Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA.
University of Montréal, Montréal, Québec, Canada.
Eur Urol. 2017 Jul;72(1):10-13. doi: 10.1016/j.eururo.2017.03.007. Epub 2017 Mar 15.
In the COU-AA-302 trial, abiraterone acetate plus prednisone significantly increased overall survival for patients with chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC). Limited information exists regarding response to subsequent androgen signaling-directed therapies following abiraterone acetate plus prednisone in patients with mCRPC. We investigated clinical outcomes associated with subsequent abiraterone acetate plus prednisone (55 patients) and enzalutamide (33 patients) in a post hoc analysis of COU-AA-302. Prostate-specific antigen (PSA) response was assessed. Median time to PSA progression was estimated using the Kaplan-Meier method. The PSA response rate (≥50% PSA decline, unconfirmed) was 44% and 67%, respectively. The median time to PSA progression was 3.9 mo (range 2.6-not estimable) for subsequent abiraterone acetate plus prednisone and 2.8 mo (range 1.8-not estimable) for subsequent enzalutamide. The majority of patients (68%) received intervening chemotherapy before subsequent abiraterone acetate plus prednisone or enzalutamide. While acknowledging the limitations of post hoc analyses and high censoring (>75%) in both treatment groups, these results suggest that subsequent therapy with abiraterone acetate plus prednisone or enzalutamide for patients who progressed on abiraterone acetate is associated with limited clinical benefit.
This analysis showed limited clinical benefit for subsequent abiraterone acetate plus prednisone or enzalutamide in patients with metastatic castration-resistant prostate cancer following initial treatment with abiraterone acetate plus prednisone. This analysis does not support prioritization of subsequent abiraterone acetate plus prednisone or enzalutamide following initial therapy with abiraterone acetate plus prednisone.
在 COU-AA-302 试验中，醋酸阿比特龙联合泼尼松显著提高了化疗初治转移性去势抵抗性前列腺癌（mCRPC）患者的总生存期。对于 mCRPC 患者在接受醋酸阿比特龙联合泼尼松治疗后，对后续雄激素信号靶向治疗的反应有限。我们在后 COU-AA-302 分析中调查了后续醋酸阿比特龙联合泼尼松（55 例）和恩扎卢胺（33 例）治疗与临床结局的相关性。评估前列腺特异性抗原（PSA）的反应。使用 Kaplan-Meier 方法估计 PSA 进展的中位时间。PSA 缓解率（≥50% PSA 下降，未经确认）分别为 44%和 67%。后续醋酸阿比特龙联合泼尼松的 PSA 进展中位时间为 3.9 个月（范围 2.6-不可估计），后续恩扎卢胺的 PSA 进展中位时间为 2.8 个月（范围 1.8-不可估计）。大多数患者（68%）在后续醋酸阿比特龙联合泼尼松或恩扎卢胺治疗前接受了中间化疗。虽然承认后分析的局限性和两个治疗组中高删失率（>75%），但这些结果表明，对于在醋酸阿比特龙治疗后进展的患者，随后使用醋酸阿比特龙联合泼尼松或恩扎卢胺治疗与有限的临床获益相关。
这项分析表明，在初始治疗后使用醋酸阿比特龙联合泼尼松治疗转移性去势抵抗性前列腺癌的患者中，随后使用醋酸阿比特龙联合泼尼松或恩扎卢胺治疗的临床获益有限。该分析不支持在初始醋酸阿比特龙联合泼尼松治疗后优先选择后续的醋酸阿比特龙联合泼尼松或恩扎卢胺治疗。
