一线醋酸阿比特龙或恩扎鲁胺治疗去势抵抗性前列腺癌与单独雄激素剥夺治疗或 ADT 治疗转移性激素敏感性前列腺癌的临床结局比较。
Clinical Outcomes of First-line Abiraterone Acetate or Enzalutamide for Metastatic Castration-resistant Prostate Cancer After Androgen Deprivation Therapy + Docetaxel or ADT Alone for Metastatic Hormone-sensitive Prostate Cancer.
机构信息
Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Sapienza Università di Roma, Rome, Italy.
Tom Baker Cancer Centre, Calgary, AB, Canada.
出版信息
Clin Genitourin Cancer. 2018 Apr;16(2):130-134. doi: 10.1016/j.clgc.2017.12.012. Epub 2017 Dec 27.
BACKGROUND
The CHAARTED (ChemoHormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer) and STAMPEDE (Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy) trials showed that the addition of docetaxel (D) to androgen deprivation therapy (ADT) prolonged longevity of men with metastatic hormone-sensitive prostate cancer (mHSPC). However, the impact of upfront D on subsequent therapies is still unexplored. As abiraterone acetate (AA) and enzalutamide (E) are the most commonly used first-line treatment for metastatic castration-resistant prostate cancer (mCRPC), we aimed to assess whether they maintained their efficacy after ADT+D versus ADT alone.
PATIENTS AND METHODS
A cohort of patients with mCRPC treated between 2014 and 2017 with first-line AA or E for mCRPC was identified from 3 hospitals' institutional review board-approved databases. Patients were classified by use of D for mHSPC. This time frame was chosen as ADT+D became a valid therapeutic option for mHSPC in 2014, and it inherently entailed a short follow-up time on AA/E. The endpoints included overall survival from ADT start, overall survival from AA/E start, and time to AA/E start from ADT start. Differences between groups were assessed using the log-rank test.
RESULTS
Of the 102 patients with mCRPC identified, 50 (49%) had previously received ADT alone, while 52 (51%) had ADT+D. No statistically significant difference in any of the evaluated outcomes was observed between the 2 cohorts. Yet, deaths in the ADT+D group were 12 versus 21 in the ADT alone, after a median follow-up of 24.4 and 29.8 months, respectively.
CONCLUSION
In a cohort of ADT/ADT+D-treated patients with mCRPC with short times to first-line AA/E and follow-up, the efficacy of AA/E is similar regardless of previous use of D.
背景
CHARTED（化疗激素治疗与雄激素剥夺随机试验在前列腺癌广泛疾病中的应用）和 STAMPEDE（系统治疗进展或转移性前列腺癌：药物疗效评估）试验表明，多西他赛（D）联合雄激素剥夺治疗（ADT）可延长转移性激素敏感型前列腺癌（mHSPC）患者的生存期。然而，D 在前瞻性应用对后续治疗的影响仍未得到探索。阿比特龙（AA）和恩扎鲁胺（E）是转移性去势抵抗性前列腺癌（mCRPC）最常用的一线治疗药物，我们旨在评估它们在 ADT+D 与 ADT 单独应用后的疗效是否仍然有效。
患者和方法
从 3 家医院机构审查委员会批准的数据库中确定了一组在 2014 年至 2017 年间接受一线 AA 或 E 治疗 mCRPC 的 mCRPC 患者。根据 mHSPC 中 D 的使用情况对患者进行分类。选择这个时间框架是因为 2014 年 ADT+D 成为 mHSPC 的有效治疗选择，并且它固有地需要 AA/E 的短期随访时间。终点包括从 ADT 开始的总生存时间、从 AA/E 开始的总生存时间以及从 ADT 开始到 AA/E 开始的时间。使用对数秩检验评估组间差异。
结果
在确定的 102 例 mCRPC 患者中，50 例（49%）既往接受过 ADT 单药治疗，52 例（51%）接受过 ADT+D 治疗。在这两个队列中，任何评估结果之间均无统计学显著差异。然而，在中位随访 24.4 和 29.8 个月后，ADT+D 组的死亡人数分别为 12 例和 21 例。
结论
在 mCRPC 患者接受 ADT/ADT+D 治疗的队列中，在接受一线 AA/E 治疗和随访时间较短的情况下，无论之前是否使用 D，AA/E 的疗效相似。
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