Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
The Second Military Medical University, Shanghai, China.
Prostate. 2019 May;79(6):567-573. doi: 10.1002/pros.23762. Epub 2019 Jan 6.
To evaluate the value of the serum neuroendocrine differentiation (NED) markers in helping to select the best treatment sequence of abiraterone acetate (AA) and docetaxel-prednisone (DP) in mCRPC.
Eighty-eight mCRPC patients were identified (42 in the DP-to-AA group and 46 in the AA-to-DP group). The serum levels of NED markers were measured before the first-line treatment in 88 patients and also before and after DP therapy in 38 patients. We determined their impact on OS, radiographic progression-free survival (rPFS), and PSA-PFS.
In men with an elevation of at least one NED marker (n = 46) before the first-line treatment, those who received AA and then DP had significantly better worse OS (21.7 months [95% CI 21.0-22.4] vs 19.9 months (95% CI 15.3-24.5); P = 0.023. In a multivariate Cox regression analysis, treatment sequencing selection (selecting DP-AA rather than AA-DP) independently predicted OS (HR 0.4, 95% CI 0.2-0.9, P = 0.035) in patients with an elevation of at least one NED marker. However, in the subgroup without NED marker elevation, there was no significant difference in clinical outcomes between AA-DP and DP-AA groups (all P > 0.05). In the group with continued NED marker evaluation during DP treatment, patients with higher baseline NED markers and obtaining PSA response to DP were more inclined to experience NED markers decline.
Elevated pretreatment serum NED markers might indicate mCRPC patients would get better clinical outcomes from DP-AA than AA-DP. In contrast, those without NED marker elevation had similar outcomes regardless of which agent was chosen first. mCRPC patients with elevated NED markers and chemotherapy response were more inclined to obtain NED markers decline during DP therapy, which could account for this phenomenon.
评估血清神经内分泌分化（NED）标志物在帮助选择醋酸阿比特龙（AA）和多西他赛-泼尼松（DP）一线治疗mCRPC 最佳治疗顺序中的价值。
确定 88 例 mCRPC 患者（DP 组至 AA 组 42 例，AA 组至 DP 组 46 例）。88 例患者在一线治疗前测定血清 NED 标志物水平，38 例患者在 DP 治疗前后测定。我们确定了它们对 OS、影像学无进展生存期（rPFS）和 PSA-PFS 的影响。
在一线治疗前至少有一项 NED 标志物升高的男性患者（n=46）中，接受 AA 序贯 DP 治疗的患者 OS 明显较差（21.7 个月[95%CI 21.0-22.4] vs 19.9 个月[95%CI 15.3-24.5]；P=0.023）。多因素 Cox 回归分析显示，治疗序列选择（选择 DP-AA 而不是 AA-DP）独立预测 NED 标志物升高患者的 OS（HR 0.4，95%CI 0.2-0.9，P=0.035）。然而，在无 NED 标志物升高的亚组中，AA-DP 和 DP-AA 组之间的临床结局无显著差异（均 P>0.05）。在 DP 治疗期间继续进行 NED 标志物评估的亚组中，基线时 NED 标志物较高且对 DP 有 PSA 反应的患者更倾向于出现 NED 标志物下降。
治疗前血清 NED 标志物升高可能提示 mCRPC 患者从 DP-AA 中获得更好的临床结局，而非 AA-DP。相比之下，那些没有 NED 标志物升高的患者无论选择哪种药物作为一线治疗，其结局相似。NED 标志物升高且对化疗有反应的 mCRPC 患者在 DP 治疗期间更倾向于出现 NED 标志物下降，这可能是造成这种现象的原因。
