response.
All patients had a follow-up of at least 3 months. The median PSA response following 1 month of enzalutamide was -12% (range -56% to 76%), while the median best PSA response was -22% (-76% to 76%). Forty-six percent had a greater than 30% decrease in PSA. The PSA response to enzalutamide did not correlate with the number of prior cancer treatments (p = 0.57), time from diagnosis to mCRPC (p = 0.11) or prior response to docetaxel (p = 0.67). However, patients treated with second line cabazitaxel had an inferior PSA response to enzalutamide (p = 0.03), and there was a trend for the PSA response to abiraterone to correlate with the PSA response to the succeeding enzalutamide (B = 0.22, p = 0.05). The median OS was 4.8 months.
Previous abiraterone therapy is associated with a less marked fall in PSA following enzalutamide therapy in post-chemotherapy mCRPC patients compared with reported results in randomized trials. Larger prospective studies of sequencing are warranted.
本研究旨在记录一组在化疗后阿比特龙治疗进展后接受恩杂鲁胺治疗的转移性去势抵抗性前列腺癌（mCRPC）患者的前列腺特异性抗原（PSA）反应和总生存期（OS）。
24例在一线多西他赛治疗后阿比特龙治疗进展的mCRPC患者接受每日160mg恩杂鲁胺治疗。记录一线多西他赛、阿比特龙和恩杂鲁胺治疗后的PSA反应百分比。采用Fisher精确检验、Mann-Whitney U检验和线性回归模型来检验PSA反应的差异。
所有患者均随访至少3个月。恩杂鲁胺治疗1个月后的PSA反应中位数为-12%（范围为-56%至76%），而最佳PSA反应中位数为-22%（-76%至76%）。46%的患者PSA下降超过30%。恩杂鲁胺的PSA反应与既往癌症治疗次数（p = 0.57）、从诊断到mCRPC的时间（p = 0.11）或既往对多西他赛的反应（p = 0.67）均无相关性。然而，接受二线卡巴他赛治疗的患者对恩杂鲁胺的PSA反应较差（p = 0.03），并且阿比特龙的PSA反应与后续恩杂鲁胺的PSA反应存在相关性趋势（B = 0.22，p = 0.05）。中位总生存期为4.8个月。
与随机试验报告的结果相比，在化疗后mCRPC患者中，既往阿比特龙治疗与恩杂鲁胺治疗后PSA下降不明显相关。需要进行更大规模的前瞻性序贯研究。
