Hoshi Senji, Numahata Kenji, Ono Kunio, Yasuno Nobuhiro, Bilim Vladimir, Hoshi Kiyotsugu, Amemiya Hiroshi, Sasagawa Isoji, Ohta Shoichiro
Department of Urology, Yamagata Prefectural Central Hospital, Yamagata 990-2214, Japan.
Department of Urology, Yamagata Tokushukai Hospital, Yamagata 990-0834, Japan.
Mol Clin Oncol. 2017 Oct;7(4):601-603. doi: 10.3892/mco.2017.1361. Epub 2017 Aug 3.
In recent years, abiraterone acetate (AA) and enzalutamide (EZL) have become available for the treatment of cancer. Prior clinical trials have demonstrated the benefits of these agents in males with castration-resistant prostate cancer (CRPC). The optimal sequencing of available therapies in the context of efficacy and known cross-resistance remains uncertain. Based on the mechanisms of action and accessible clinical data, AA and EZL may be indicated for the early stages of prostate cancer. Until clinical trials are conducted to determine the best treatment sequence, individualized therapy is required for each patient based on the clinicopathological characteristics. In the present study, 46 sequential patients (median age: 77, range 59-89; median serum PSA level: 56 ng/ml, range 1.5-3,211) with CRPC treated with EZL (160 mg/day) were retrospectively analyzed between June 2014 and July 2015 at the following institutions: Yamagata Prefectural Central Hospital (Yamagata, Japan); Yamagata Tokushukai Hospital (Yamagata, Japan); Ishinomaki Red Cross Hospital (Ishinomaki, Japan); Kan-etsu Hospital (Tsurugashima, Japan); Niigata Cancer Center Hospital (Niigata, Japan); Sakado Central Hospital (Sakado, Japan). A total of 18 patients were pre-treated with Docetaxel (DOC) and 28 patients were DOC-naïve. Once EZL therapy was initiated, increases in prostate specific antigen (PSA) levels were observed in 3/18 patients (17%) pre-treated with DOC and in 6/20 (30%) who were DOC-naïve. In total, 8/28 DOC-naïve patients were treated with AA without EZL. An increase in the PSA level was observed in only 1/8 (12%) cases following AA treatment in the DOC-naïve group. It was demonstrated that AA had a better efficacy in DOC-naïve patients. The efficacy of EZL was limited in AA-pre-treated patients following DOC administration.
近年来，醋酸阿比特龙（AA）和恩杂鲁胺（EZL）已可用于癌症治疗。先前的临床试验已证明这些药物对去势抵抗性前列腺癌（CRPC）男性患者有益。在疗效和已知交叉耐药的背景下，现有疗法的最佳序贯治疗仍不确定。基于作用机制和可获取的临床数据，AA和EZL可能适用于前列腺癌的早期阶段。在进行临床试验以确定最佳治疗顺序之前，需要根据临床病理特征对每位患者进行个体化治疗。在本研究中，对2014年6月至2015年7月期间在以下机构接受EZL（160毫克/天）治疗的46例序贯CRPC患者（中位年龄：77岁，范围59 - 89岁；中位血清PSA水平：56纳克/毫升，范围1.5 - 3211）进行了回顾性分析：山形县中央医院（日本山形）；山形德洲会医院（日本山形）；石卷红十字医院（日本石卷）；关内医院（日本鹤岛）；新潟癌症中心医院（日本新潟）；坂户中央医院（日本坂户）。共有18例患者曾接受多西他赛（DOC）预处理，28例患者未接受过DOC治疗。一旦开始EZL治疗，在接受过DOC预处理的3/18例患者（17%）和未接受过DOC治疗的6/20例患者（30%）中观察到前列腺特异性抗原（PSA）水平升高。总共有8/28例未接受过DOC治疗的患者接受了AA治疗而未使用EZL。在未接受过DOC治疗的组中，AA治疗后仅1/八（12%）例观察到PSA水平升高。结果表明，AA在未接受过DOC治疗的患者中疗效更好。在接受过DOC给药后再用AA预处理的患者中，EZL的疗效有限。
