Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France.
Department of Medicine, Centre Léon Bérard, Lyon, France.
Eur J Cancer. 2014 Jun;50(9):1602-9. doi: 10.1016/j.ejca.2014.03.015. Epub 2014 Apr 8.
A prostate-specific antigen (PSA) flare occurs in about 15% of metastatic castration-resistant prostate cancer (mCRPC) patients receiving docetaxel. This flare has no standard definition. Its impact on treatment efficacy is unclear. We sought to evaluate the incidence and characteristics of PSA flare on cabazitaxel, and its impact on survival.
Multicentre retrospective review of consecutive patients treated with cabazitaxel second-line chemotherapy for mCRPC. Collection of baseline characteristics, disease history and PSA levels before and during cabazitaxel therapy. Overall survival (OS) and radiological/clinical progression-free survival (PFS) for patient groups corresponding to different definitions of PSA flare estimated by the Kaplan-Meier method and compared using the log-rank test.
Overall, 125 patients were included. Median PFS and OS were 6.5 and 13.3 months, respectively. Depending upon the definition used, flare incidence ranged from 8.3% to 30.6%. The flare lasted <2.6 months. A PSA flare followed by a ⩾ 50% decrease was associated with a median PFS and OS of 11.2 and 25.2 months, respectively. Median PFS and OS for a ⩾ 30% rather than ⩾ 5 0% decrease were 10.4 and 16.5 months. These outcomes were not significantly different from those in patients with immediate PSA decreases of ⩾ 50% or ⩾ 30% from baseline, but were significantly better than in patients experiencing no PSA decrease (p = 0.006 and 0.015, respectively, for OS).
The PSA response to cabazitaxel, with or without initial flare, was associated with a strong survival benefit. The taxane-induced flare during the first 12 weeks of therapy can be ignored when evaluating PSA response.
在接受多西他赛治疗的转移性去势抵抗性前列腺癌（mCRPC）患者中，约有 15%会出现前列腺特异性抗原（PSA） flares。这种 flares 尚无标准定义，其对治疗效果的影响尚不清楚。我们旨在评估 cabazitaxel 治疗时 PSA flares 的发生率和特征及其对生存的影响。
对接受 cabazitaxel 二线化疗的 mCRPC 连续患者进行多中心回顾性研究。收集基线特征、疾病史和 cabazitaxel 治疗前后的 PSA 水平。通过 Kaplan-Meier 方法估计不同 PSA flares 定义的患者组的总生存（OS）和影像学/临床无进展生存（PFS），并使用对数秩检验进行比较。
共纳入 125 例患者。中位 PFS 和 OS 分别为 6.5 和 13.3 个月。根据使用的定义，flare 发生率为 8.3%至 30.6%。flare 持续时间<2.6 个月。PSA flare 后 PSA 下降 ⩾50%与中位 PFS 和 OS 分别为 11.2 和 25.2 个月相关。PSA 下降 ⩾30%而非 ⩾50%与中位 PFS 和 OS 分别为 10.4 和 16.5 个月相关。这些结果与 PSA 立即下降 ⩾50%或 ⩾30%的患者无显著差异，但明显优于无 PSA 下降的患者（OS 分别为 p=0.006 和 0.015）。
无论初始 flares 如何，cabazitaxel 治疗后的 PSA 反应均与生存获益密切相关。在评估 PSA 反应时，可以忽略治疗前 12 周内 taxane 诱导的 flares。
