Dülgar Özgecan, Özyükseler Deniz Tataroğlu, Başak Mustafa, Ay Seval, Tural Deniz, Yıldırım Mahmut Emre, Gümüş Mahmut
Istanbul Medeniyet University, Goztepe Education and Research Hospital, Department of Medical Oncology, Istanbul, Turkey.
Istanbul Kartal Lutfi Kırdar Education and Research Hospital Department of Medical Oncology, Istanbul, Turkey.
J Oncol Pharm Pract. 2021 Sep;27(6):1388-1394. doi: 10.1177/1078155220951612. Epub 2020 Aug 26.
Prostate cancer is the second leading cause of cancer death in men. Androgen deprivation therapy (ADT) has been the primary therapeutic approach for treatment of prostate cancer. However,nearly all patients develop the castration-resistant disease . We evaluated real-world data with abiraterone and enzalutamide treatment. By this data, we aimed to analyze whether that prior short response to ADT could predict response to subsequent therapy with androgen receptor axis targeted agent (ARATA).
We collected data from two cancer centers, 151 consecutive patients with treated abiraterone or enzalutamide in the first line of metastatic castration resistant prostat cancer (mCRPC) setting were included. The patients who received docetaxel in castration naive setting is also included. Time to castration resistance (TTCR) was defined as the duration from the initial to failure of primary ADT.
Patients with treated ARATA were divided into two groups according to the time to castration resistance (TTCR). Patients who became resistant to ADT up to one year had a median PFS of 6.6 months, compared to median PFS of 13.3 months for patients who responded ADT for more than 1 year. (p = 0.002). In the post-docetaxel setting, median PFS is 12.6 months of patients with treated ARATA who had TTCR for more than one year, and median PFS is 6.6 months in those who had TTCR less than one year (p = 0.007).Univariate and multivariate analyses were performed to determine the clinical factors on ARATA outcomes. Eastern Cooperative Oncology Group (ECOG) performance status(PS), median prostate-specific antigen(PSA) and time to CRPC were significantly predicted outcomes of ARATA on multivariate analysis.
TTCR is also a predictor for PFS of the patients who were treated ARATA both whole cohort and post-docetaxel.
前列腺癌是男性癌症死亡的第二大主要原因。雄激素剥夺疗法（ADT）一直是治疗前列腺癌的主要治疗方法。然而，几乎所有患者都会发展为去势抵抗性疾病。我们评估了阿比特龙和恩杂鲁胺治疗的真实世界数据。通过这些数据，我们旨在分析先前对ADT的短期反应是否可以预测对随后雄激素受体轴靶向药物（ARATA）治疗的反应。
我们从两个癌症中心收集数据，纳入了151例在转移性去势抵抗性前列腺癌（mCRPC）一线接受阿比特龙或恩杂鲁胺治疗的连续患者。还包括在去势初治阶段接受多西他赛治疗的患者。去势抵抗时间（TTCR）定义为从初始ADT到失败的持续时间。
接受ARATA治疗的患者根据去势抵抗时间（TTCR）分为两组。对ADT耐药达一年的患者的中位无进展生存期（PFS）为6.6个月，而对ADT反应超过一年的患者的中位PFS为13.3个月。（p = 0.002）。在多西他赛治疗后阶段，TTCR超过一年的接受ARATA治疗的患者的中位PFS为12.6个月，而TTCR少于一年的患者的中位PFS为6.6个月（p = 0.007）。进行单因素和多因素分析以确定影响ARATA治疗结果的临床因素。东部肿瘤协作组（ECOG）体能状态（PS）、中位前列腺特异性抗原（PSA）和至CRPC时间在多因素分析中显著预测了ARATA的治疗结果。
TTCR也是整个队列以及多西他赛治疗后接受ARATA治疗患者PFS的预测指标。
