Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
Int J Cancer. 2015 Mar 15;136(6):E760-72. doi: 10.1002/ijc.29231. Epub 2014 Oct 3.
Cabazitaxel and abiraterone have both received approval for treating metastatic castrate-resistant prostate cancer (mCRPC) patients after first-line docetaxel therapy. In the cabazitaxel and abiraterone sequential treatment (CAST) study, the clinical outcome of docetaxel-treated mCRPC patients treated sequentially with both cabazitaxel and abiraterone was studied. Data were collected retrospectively from mCRPC patients at 12 hospitals across the Netherlands who initiated cabazitaxel and/or abiraterone before December 2012. Primary outcome measure was overall survival (OS); secondary measures were progression-free survival (PFS), biochemical PFS, and best clinical and PSA response. Hospital admission data during treatment were collected, as well as toxicities resulting in treatment discontinuation or patient death. Sixty-three and 69 patients received Cab→Abi (cabazitaxel prior to abiraterone) and Abi→Cab before July 10th, 2013, respectively. Median OS was 19.1 months and 17.0 months in Cab→Abi and Abi→Cab treated patients, respectively (p = 0.369). Median PFS and biochemical PFS were significantly longer in Cab→Abi treated patients: 8.1 versus 6.5 (p = 0.050) and 9.5 versus 7.7 months (p = 0.024), respectively. Although partial responses to cabazitaxel occurred in both groups, Abi→Cab treated patients had a significantly decreased antitumor response from cabazitaxel than Cab→Abi treated patients (median PFS 5.0 versus 2.6 months, p < 0.001). Minor differences in toxicities were observed based on therapy sequence; generally, toxicity from cabazitaxel could be severe, while abiraterone toxicity was milder. This retrospective analysis indicates that primary progression on cabazitaxel or abiraterone did not preclude a response to the other agent in mCRPC patients. However, tumor response of both agents, particularly cabazitaxel, was lower when administered as higher-line therapy in the selected study population.
卡巴他赛和阿比特龙均已获得批准，可用于治疗一线多西紫杉醇治疗后转移性去势抵抗性前列腺癌（mCRPC）患者。在卡巴他赛和阿比特龙序贯治疗（CAST）研究中，研究了接受多西紫杉醇治疗的 mCRPC 患者序贯使用卡巴他赛和阿比特龙的临床结局。从荷兰 12 家医院接受卡巴他赛和/或阿比特龙治疗的 mCRPC 患者中回顾性收集数据，这些患者于 2012 年 12 月前开始治疗。主要结局指标为总生存期（OS）；次要指标为无进展生存期（PFS）、生化无进展生存期和最佳临床和 PSA 反应。收集了治疗期间的住院数据，以及导致治疗中断或患者死亡的毒性反应。分别有 63 名和 69 名患者在 2013 年 7 月 10 日前接受了 Cab→Abi（卡巴他赛在前，阿比特龙在后）和 Abi→Cab 治疗。Cab→Abi 和 Abi→Cab 治疗患者的中位 OS 分别为 19.1 个月和 17.0 个月（p = 0.369）。Cab→Abi 治疗患者的中位 PFS 和生化无进展生存期显著延长：8.1 个月对比 6.5 个月（p = 0.050）和 9.5 个月对比 7.7 个月（p = 0.024）。尽管两组均观察到卡巴他赛的部分缓解，但 Abi→Cab 治疗患者的抗肿瘤反应明显低于 Cab→Abi 治疗患者（中位 PFS 5.0 个月对比 2.6 个月，p < 0.001）。根据治疗顺序观察到毒性的细微差异；一般来说，卡巴他赛的毒性可能很严重，而阿比特龙的毒性较轻。这项回顾性分析表明，在 mCRPC 患者中，卡巴他赛或阿比特龙的原发性进展并不排除对另一药物的反应。然而，在选定的研究人群中，作为二线治疗使用时，两种药物的肿瘤反应均较低，尤其是卡巴他赛。
