Giacinti Silvana, Carlini Paolo, Roberto Michela, Bassanelli Maria, Strigari Lidia, Pavese Francesco, Aschelter Anna M, Felici Alessandra, Valeriani Maurizio, Cognetti Francesco, Marchetti Paolo
aDepartment of Clinical and Molecular Medicine, University Sapienza of Rome bDepartment of Radiation Oncology, Sant'Andrea Hospital Departments of cMedical Oncology dMedical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy.
Anticancer Drugs. 2017 Jan;28(1):110-115. doi: 10.1097/CAD.0000000000000434.
Abiraterone acetate (AA) demonstrated its efficacy in the treatment of patients with metastatic castration resistance prostate cancer (mCRPC) in predocetaxel and postdocetaxel setting. However, we learn from pivotal studies that forms of primary and acquired resistance to this drug exist. Patient selection becomes so crucial to optimize treatment results. Potential predictive biomarkers have been identified but are not yet validated. In this scenario, clinical features and disease characteristics may still be of value in selecting patients for different treatments. The objective of this retrospective study was to assess whether or not a correlation between duration of response to first androgen deprivation therapy (ADT), time to castration-resistant prostate cancer (TTCRPC), and outcome of AA therapy exists. A retrospective analysis of clinical data of mCRPC patients treated with AA at two Italian cancer centers was carried out. The Kaplan-Meier method and Cox proportional hazard model were used to analyze survival data. Correlation between median duration of response to first ADT or median TTCRPC and the outcome of patients treated with AA was analyzed. From January 2015 to November 2015, data of 59 patients with mCRPC were collected. We observed no differences in patient's median progression-free survival (PFS) and biochemical progression-free survival (bPFS), according to both median duration of response to first-line ADT (duration of first ADT<13 months: median PFS and bPFS were 11 and 5 months, respectively; duration of ADT≥13 months: median PFS and bPFS were 9 and 6 months, respectively) and median TTCRPC (TTCRPC<28 months: median PFS and bPFS were 8 and 5 months, respectively; TTCRPC≥28 months: median PFS and bPFS were 10 and 9 months, respectively). Overall survival, in the same group, did not differ between patients with a duration of response to first ADT over or under 13 months (P=0.90) but in patients with a TTCRPC of 28 months or more, there was a trend toward longer survival than patients with TTCRPC less than 28 months (5-year overall survival was 74 vs. 50%; P=0.14). The duration of response to first-line ADT and the TTCRPC showed no significant association with outcome of AA therapy in patients with mCRPC. However, large prospective trials are desirable to confirm these data.
醋酸阿比特龙（AA）在多西他赛治疗前和治疗后的转移性去势抵抗性前列腺癌（mCRPC）患者治疗中显示出疗效。然而，我们从关键研究中了解到，对这种药物存在原发性和获得性耐药形式。患者选择对于优化治疗结果至关重要。已确定了潜在的预测生物标志物，但尚未得到验证。在这种情况下，临床特征和疾病特征在为不同治疗选择患者时可能仍然具有价值。这项回顾性研究的目的是评估首次雄激素剥夺治疗（ADT）的反应持续时间、去势抵抗性前列腺癌发生时间（TTCRPC）与AA治疗结果之间是否存在相关性。对意大利两个癌症中心接受AA治疗的mCRPC患者的临床数据进行了回顾性分析。采用Kaplan-Meier方法和Cox比例风险模型分析生存数据。分析了首次ADT的中位反应持续时间或中位TTCRPC与接受AA治疗患者的结果之间的相关性。2015年1月至2015年11月，收集了59例mCRPC患者的数据。根据一线ADT的中位反应持续时间（首次ADT持续时间<13个月：中位无进展生存期（PFS）和生化无进展生存期（bPFS）分别为11个月和5个月；ADT持续时间≥13个月：中位PFS和bPFS分别为9个月和6个月）以及中位TTCRPC（TTCRPC<28个月：中位PFS和bPFS分别为8个月和5个月；TTCRPC≥28个月：中位PFS和bPFS分别为10个月和9个月），我们观察到患者的中位无进展生存期和生化无进展生存期没有差异。在同一组中，首次ADT反应持续时间超过或低于13个月的患者总体生存期没有差异（P=0.90），但在TTCRPC为28个月或更长时间的患者中，生存期有比TTCRPC小于28个月的患者更长的趋势（5年总生存率为74%对50%；P=0.14）。在mCRPC患者中，一线ADT的反应持续时间和TTCRPC与AA治疗结果无显著关联。然而，需要大型前瞻性试验来证实这些数据。
