Lebret Thierry, Ruffion Alain, Latorzeff Igor, Zerbib Marc, Moreau Jean-Luc, Rossi Dominique, Pello-Leprince-Ringuet Nathalie, Perrot Valérie, Hennequin Christophe
Hôpital Foch, Université Versailles St. Quentin en Yvelines, Chef de Service Urologie et Transplantation Rénale, 40 Rue Worth, 92151 Suresnes, France.
Centre Hospitalier Lyon Sud, Pierre Bénite, France.
Ther Adv Urol. 2018 Oct 24;10(12):365-376. doi: 10.1177/1756287218808496. eCollection 2018 Dec.
No published studies have specifically assessed whether treatment modifications to androgen deprivation therapy (ADT) for prostate cancer (PCa) are frequently carried out in routine clinical practice. The current study was conducted to determine what proportion of patients who had initiated hormone therapy with a gonadotropin-releasing hormone (GnRH) analogue then had their treatment regimen modified during the first 24 months.
A prospective, noninterventional study was carried out in routine clinical practice in France. Patients with locally advanced or metastatic PCa were followed up for 2 years after treatment initiation with a GnRH analogue. The primary endpoint was the proportion of patients with a modification to their initial hormone therapy.
In total, 1301 patients were enrolled into the study by 204 physicians, and the primary endpoint could be evaluated for 891 patients. The GnRH analogue treatment was initiated for metastatic PCa (24.2%), locally advanced PCa without planned local treatment (20.6%), locally advanced PCa in association with radiotherapy (31.6%), and biochemical recurrence after local treatment (21.4%). Hormonal treatment was modified in 43.8% (390/891) of patients during the 24-month follow-up period after GnRH analogue initiation. In 61.3% of cases (239/390), the type of modification involved a change of GnRH analogue formulation or switch to another GnRH analogue. A total of five significant predictive factors for GnRH analogue treatment modification were identified: metastatic stage; physician sector; physician speciality; presence or absence of urinary symptoms; and intermittent continuous ADT.
This study shows that in 43.8% of the patients with advanced PCa, ADT is modified in the first 2 years after initiation in routine clinical practice. Predictive factors for alteration of ADT were metastatic stage and the choice of an intermittent schedule.
尚无已发表的研究专门评估在常规临床实践中是否经常对前列腺癌（PCa）的雄激素剥夺疗法（ADT）进行治疗调整。本研究旨在确定在最初使用促性腺激素释放激素（GnRH）类似物开始激素治疗的患者中，在最初24个月内其治疗方案发生改变的患者比例。
在法国的常规临床实践中开展了一项前瞻性、非干预性研究。局部晚期或转移性PCa患者在开始使用GnRH类似物治疗后随访2年。主要终点是初始激素治疗发生改变的患者比例。
共有1301名患者由204名医生纳入研究，891名患者的主要终点可进行评估。GnRH类似物治疗用于转移性PCa（24.2%）、未计划局部治疗的局部晚期PCa（20.6%）、联合放疗的局部晚期PCa（31.6%）以及局部治疗后的生化复发（21.4%）。在GnRH类似物开始治疗后的24个月随访期内，43.8%（390/891）的患者激素治疗发生了改变。在61.3%的病例（239/390）中，改变类型涉及GnRH类似物制剂的更换或改用另一种GnRH类似物。共确定了五个GnRH类似物治疗改变的显著预测因素：转移分期；医生所在科室；医生专业；有无泌尿系统症状；以及间歇性与持续性ADT。
本研究表明，在常规临床实践中，43.8%的晚期PCa患者在开始治疗后的前2年内ADT会发生改变。ADT改变预测因素为转移分期和间歇性治疗方案的选择。
