在美国社区肿瘤学环境中，转移性去势抵抗性前列腺癌患者在一线雄激素受体靶向药物（ARTA）早期进展后接受二线化疗与接受另一种ARTA的真实世界结局。
Real-world outcomes in patients with metastatic castration-resistant prostate cancer receiving second-line chemotherapy versus an alternative androgen receptor-targeted agent (ARTA) following early progression on a first-line ARTA in a US community oncology setting.
作者信息
Oh William K, Cheng Wendy Y, Miao Raymond, Vekeman Francis, Gauthier-Loiselle Marjolaine, Duh Mei Sheng, Drea Edward, Szatrowski Ted P
机构信息
Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
Analysis Group, Inc., Boston, MA.
出版信息
Urol Oncol. 2018 Nov;36(11):500.e1-500.e9. doi: 10.1016/j.urolonc.2018.08.002. Epub 2018 Sep 7.
OBJECTIVE
This retrospective observational study assessed if second-line chemotherapy vs. androgen receptor-targeted agents (ARTAs; abiraterone/enzalutamide) is associated with improved outcomes in metastatic castration-resistant prostate cancer (mCRCaP) patients who experience early progression on first-line ARTAs in a US community setting.
METHODS
Patients with mCRCaP (n = 345) who progressed ≤ 12 months after first-line ARTA and received second-line chemotherapy (docetaxel/cabazitaxel; n = 147) or ARTA (n = 198) between May 2011 and October 2014 were identified. Overall survival (OS), prostate-specific antigen (PSA) response and progression, and clinical response were compared for second-line chemotherapy vs. ARTA, using one-sided tests from second-line therapy initiation. Multivariate analyses were adjusted for: year, age, metastases, opioid use, Eastern Cooperative Oncology Group performance score, PSA, hemoglobin, alkaline phosphatase, lactate dehydrogenase (LDH), and albumin levels.
RESULTS
Patients receiving second-line chemotherapy vs. ARTA were younger (median: 74 vs. 79 years) and had a poorer prognosis in terms of PSA, LDH, alkaline phosphatase, albumin and hemoglobin levels, opioid use, and Halabi risk score (P < 0.05). Response rates were higher for chemotherapy vs. ARTA (PSA: adjusted odds ratio = 2.27, P = 0.005; clinical: adjusted odds ratio = 1.78; P = 0.020) and time to PSA progression was longer (adjusted hazard ratio [aHR] = 0.66; P = 0.010). A trend favored chemotherapy vs. ARTA for OS (aHR = 0.81, P = 0.148). Among patients with poor prognostic features, those receiving chemotherapy had significantly improved OS (Halabi intermediate-/high-risk score: aHR = 0.55, P = 0.009; hemoglobin < 11 g/dl: aHR = 0.41, P = 0.002; LDH > upper limit of normal: aHR = 0.18, P = 0.014; albumin < lower limit of normal: aHR = 0.42, P = 0.020).
CONCLUSION
Following early progression on first-line ARTA, second-line chemotherapy may be more beneficial in mCRCaP compared with second-line ARTA in patients with a poor prognosis.
目的
这项回顾性观察性研究评估了在美国社区环境中，转移性去势抵抗性前列腺癌（mCRCaP）患者在一线雄激素受体靶向药物（ARTA；阿比特龙/恩杂鲁胺）治疗早期进展后，接受二线化疗与ARTA治疗相比，是否能带来更好的治疗结果。
方法
确定了2011年5月至2014年10月期间，mCRCaP患者（n = 345），这些患者在一线ARTA治疗后≤12个月出现疾病进展，并接受了二线化疗（多西他赛/卡巴他赛；n = 147）或ARTA（n = 198）治疗。从二线治疗开始，采用单侧检验比较二线化疗与ARTA治疗的总生存期（OS）、前列腺特异性抗原（PSA）反应与进展情况以及临床反应。多变量分析对以下因素进行了调整：年份、年龄、转移情况、阿片类药物使用情况、东部肿瘤协作组体能状态评分、PSA、血红蛋白、碱性磷酸酶、乳酸脱氢酶（LDH）和白蛋白水平。
结果
接受二线化疗的患者与接受ARTA治疗的患者相比更年轻（中位年龄：74岁对79岁），在PSA、LDH、碱性磷酸酶、白蛋白和血红蛋白水平、阿片类药物使用情况以及哈拉比风险评分方面预后较差（P < 0.05）。化疗组的反应率高于ARTA组（PSA：调整后的优势比 = 2.27，P = 0.005；临床反应：调整后的优势比 = 1.78；P = 0.020），且PSA进展时间更长（调整后的风险比[aHR] = 0.66；P = 0.010）。OS方面有化疗优于ARTA的趋势（aHR = 0.81，P = 0.148）。在预后特征较差的患者中，接受化疗的患者OS显著改善（哈拉比中/高风险评分：aHR = 0.55，P = 0.009；血红蛋白 < 11 g/dl：aHR = 0.41，P = 0.002；LDH > 正常上限：aHR = 0.18，P = 0.014；白蛋白 < 正常下限：aHR = 0.42，P = 0.020）。
结论
在一线ARTA治疗早期进展后，对于预后较差的mCRCaP患者，二线化疗可能比二线ARTA治疗更有益。
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