一线多西他赛治疗后转移性去势抵抗性前列腺癌的治疗模式及临床疗效

Treatment patterns and clinical effectiveness in metastatic castrate resistant prostate cancer after first-line docetaxel.

作者信息

Houts Arthur C, Hennessy Daniel, Walker Mark S, Nicacio Leonardo, Thompson Stephen F, Miller Paul Je, Somer Bradley G

机构信息

ACORN Research LLC, Memphis, Tennessee, USA.

Sanofi US LLC, Bridgewater, New Jersey, USA.

出版信息

J Community Support Oncol. 2014 Sep;12(9):321-8. doi: 10.12788/jcso.0072.

DOI:10.12788/jcso.0072

PMID:25848909

Abstract

BACKGROUND

Treatment for metastatic castrate-resistant prostate cancer in community settings is not well understood.

OBJECTIVE

To examine treatment patterns, sequencing, and outcomes in patients receiving second- and third-line treatment after first-line docetaxel.

METHODS

We used a community oncology database to identify patients who progressed after line 1 docetaxel (D) and received line 2 cabazitaxel (DC), abiraterone (DA), or other therapy (DO). Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan- Meier and Cox regression models. Line 3 included subsets DCA and DAC.

RESULTS

Line 2 groups (DC = 60 patients, DA = 71, DO = 153) did not differ significantly on demographic and clinical characteristics or median PFS on docetaxel therapy. Cox regression for OS by line 2 groups showed increased risk for DA compared with DC (HR, 1.69; P = .026) when 24 untreated DO patients were excluded. A similar nonsignificant pattern was observed when the 24 untreated patients were included. Of patients receiving DC in line 2, a nominally greater proportion received A in line 3 (57%, 34 of 60 patients) than did patients who received DA in line 2 followed by C in line 3 (25%, 18 of 71).

LIMITATIONS

There was a small sample for line 3, and unexamined confounds and selection biases in observational research. Conclusions Treatment patterns in community settings following docetaxel are complex and may involve multiple hormonal agents prior to disease progression. Cabazitaxel may not be optimally used in advanced disease. Although Cox regression showed increased risk of death for DA compared with DC, results need to be validated prospectively.

CONCLUSIONS

Treatment patterns in community settings following docetaxel are complex and may involve multiple hormonal agents prior to disease progression. Cabazitaxel may not be optimally used in advanced disease. Although Cox regression showed increased risk of death for DA compared with DC, results need to be validated prospectively.

摘要

背景

社区环境中转移性去势抵抗性前列腺癌的治疗情况尚不清楚。

目的

研究接受一线多西他赛治疗后接受二线和三线治疗的患者的治疗模式、治疗顺序及治疗结果。

方法

我们使用一个社区肿瘤学数据库来识别在一线多西他赛（D）治疗后病情进展且接受二线卡巴他赛（DC）、阿比特龙（DA）或其他治疗（DO）的患者。采用Kaplan-Meier法和Cox回归模型评估无进展生存期（PFS）和总生存期（OS）。三线治疗包括DCA和DAC亚组。

结果

二线治疗组（DC组60例患者，DA组71例，DO组153例）在人口统计学和临床特征或多西他赛治疗的中位PFS方面无显著差异。排除24例未接受治疗的DO患者后，二线治疗组的OS的Cox回归显示，与DC组相比，DA组死亡风险增加（风险比，1.69；P = 0.026）。纳入这24例未接受治疗的患者时，观察到类似的无显著差异模式。在二线接受DC治疗的患者中，三线接受A治疗的比例（57%，60例患者中的34例）名义上高于二线接受DA治疗且三线接受C治疗的患者（25%，71例患者中的18例）。