Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Urology, Harasanshin Hospital, Fukuoka, Japan.
Int J Urol. 2020 Dec;27(12):1109-1115. doi: 10.1111/iju.14366. Epub 2020 Sep 15.
To assess the impact of antiandrogen withdrawal syndrome after bicalutamide withdrawal in castration-resistant prostate cancer patients treated with androgen receptor-axis targeted agents.
The study cohort comprised 94 patients treated with abiraterone (n = 34) or enzalutamide (n = 60) as a first-line androgen receptor-axis targeted agent for castration-resistant prostate cancer despite combined androgen blockade by castration with bicalutamide as the first-line therapy. The association between clinicopathological factors (including antiandrogen withdrawal syndrome) and therapeutic outcome after using abiraterone and enzalutamide was investigated.
The decline in the prostate-specific antigen level after use of abiraterone or enzalutamide was comparable between patients with and without antiandrogen withdrawal syndrome. Antiandrogen withdrawal syndrome (hazard ratio 3.84, 95% confidence interval 1.29-11.45; P = 0.016) was associated with a higher risk of progression on multivariate analysis, but not all-cause death after abiraterone use. Progression-free survival and overall survival after enzalutamide use did not differ between patients with and without antiandrogen withdrawal syndrome.
The present data suggest a modest therapeutic efficacy of abiraterone in castration-resistant prostate cancer patients with anti-androgen withdrawal syndrome after bicalutamide withdrawal.
评估去势抵抗性前列腺癌患者在接受雄激素受体轴靶向药物治疗时，比卡鲁胺停药后出现抗雄激素撤退综合征对预后的影响。
本研究队列纳入了 94 例接受阿比特龙（n=34）或恩扎卢胺（n=60）治疗的患者，这些患者一线治疗为去势联合比卡鲁胺治疗，但仍发展为去势抵抗性前列腺癌。研究分析了临床病理因素（包括抗雄激素撤退综合征）与使用阿比特龙和恩扎卢胺后的治疗结局之间的关系。
阿比特龙或恩扎卢胺治疗后前列腺特异性抗原水平下降在有和无抗雄激素撤退综合征的患者之间无显著差异。多因素分析显示，抗雄激素撤退综合征（风险比 3.84，95%置信区间 1.29-11.45；P=0.016）与较高的进展风险相关，但与阿比特龙治疗后的全因死亡无关。恩扎卢胺治疗后的无进展生存期和总生存期在有和无抗雄激素撤退综合征的患者之间无显著差异。
本研究数据表明，在比卡鲁胺停药后出现抗雄激素撤退综合征的去势抵抗性前列腺癌患者中，阿比特龙的疗效中等。
