Weill Cornell Medical College and Meyer Cancer Center, New York, NY, USA.
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Eur Urol. 2016 Nov;70(5):718-721. doi: 10.1016/j.eururo.2016.01.028. Epub 2016 Feb 3.
UNLABELLED: Coadministration of docetaxel and abiraterone acetate plus prednisone (AA + P) may benefit patients with metastatic castration-resistant prostate cancer (mCRPC) because of complementary mechanisms of action. COU-AA-206 was a phase 1b study to determine the safe dose combination of docetaxel and AA + P in three cohorts of chemotherapy-naïve mCRPC patients. Twenty-two patients received escalating doses of docetaxel plus AA + P. The primary endpoint was the proportion of patients with a dose-limiting toxicity (DLT) between weeks 2 and 7. The recommended phase 2 dose (RP2D) was the highest safe combination of docetaxel plus AA + P. Prostate-specific antigen (PSA) changes and intensive pharmacokinetic parameters for each drug were evaluated. Docetaxel 75mg/m + AA 1000mg + P 10mg was deemed the RP2D, with DLT in one of six patients. PSA declines from baseline of ≥50% and ≥90% were observed for 85.7% and 66.7% of patients, respectively. During median follow-up of 14.5 mo, eight patients had PSA progression and six had radiographic progression or died. Systemic exposure was comparable for docetaxel and abiraterone when given alone or in combination. Studies are ongoing to confirm the efficacy of potent androgen receptor-targeted therapy plus taxane in early mCRPC. PATIENT SUMMARY: The combination of hormonal therapy and chemotherapy may improve outcomes in men with metastatic prostate cancer. This study demonstrates the ability to combine the hormonal therapy agent abiraterone acetate, plus prednisone, and the chemotherapy drug docetaxel with an acceptable side effect profile. A high rate of prostate-specific antigen decline was seen, but the study was small and additional research is needed before this becomes a standard approach.
未标注:多西他赛与醋酸阿比特龙联合泼尼松(AA+P)的联合治疗可能对转移性去势抵抗性前列腺癌(mCRPC)患者有益,因为其具有互补的作用机制。COU-AA-206 是一项 1b 期研究,旨在确定三个化疗初治 mCRPC 患者队列中多西他赛与 AA+P 的安全剂量组合。22 例患者接受了递增剂量的多西他赛联合 AA+P 治疗。主要终点是在第 2 周至第 7 周期间出现剂量限制毒性(DLT)的患者比例。推荐的 2 期剂量(RP2D)是多西他赛与 AA+P 的最高安全联合剂量。评估了前列腺特异性抗原(PSA)的变化和每种药物的强化药代动力学参数。多西他赛 75mg/m+AA 1000mg+P 10mg 被认为是 RP2D,有 1 例患者(6 例患者中的 1 例)出现 DLT。分别有 85.7%和 66.7%的患者的 PSA 自基线下降≥50%和≥90%。在中位随访 14.5 个月期间,8 例患者出现 PSA 进展,6 例患者出现影像学进展或死亡。当单独使用或联合使用时,多西他赛和阿比特龙的全身暴露情况相似。正在进行研究以确认在早期 mCRPC 中使用强效雄激素受体靶向治疗联合紫杉烷的疗效。
患者总结:激素治疗和化疗的联合可能改善转移性前列腺癌男性的预后。本研究表明,联合使用激素治疗药物醋酸阿比特龙、泼尼松和化疗药物多西他赛是可行的,且具有可接受的副作用谱。研究中观察到 PSA 显著下降,但该研究规模较小,在成为标准治疗方法之前还需要进一步研究。