Maines Francesca, Caffo Orazio, Veccia Antonello, Trentin Chiara, Tortora Giampaolo, Galligioni Enzo, Bria Emilio
Medical Oncology, S. Chiara Hospital, Largo Medaglie d'oro 1, 38122 Trento, Italy.
Medical Oncology, S. Chiara Hospital, Largo Medaglie d'oro 1, 38122 Trento, Italy.
Crit Rev Oncol Hematol. 2015 Dec;96(3):498-506. doi: 10.1016/j.critrevonc.2015.07.013. Epub 2015 Aug 1.
Two new hormonal agents (NHAs), abiraterone and enzalutamide, and one chemotherapeutic agent, cabazitaxel (CABA) improved overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) who progress after docetaxel. Although several analyses of patient cohorts receiving a sequence of two different new agents (NAs) after docetaxel have been published, no definite conclusions can be drawn regarding the best treatment strategy.
All published studies reporting monthly OS rates of mCRPC patients receiving third-line NA after having previously received docetaxel and another NA have been analyzed. The treatments were merged into three groups: one NHA followed by another, one NHA followed by CABA, and CABA followed by one NHA. The cumulative monthly OS rates in each group were determined using a weighted-average approach.
Thirteen retrospective studies including 1016 patients who received NHA/NHA (469), NHA/CABA (318) or CABA/NHA (229) were evaluated. The 12-month OS rates were 28.5%, 61.3%, and 76.4%, respectively. There were no statistically significant differences in terms of known prognostic factors.
Although the retrospective nature of the studies and potential selection biases, our data seem to confirm the potential cumulative survival benefit of using the NAs sequentially after docetaxel. There was no clear superiority of any one of the three strategies, but a sequence that includes CABA seems to suggest a possible OS advantage.
两种新型激素药物（NHAs），阿比特龙和恩杂鲁胺，以及一种化疗药物卡巴他赛（CABA），可改善多西他赛治疗后进展的转移性去势抵抗性前列腺癌（mCRPC）患者的总生存期（OS）。尽管已发表了几项关于多西他赛后接受两种不同新型药物（NAs）序贯治疗的患者队列分析，但关于最佳治疗策略尚无明确结论。
分析了所有已发表的研究，这些研究报告了先前接受多西他赛和另一种NA后接受三线NA治疗的mCRPC患者的每月OS率。治疗方法分为三组：一种NHA后接另一种NHA，一种NHA后接CABA，以及CABA后接一种NHA。采用加权平均法确定每组的累积每月OS率。
评估了13项回顾性研究，包括1016例接受NHA/NHA（469例）、NHA/CABA（318例）或CABA/NHA（229例）治疗的患者。12个月的OS率分别为28.5%、61.3%和76.4%。在已知的预后因素方面没有统计学上的显著差异。
尽管这些研究具有回顾性且存在潜在的选择偏倚，但我们的数据似乎证实了多西他赛后序贯使用NAs可能具有累积生存获益。三种策略中没有一种具有明显优势，但包含CABA的序列似乎显示出可能的OS优势。
