Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany.
Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
Eur Urol Focus. 2021 Nov;7(6):1308-1315. doi: 10.1016/j.euf.2020.06.018. Epub 2020 Jul 9.
Besides second-generation hormone therapy (sHT), upfront docetaxel along with androgen deprivation therapy is the current standard of care for metastasized hormone-sensitive prostate cancer (mHSPC). Evidence on second-line therapy upon progression on chemohormonal treatment outside clinical trials is scarce.
To comparatively assess the efficacy of subsequent therapy after upfront docetaxel in mHSPC in a real-world setting.
DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective multicenter analysis. Males with mHSPC on androgen-deprivation therapy progressed to castration-resistant prostate cancer (CRPC) after upfront docetaxel.
Overall survival (OS), progression-free survival 2 (PFS2), and time to progression 2 (TTP2) were assessed. Chi-square test and Mann-Whitney U test were used for univariate comparison between the sHT and non-sHT (other therapies) cohorts. Median time to event was tested by Kaplan-Meier method and log-rank test. Univariate and multivariate analysis regression was performed with the Cox proportional-hazard model.
Sixty-five patients were included in the final analysis. Median TTP2 was 20 mo, median PFS2 was 29 mo, and median OS was not reached; sHT was an independent predictor of favorable PFS2 as compared with non-sHT. Time to CRPC was also confirmed to be the strongest predictor for novel endpoints PFS2 and TTP2. Time to CRPC >18 mo conferred advantage to sHT over non-sHT in relation to PFS2 and OS. Second-line therapies were well tolerated. The analysis is prone to inherent flaws and biases due to its retrospective nature.
In real-world patients progressing after upfront docetaxel, sHT is independently associated with favorable PFS2 favoring drug class switch. Longer time to CRPC predicts strongly for superior PFS2 and TTP2. Further prospective research is warranted in order to guide treatment sequencing and improve outcomes and quality of life of males with metastasized prostate cancer.
We analyzed the efficacy of second-line therapy after docetaxel in hormone-dependent metastatic prostate cancer. Novel hormone therapy appears to be a preferable option for deferring progression optimally. Larger patient databases are eagerly awaited.
除了第二代激素治疗（sHT）之外，在转移性激素敏感前列腺癌（mHSPC）中，一线使用多西他赛联合雄激素剥夺治疗是目前的标准治疗方法。在临床试验之外，关于化疗联合激素治疗进展后二线治疗的证据很少。
在真实环境中比较评估 mHSPC 中一线多西他赛后后续治疗的疗效。
设计、地点和参与者：这是一项回顾性多中心分析。在雄激素剥夺治疗的 mHSPC 男性患者在一线多西他赛后进展为去势抵抗性前列腺癌（CRPC）。
评估总生存期（OS）、无进展生存期 2（PFS2）和进展时间 2（TTP2）。使用卡方检验和曼-惠特尼 U 检验对 sHT 和非 sHT（其他治疗）队列进行单变量比较。使用 Kaplan-Meier 方法和对数秩检验测试中位时间至事件。使用 Cox 比例风险模型进行单变量和多变量分析回归。
最终分析纳入 65 例患者。中位 TTP2 为 20 个月，中位 PFS2 为 29 个月，中位 OS 未达到；与非 sHT 相比，sHT 是 PFS2 有利的独立预测因素。CRPC 时间也是新终点 PFS2 和 TTP2 的最强预测因素。CRPC 时间>18 个月使 sHT 在 PFS2 和 OS 方面优于非 sHT。二线治疗的耐受性良好。由于其回顾性，分析容易受到固有缺陷和偏倚的影响。
在一线多西他赛后进展的真实世界患者中，sHT 与有利的 PFS2 独立相关，有利于药物类别转换。更长的 CRPC 时间强烈预测更好的 PFS2 和 TTP2。需要进一步进行前瞻性研究，以指导治疗顺序，改善转移性前列腺癌男性的预后和生活质量。
我们分析了多西他赛治疗后二线治疗在激素依赖性转移性前列腺癌中的疗效。新型激素治疗似乎是最佳延迟进展的选择。期待更大的患者数据库。
